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Context: Meniscal injury is a common pathology, and the postoperative rehabilitation program is essential to patients after surgery. However, the optimal rehabilitation plan after meniscus suture is still controversial. Objective: To compare the clinical outcomes between accelerated rehabilitation and restricted programs in patients with meniscus suture (with or without anterior cruciate ligament reconstruction, ACLR). Evidence acquisition: Four databases, including PubMed, Ovid, Embase, and the Cochrane Library, were searched up to November 2021. This study only included studies comparing the clinical outcomes between accelerated (immediate range of motion and weight-bearing) and restricted rehabilitation (immobilization and progressive weight-bearing) for meniscus suture. All selected studies were divided into 2 subgroups: isolated meniscus suture or combined with ACLR. The Lysholm score, Tegner score, and Knee Injury and Osteoarthritis Outcome Score were evaluated in simple meniscus sutures no less than 1 year. Failure rate was evaluated in both groups, and the tunnel enlargement was additionally evaluated in patients who underwent ACLR. Evidence synthesis: Eleven studies with 612 patients were eligible for analysis. The accelerated group included 4 studies with 330 participants, while the restricted group included 7 studies with 282 participants. For the patients after isolated meniscus suture, the accelerated group achieved higher Lysholm scores (mean difference = -4.66; 95% confidence interval, -8.6 to -0.73; P = .02; I² = 88%) than the restricted group. For the patients after meniscus suture with ACLR, patients undergoing accelerated rehabilitation were associated with a significantly larger tibial tunnel enlargement in the anterior-posterior view (mean difference = -7.08; 95% confidence interval, -10.92 to -3.24; P = .0003; I² = 0%) and lateral view (mean difference = -10.33; 95% confidence interval, -16.9 to -3.75; P = .002; I² = 17%). Conclusion: This meta-analysis evaluated the effects of postoperative rehabilitation in either accelerated or restricted programs in patients with meniscus lesions after repair. A significant higher mean self-reported function was discovered at final follow-ups in the accelerated group. However, a significant increase in tibial tunnel enlargement was also found in accelerated group. [ABSTRACT FROM AUTHOR]

Purpose: The duration for which anterior cruciate ligament reconstruction (ACLR) can be delayed without resulting in a risk of subsequent meniscus injury has remained a debatable topic. The main purpose of this study was to determine the safest delay interval for a delayed ACLR. Methods: This retrospective study included all patients who underwent ACLR between January 2020 and January 2022. The patients were divided into four groups based on the delay interval: <3 months, 3–6 months, 6–12 months and >12 months. Clinical outcomes were assessed using the International Knee Documentation Committee (IKDC) score and Knee Injury and Osteoarthritis Outcomes Score (KOOS) at 1‐year postoperatively. Results: A total of 95 patients were included in this study. ACLR delay of 3–6 months was not associated with the risk of meniscus injury, while a delay of 6–12 months (odds ratio [OR] = 4.35; 95% confidence interval [CI] = 1.13–16.79; p = 0.031) and >12 months (OR = 10.68; 95% CI = 2.55–42.22; p = 0.001) was associated with a likelihood of developing meniscus injury. Meniscus injury risk increased by 12% for each month of ACLR delay (OR = 1.12; 95% CI = 1.04–1.22; p = 0.003). Regarding clinical outcomes at 1‐year postoperatively, all groups exhibit the same clinical results. Conclusion: ACLR can be safely delayed up to 6 months after the initial injury. However, a delay for >6 months must be avoided, as it was found to significantly increase the likelihood of developing a meniscus injury. Level of Evidence: Level III, retrospective comparative study. [ABSTRACT FROM AUTHOR]

Abstract Background Magnetic resonance imaging (MRI) can diagnose meniscal lesions anatomically, while quantitative MRI can reflect the changes of meniscal histology and biochemical structure. Our study aims to explore the association between the measurement values obtained from synthetic magnetic resonance imaging (SyMRI) and Stoller grades. Additionally, we aim to assess the diagnostic accuracy of SyMRI in determining the extent of meniscus injury. This potential accuracy could contribute to minimizing unnecessary invasive examinations and providing guidance for clinical treatment. Methods Total of 60 (n=60) patients requiring knee arthroscopic surgery and 20 (n=20) healthy subjects were collected from July 2022 to November 2022. All subjects underwent conventional MRI and SyMRI. Manual measurements of the T1, T2 and proton density (PD) values were conducted for both normal menisci and the most severely affected position of injured menisci. These measurements corresponded to the Stoller grade of meniscus injuries observed in the conventional MRI. All patients and healthy subjects were divided into normal group, degeneration group and torn group according to the Stoller grade on conventional MRI. One-way analysis of variance (ANOVA) was employed to compare the T1, T2 and PD values of the meniscus among 3 groups. The accuracy of SyMRI in diagnosing meniscus injury was assessed by comparing the findings with arthroscopic observations. The diagnostic efficiency of meniscus degeneration and tear between conventional MRI and SyMRI were analyzed using McNemar test. Furthermore, a receiver operating characteristic curve (ROC curve) was constructed and the area under the curve (AUC) was utilized for evaluation. Results According to the measurements of SyMRI, there was no statistical difference of T1 value or PD value measured by SyMRI among the normal group, degeneration group and torn group, while the difference of T2 value was statistically significant among 3 groups (P=0.001). The arthroscopic findings showed that 11 patients were meniscal degeneration and 49 patients were meniscal tears. The arthroscopic findings were used as the gold standard, and the difference of T1 and PD values among the 3 groups was not statistically significant, while the difference of T2 values (32.81±2.51 of normal group, 44.85±3.98 of degeneration group and 54.42±3.82 of torn group) was statistically significant (P=0.001). When the threshold of T2 value was 51.67 (ms), the maximum Yoden index was 0.787 and the AUC value was 0.934. Conclusions The measurement values derived from SyMRI could reflect the Stoller grade, illustrating that SyMRI has good consistency with conventional MRI. Moreover, the notable consistency observed between SyMRI and arthroscopy suggests a potential role for SyMRI in guiding clinical diagnoses.

BACKGROUND: Currently, there have been a variety of conservative and surgical treatment plans for spontaneous osteonecrosis of the knee, achieving excellent results. However, a broad consensus on indication and guide of surgical treatment has not been announced. In clinical practice, there is still a misunderstanding that unicondylar replacement or total knee arthroplasty should be performed upon the discovery of spontaneous osteonecrosis of the knee, while an urgent need for universal access to the concept of stepwise therapy. OBJECTIVE: To summarize and find the factors leading to the poor effect of conservative treatment in spontaneous osteonecrosis of the knee, which occurred on the medial femoral condyle, from the literature and clinical cases, at the same time, combined with the Koshino stage, to propose the strategy of stepwise spontaneous osteonecrosis of the knee treatment on the medial femoral condyle. METHODS: A systematic search of the literature database was conducted to summarize the factors leading to poor outcomes of conservative treatment in spontaneous osteonecrosis of the medial femoral condyle. Meanwhile, according to the Clinical & Health Records for analytics & Sharing system, the cases receiving conservative and surgical treatment in spontaneous osteonecrosis of the medial femoral condyle in the Department of Orthopedics of Guangdong Provincial Hospital of Chinese Medicine from January 2017 to January 2023 were analyzed retrospectively, then the causes of success and failure in typical cases were summarized and analyzed. RESULTS AND CONCLUSION: (1) Early diagnosis and treatment of spontaneous osteonecrosis of the knee were very important for prognosis. For sudden knee pain in some patients, if no obvious abnormality was found in the X-ray examination, and the symptoms persisted and could not be relieved for more than 1 week, an MRI examination was recommended to detect early spontaneous osteonecrosis of the knee. (2) The X-ray images of Koshino stage 1 and stage 2 of spontaneous osteonecrosis of the medial femoral condyle were difficult to be distinguished, which needed to be probed by MRI. MRI images of Koshino stage 1 were mainly characterized by bone marrow edema, and an osteonecrosis area with a clear boundary was not formed, while MR images of Koshino stage 2 showed a necrotic area with a clear boundary. (3) Five factors leading to the poor effect of conservative treatment on spontaneous osteonecrosis of the medial femoral condyle were summarized: a. The necrotic area was > 5 cm²; b. The necrotic area accounted for more than 40% of the condyle; c. relative compression percentage of medial meniscus ≥33% (with or without medial meniscus injury and subchondral bone marrow edema); d. MRI depth of necrotic area (anteriorposterior diameter of sagittal necrotic area) > 20 mm; e. varus deformity of lower limb >6°. (4) Conservative treatment of spontaneous osteonecrosis of the knee in Koshino stage 1 was good. For spontaneous osteonecrosis of the knee in Koshino stage 2, conservative treatment was preferred or combined with drilling decompression. If there was no relief or improvement of symptoms or in MRI after 3 months, while the patient had any of the previous five factors, then knee preservation surgery should be considered. For spontaneous osteonecrosis of the knee in Koshino stage 3 and stage 4, knee preservation surgery should be selected based on the previous five factors, including age, gender and activity level of the patient. Total knee arthroplasty was used for spontaneous osteonecrosis in Koshino stage 4, which was associated with symptomatic patellofemoral arthritis, valgus alignment, or necrotic area, which greatly affected the stability of unicondyle prosthesis. [ABSTRACT FROM AUTHOR]

(1) Background: The aim of this study was to investigate how a medial meniscus injury accompanying an anterior cruciate ligament rupture affects the clinical outcome 10 years after ACL reconstruction. (2) Methods: A total of 37 patients who received anterior cruciate ligament reconstruction (ACLR) were included in this retrospective study. Two groups were analyzed at a single follow-up of 10 years: (i) "isolated (ACLR)" (n = 20) and (ii) "ACLR with medial meniscal injury" (n = 17). The following clinical scores were recorded: International Knee Documentation Committee (IKDC), the Knee Injury and Osteoarthritis Outcome Score (KOOS), Lysholm Score and Tegner Activity Score. To determine the degree of osteoarthritis the Kellgren–Lawrence score was used. (3) Results: The "isolated ACLR" study group scored significantly higher (p < 0.05) on the IKDC subjective questionnaire (mean: 88.4) than the "ACLR with medial meniscus injury" group (mean: 81). The KOOS category "activities of daily living" showed significantly better results in the isolated ACLR group (p < 0.05). The "ACLR with medial meniscus injury" group had significantly higher degree of osteoarthritis (p < 0.05). No significant differences were found in all the other clinical scores. (4) Conclusions: The results of this study further indicate that patients with a concomitant medial meniscus injury have slightly more discomfort in everyday life and increased risk of developing osteoarthritis 10 years after surgery. [ABSTRACT FROM AUTHOR]

Background: Magnetic resonance imaging (MRI) can diagnose meniscal lesions anatomically, while quantitative MRI can reflect the changes of meniscal histology and biochemical structure. Our study aims to explore the association between the measurement values obtained from synthetic magnetic resonance imaging (SyMRI) and Stoller grades. Additionally, we aim to assess the diagnostic accuracy of SyMRI in determining the extent of meniscus injury. This potential accuracy could contribute to minimizing unnecessary invasive examinations and providing guidance for clinical treatment. Methods: Total of 60 (n=60) patients requiring knee arthroscopic surgery and 20 (n=20) healthy subjects were collected from July 2022 to November 2022. All subjects underwent conventional MRI and SyMRI. Manual measurements of the T1, T2 and proton density (PD) values were conducted for both normal menisci and the most severely affected position of injured menisci. These measurements corresponded to the Stoller grade of meniscus injuries observed in the conventional MRI. All patients and healthy subjects were divided into normal group, degeneration group and torn group according to the Stoller grade on conventional MRI. One-way analysis of variance (ANOVA) was employed to compare the T1, T2 and PD values of the meniscus among 3 groups. The accuracy of SyMRI in diagnosing meniscus injury was assessed by comparing the findings with arthroscopic observations. The diagnostic efficiency of meniscus degeneration and tear between conventional MRI and SyMRI were analyzed using McNemar test. Furthermore, a receiver operating characteristic curve (ROC curve) was constructed and the area under the curve (AUC) was utilized for evaluation. Results: According to the measurements of SyMRI, there was no statistical difference of T1 value or PD value measured by SyMRI among the normal group, degeneration group and torn group, while the difference of T2 value was statistically significant among 3 groups (P=0.001). The arthroscopic findings showed that 11 patients were meniscal degeneration and 49 patients were meniscal tears. The arthroscopic findings were used as the gold standard, and the difference of T1 and PD values among the 3 groups was not statistically significant, while the difference of T2 values (32.81±2.51 of normal group, 44.85±3.98 of degeneration group and 54.42±3.82 of torn group) was statistically significant (P=0.001). When the threshold of T2 value was 51.67 (ms), the maximum Yoden index was 0.787 and the AUC value was 0.934. Conclusions: The measurement values derived from SyMRI could reflect the Stoller grade, illustrating that SyMRI has good consistency with conventional MRI. Moreover, the notable consistency observed between SyMRI and arthroscopy suggests a potential role for SyMRI in guiding clinical diagnoses. [ABSTRACT FROM AUTHOR]

Objective: To identify key ferroptosis-related biomarkers and investigate immune infiltration in meniscus injuries among individuals of different age groups. Methods: (1) We obtained our training dataset from the GEO database and analyzed gene expression matrices from the GSE191157 gene chip dataset. Simultaneously, we downloaded relevant genes associated with ferroptosis for further analysis. (2)Using the "limma" package, we conducted differential gene expression analysis between elderly and young patients with meniscus injuries and performed weighted gene co-expression network analysis (WGCNA) on all genes in the GSE191157 gene chip dataset. (3) We selected two color modules most correlated with meniscus injury and then intersected the genes in these modules with ferroptosis-related genes. (4)Subsequently, we conducted ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses on the intersected genes. (5) Using LASSO regression in machine learning, we analyzed the intersected genes related to ferroptosis in meniscus injuries among individuals of different ages and extracted core genes. (6) Finally, we conducted gene set enrichment analysis (GSEA) and single-sample gene set enrichment variation analysis (ssG-SEA) for immune infiltration and confirmed the correlation between core genes and ferroptosis in meniscus injuries. Results: A total of 2 517 differentially expressed genes were identified, and the intersection of these genes with ferroptosis-related genes yielded 61 genes. After WGCNA analysis, the blue and yellow modules were found to be most relevant to the disease, resulting in 46 intersected genes. Through LASSO regression analysis, four core genes (BEX1, MMP13, PTPN18, and SLC38A1) were selected. GSEA results indicated that ferroptosis in meniscus injuries is primarily associated with Toll-like receptor signaling, RNA transcription and splicing, mTOR signaling, and ECM-receptor interaction. Immune cell infiltration analysis revealed a significant correlation between core gene expression and immune cell infiltration. MMP13 exhibited a negative correlation with effector memory CD8 T cells, CD56dim natural killer cells, and central memory CD4 T cells, while SLC38A1, BEX1, and PTPN18 were positively correlated. Conclusion: This study identified four key genes associated with ferroptosis in meniscus injuries among individuals of different age groups, namely BEX1, MMP13, PTPN18, and SLC38A1. Immune cell infiltration analysis demonstrated a clear correlation between core gene expression and immune cell infiltration. [ABSTRACT FROM AUTHOR]

ABSTRACT Purpose The duration for which anterior cruciate ligament reconstruction (ACLR) can be delayed without resulting in a risk of subsequent meniscus injury has remained a debatable topic. The main purpose of this study was to determine the safest delay interval for a delayed ACLR. Methods This retrospective study included all patients who underwent ACLR between January 2020 and January 2022. The patients were divided into four groups based on the delay interval: 12 months. Clinical outcomes were assessed using the International Knee Documentation Committee (IKDC) score and Knee Injury and Osteoarthritis Outcomes Score (KOOS) at 1‐year postoperatively. Results A total of 95 patients were included in this study. ACLR delay of 3–6 months was not associated with the risk of meniscus injury, while a delay of 6–12 months (odds ratio [OR] = 4.35; 95% confidence interval [CI] = 1.13–16.79; p = 0.031) and >12 months (OR = 10.68; 95% CI = 2.55–42.22; p = 0.001) was associated with a likelihood of developing meniscus injury. Meniscus injury risk increased by 12% for each month of ACLR delay (OR = 1.12; 95% CI = 1.04–1.22; p = 0.003). Regarding clinical outcomes at 1‐year postoperatively, all groups exhibit the same clinical results. Conclusion ACLR can be safely delayed up to 6 months after the initial injury. However, a delay for >6 months must be avoided, as it was found to significantly increase the likelihood of developing a meniscus injury. Level of Evidence Level III, retrospective comparative study.

Introduction Football stands as the most widely embraced organized sport globally, boasting a staggering participation of over 200 million males and 21 million females officially registered under the auspices of the Fèdèration Internationale de Football Association (FIFA). Knee injuries are one of the most common health issues among soccer players at various levels of expertise. They arise from the intense nature of the game, which requires quick turns, running, jumping, kicking, and sudden changes in direction. These stresses can lead to strains and injuries in the structures of the knee joint, including ligaments, meniscus, tendons, and other soft tissues. This study gathers information about the most common types of knee injuries in soccer players, including situations in which these injuries occur, methods of diagnosis, treatment options, and strategies for injury prevention. Aim The aim of this study is to gather and analyse the studies about knee injuries in soccer players at various levels of expertise. Materials and Methods Review and summary of research studies available in databases on Google Scholar and PubMed. Databases such as PubMed and Google Scholar were searched using the keywords: ‘soccer knee injuries’, ‘soccer injuries’, ‘ACL tear’, ‘MCL injury’, ‘meniscus injury’, ‘PCL and LCL tear’. Summary Soccer, as a high-contact sport, inherently carries a significant risk of various injuries, particularly to the knees. The prevalence of knee injuries, such as ACL, MCL, and meniscus tears, underscores the importance of effective prevention strategies. Proper warm-ups and specialized preventive exercises, such as those in the FIFA 11+ program, are crucial in reducing the incidence of these injuries. Injuries can severely impact a player's career, leading to long-term health consequences. Therefore, timely and accurate diagnosis, along with appropriate treatment, is essential for recovery and career longevity.

Purpose: Meniscus injury and meniscus extrusion cause meniscus dysfunction, which then leads to the initiation and progression of knee osteoarthritis. Meniscus preservation surgery therefore plays an important role in preventing long-term cartilage degeneration. The purpose of this paper was to review the current information about meniscus preservation surgeries, such as meniscal repair and centralization. Methods: We reviewed recent articles related to meniscus preservation surgery. We compiled sections for some special meniscus pathologies, including ramp lesion, discoid lateral meniscus, degenerative meniscus tear, posterior root tear, and meniscus extrusion. Results: Reoperation rates are higher after meniscal repair compared with arthroscopic partial meniscectomy; however, long-term follow-up studies have demonstrated better clinical outcomes and less severe degenerative changes for meniscal repair than for partial meniscectomy. Therefore, meniscal repair should be considered the first option for any meniscus injury when surgical intervention is necessary. Posterior root tears of the meniscus substantially affect meniscal hoop function and accelerate cartilage degeneration and accompanying meniscus extrusion. Therefore, surgical repair should be considered as early as possible. A centralization procedure has been developed to reduce meniscus extrusion and improve meniscus hoop function. Long-term follow-up should also be considered essential for the prevention of osteoarthritis. Conclusions: Meniscus preservation surgery provides satisfactory clinical outcomes at short- and mid-term follow-up. Further understanding of meniscus pathology and continued development of surgical techniques will improve the outcomes of meniscus preservation surgery. The long-term efficacy of these procedures should also be confirmed to validate this treatment strategy for meniscus dysfunction.

Objective: To determine the efficacy of extracorporeal shock wave (ESW) combined with autologous platelet-rich plasma (PRP) therapy on knee osteoarthritis (KOA) with meniscus injury in terms of pain relief, functional outcome and complications. Methods: This is a retrospective observational study. Clinical data of 144 patients with KOA accompanied by medial meniscus injury, who received treatment in Jilin Provincial People's Hospital from March 2021 to December 2022, were retrospectively evaluated. A total of 128 patients (81 males and 47 females) were finally included in the study after screening. Of them, 45 patients received PRP treatment (PRP-group), 43 patients received ESW treatment (ESW-group), and 40 patients received ESW combined with PRP treatment (Combined-group). The relief of knee joint pain and functional improvement among three groups of patients were compared. Results: After treatment, visual analogue scale (VAS), Lequesne, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores of patients in the Combined-group were significantly lower than those in the other two groups (p<0.05). Combined ESW-PRP treatment was associated with significantly greater joint range of motion of patients compared to ESW and PRP alone (p<0.05). The total incidence of related complications in the Combined-group was lower compared to the other two groups (p<0.05). Conclusions: Compared with PRP or ESW treatment alone, ESW combined with PRP for KOA with meniscus injury can better alleviate pain, achieve faster functional recovery, and significantly reduce complications. [ABSTRACT FROM AUTHOR]

The meniscus in the knee joint plays an important role in bearing load, shock absorption, joint lubrication, and increasing the stability of the knee joint in various directions. Meniscal injury is a common ailment in knee joint injuries, which can cause severe knee pain and limited knee joint movement, significantly affecting the patient's quality of life. Arthroscopic minimally invasive treatment has become the main approach for treating meniscal injuries, with the consensus being to preserve the meniscus morphology and structure as much as possible. By introducing the structure and function of the meniscus, the mechanism of injury, and focusing on several suture techniques for arthroscopic meniscal injury treatment, analyzing their advantages and disadvantages, it aims to provide some reference for clinical research on arthroscopic suture of the meniscus. [ABSTRACT FROM AUTHOR]

Background: Past studies found that an increased lateral femoral condyle ratio is associated with anterior cruciate ligament injuries, but it is not clear if there is a link between MRI-measured lateral femoral condyle ratios and meniscal injuries. MRI provides a more accurate selection of measurement planes. Compared to X-rays, it further reduces data errors due to non-standard positions.Objective: To study the relationship between knee bone morphology and Solitary meniscal injuries by MRI.Methods: A total of 175 patients were included in this retrospective case-control study, including 54 cases of pure medial meniscus injury, 44 cases of pure lateral meniscus injury as the experimental group, and 77 control subjects. MRI images were used to measure the femoral notch width, femoral condylar width, femoral notch width index, lateral femoral condylar ratio (LFCR), posterior tibial slope, medial tibial plateau depth, and meniscus slope. In addition, carefully check for the presence of specific signs such as bone contusions and meniscal extrusions. Comparing the anatomical differences in multiple bone morphologies between the two groups, a stepwise forward multifactorial logistic analysis was used to identify the risk factors for Solitary meniscal injuries. Finally, ROC curves were used to determine the critical values and best predictors of risk factors.Results: MTS, LTS, and LFCR ended up as independent risk factors for meniscus injury. Among all risk factors, LFCR had the largest AUC of 0.781 (0.714–0.848) with a threshold of 72.75%. When combined with MTS (>3.63°), diagnostic performance improved with an AUC of 0.833 (0.774–0.892).Conclusion: Steep medial tibial plateau slope, steep lateral tibial plateau slope angle, and deep posterior lateral femoral condyles on MRI are independent risk factors for meniscal injuries. In patients with knee discomfort with the above imaging findings (X-ray, MRI), we should suspect and carefully evaluate the occurrence of meniscal injuries. It not only provides a theoretical basis to understand the mechanism of meniscus injury but also provides theoretical guidance for the prevention of meniscus injury and the development of intervention measures. Level of evidence III.

Purpose: To evaluate the overall evidence of published health-economic evaluation studies on meniscus tear treatment. Methods: Our systematic review focuses on health-economic evaluation studies of meniscus tear treatment interventions found in PubMed and Embase databases. A qualitative, descriptive approach was used to analyze the studies' results and systematically report them following PRISMA guidelines. The health-economic evaluation method for each included study was categorized following one of the four approaches: partial economic evaluation (PEE), cost-effectiveness analysis (CEA), cost–benefit analysis (CBA), or cost-utility analysis (CUA). The quality of each included study was assessed using the Consensus on Health Economic Criteria (CHEC) list. Comparisons of input variables and outcomes were made, if applicable. Results: Sixteen studies were included; of these, six studies performed PEE, seven studies CUA, two studies CEA, and one study combined CBA, CUA, and CEA. The following economic comparisons were analyzed and showed the respective comparative outcomes: (1) meniscus repair was more cost-effective than arthroscopic partial meniscectomy (meniscectomy) for reparable meniscus tear; (2) non-operative treatment or physical therapy was less costly than meniscectomy for degenerative meniscus tear; (3) physical therapy with delayed meniscectomy was more cost-effective than early meniscectomy for meniscus tear with knee osteoarthritis; (4) meniscectomy without physical therapy was less costly than meniscectomy with physical therapy; (5) meniscectomy was more cost-effective than either meniscus allograft transplantation or meniscus scaffold procedure; (6) the conventional arthroscopic instrument cost was lower than laser-assisted arthroscopy in meniscectomy procedures. Conclusion: Results from this review suggest that meniscus repair is the most cost-effective intervention for reparable meniscus tears. Physical therapy followed by delayed meniscectomy is the most cost-effective intervention for degenerative meniscus tears. Meniscus scaffold should be avoided, especially when implemented on a large scale. Level of evidence: Systematic review of level IV studies. [ABSTRACT FROM AUTHOR]

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BACKGROUND: Previous studies have found that both high tibial osteotomy and high tibial osteotomy combined with arthroscopy can effectively treat medial compartment osteoarthritis with varus deformity of the knee, but there are few studies comparing the therapeutic effects of the two. OBJECTIVE: To compare the clinical outcome of high tibial osteotomy and high tibial osteotomy combined with arthroscopy to treat degenerative tear in the posterior horn of medial meniscus combined with varus deformity of knee joint. METHODS: From July 2015 to January 2019, data of 48 knee osteoarthritis patients with degenerative tear in the posterior horn of medial meniscus combined with varus deformity of knee joint in Affiliated Hospital of Zunyi Medical University were retrospectively analyzed. The 24 patients in the trial group were treated with high tibial osteotomy combined with arthroscopy. The 24 patients in the control group were treated with high tibial osteotomy. The knee joint function scores and imaging detection indexes at different time points after operation were compared between the two groups. RESULTS AND CONCLUSION: (1) The hospital for special surgery knee score and knee Lysholm score of patients in the trial group at 6 and 12 months after operation were higher than those in the control group (P < 0.05). There was no significant difference in the hospital for special surgery knee score and knee Lysholm score between the two groups at 24 and 36 months after operation (P > 0.05). The visual analogue scale score of patients in the trial group was lower than that in the control group at 6 months after surgery (P < 0.05). There was no significant difference in the visual analogue scale scores between the two groups at 12, 24, and 36 months after surgery (P > 0.05). (2) The imaging examination at 12 months after operation showed that the lower limb alignment and femoral tibial angle were effectively improved in both groups, and the relative positions of the femoral tibial angle and lower limb alignment passing through the tibial plateau and the posterior tibial slope of the tibial plateau were not significantly different between the two groups (P > 0.05). (3) It is concluded that high tibial osteotomy and high tibial osteotomy combined with arthroscopic surgery can effectively treat degenerative tear in the posterior horn of medial meniscus combined with varus deformity of knee joint, effectively improve joint function and relieve pain symptoms. High tibial osteotomy combined with arthroscopy exhibited good early clinical efficacy. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study is to develop a novel automatic convolutional neural network (CNN) that aids in the diagnosis of meniscus injury, while enabling the visualization of lesion characteristics. This will improve the accuracy and reduce diagnosis times. Methods: We presented a cascaded-progressive convolutional neural network (C-PCNN) method for diagnosing meniscus injuries using magnetic resonance imaging (MRI). A total of 1396 images collected in the hospital were used for training and testing. The method used for training and testing was 5-fold cross validation. Using intraoperative arthroscopic diagnosis and MRI diagnosis as criteria, the C-PCNN was evaluated based on accuracy, sensitivity, specificity, receiver operating characteristic (ROC), and evaluation performance. At the same time, the diagnostic accuracy of doctors with the assistance of cascade- progressive convolutional neural networks was evaluated. The diagnostic accuracy of a C-PCNN assistant with an attending doctor and chief doctor was compared to evaluate the clinical significance. Results: C-PCNN showed 85.6% accuracy in diagnosing and identifying anterior horn injury, and 92% accuracy in diagnosing and identifying posterior horn injury. The average accuracy of C-PCNN was 89.8%, AUC = 0.86. The diagnosis accuracy of the attending physician with the aid of the C-PCNN was comparable to that of the chief physician. Conclusion: The C-PCNN-based MRI technique for diagnosing knee meniscus injuries has significant practical value in clinical practice. With a high rate of accuracy, clinical auxiliary physicians can increase the speed and accuracy of diagnosis and decrease the number of incorrect diagnoses. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to assess the distribution of different anterior cruciate ligament (ACL) tear locations in different magnetic resonance imaging (MRI) planes, and to explore the relationships of ACL tear types with both meniscus injuries and bone bruising. Methods: A retrospective study was performed in patients under 60 years old who underwent MRI scans in the sagittal and coronal oblique planes of the knee for ACL tears between 2014 and 2020. Patients with reports of chronic tears, partial tears, or prior surgeries were excluded. Tear locations were classified into five types, and the meniscus tear measurement variables included the presence of ramp, root, bucket-handle, and other types of tears. All injuries were confirmed by arthroscopy. Meanwhile, the presence and location of bone bruising were analysed and scored with the Whole-Organ Magnetic Resonance Imaging Score (WORMS) bone bruising subscale. Results: A total of 291 patients were included. The prevalence rates of type I and type III injuries were 23/291 (7.9%) and 145/291 (49.8%) in the sagittal plane and 22/291 (7.6%) and 179/291 (61.5%) in the oblique coronal plane, respectively. The prevalence of medial meniscus tears with ACL tears was 126/291 (43.3%), while that of lateral meniscus tears with ACL tears was 77/291 (26.5%). The highest prevalence of medial meniscus injury with ACL tears was 15/22 (68.2%) for type I injuries. Bone bruises were located on the lateral femoral center in 125 patients (46%) and on the lateral tibia posterior in 132 patients (48%); the common areas of bone bruising were slightly correlated with type III ACL tears but not correlated with type I ACL tears. Conclusion: The plane in which an MRI scan is performed affects the classification of ACL tears. The tear type is associated with the prevalence of medial meniscus injuries, and medial meniscus tears are most prevalent in type I ACL tears. Level of evidence: IV. [ABSTRACT FROM AUTHOR]

It was to analyse the denoising ability of low‐rank matrix‐based denoising algorithms for magnetic resonance imaging (MRI) images, and explore the diagnostic value of MRI for tibial plateau fracture (TPF) with meniscus injury. The Gaussian mixture algorithm was introduced based on low‐rank matrix algorithm, and a new algorithm Gaussian mixture model‐based low‐rank matrix factorization (GLRMF) was established. Then, the root‐mean‐squared error (RMSE) of the GLRMF algorithm under different noise intensities was calculated, and the structural similarity (SSIM) of the GLRMF algorithm, anisotropic diffusion filter (ADF), and nonlocal means (NLM) algorithm was compared. Sixty cases of TPF patients diagnosed in the Department of Orthopaedics and Traumatology of X Hospital from March 2018 to October 2019 were recruited as the research objects. The results of Schatzker classification of patients were counted, and the results of intraoperative exploration or arthroscopy were used as the standard to analyse the accuracy of MRI in diagnosing TPFs with meniscus injuries. It was found that with the increase of noise intensity, the RMSE of the GLRMF algorithm showed an increasing trend. When the K value was 100, the denoising effect was relatively good. Under the same noise intensity, the SSIM of the GLRMF algorithm was higher than the other two algorithms. Moreover, type VI patients accounted for 55% at most. MRI diagnosed 56 cases (93.33%) of TPF patients with meniscus injury, and 52 cases (86.67%) of meniscus injury were found in intraoperative exploration. The sensitivity of MRI in diagnosing meniscus injury was 94.76%, the accuracy was 93.33%, and the specificity was 89%. It showed that the new GLRMF algorithm based on the low‐rank matrix algorithm had a good noise reduction effect and significantly improved the image quality. The accuracy of knee MRI scanning was significantly improved, it was safe, and it was worthy of clinical application. [ABSTRACT FROM AUTHOR]

The biomechanical changes following meniscal tears and surgery could lead to or accelerate the occurrence of osteoarthritis. 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 experiments and clinical research. Magnetic resonance images of a male rabbit knee joint were used to establish a finite element model with intact menisci under resting state. A medial meniscal horizontal tear was set involving 2/3 width of a meniscus. 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). The axial load transmitted from femoral cartilage to menisci and tibial cartilage, the maximum von Mises stress and the maximum contact pressure on the menisci and cartilages, the contact area between cartilage to menisci and cartilage to cartilage, and absolute value of the meniscal displacement were analyzed and evaluated. The results showed that the HTMM had little effect on the medial tibial cartilage. After the HTMM, the axial load, maximum von Mises stress and maximum contact pressure on the medial tibial cartilage increased 1.6%, 1.2%, and 1.4%, compared with the IMM. Among different meniscectomy strategies, the axial load and the maximum von Mises stress on the medial menisci varied greatly. 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. The radial displacement of the middle body of the medial meniscal was larger than any other part in all the models. The HTMM led to few biomechanical changes in the rabbit knee joint. The SLPM showed minimal effect on joint stress among all resection strategies. It is recommended to preserve the posterior root and the remaining peripheral edge of the meniscus during surgery for an HTMM.

PurposeTo investigate a prediction model of meniscus injury in patients with tibial plateau fracture.MethodsThis retrospective study enrolled patients with tibial plateau fractures who were treated in the Third Hospital of Hebei Medical University from January 1, 2015, to June 30, 2022. Patients were divided into a development cohort and a validation cohort based on the time-lapse validation method. Patients in each cohort were divided into a group with meniscus injury and a group without meniscus injury. Statistical analysis with Student’s t-test for continuous variables and chi square test for categorical variables was performed for patients with and without meniscus injury in the development cohort. Multivariate logistic regression analysis was used to screen the risk factors of tibial plateau combined with meniscal injury, and a clinical prediction model was constructed. Model performance was measured by examining discrimination (Harrell’s C-index), calibration (calibration plots), and utility [decision analysis curves (DCA)]. The model was validated internally using bootstrapping and externally by calculating their performance in a validation cohort.ResultsFive hundred patients (313 [62.6%] males, 187 [37.4%] females) with a mean age of 47.7 ± 13.8 years were eligible and were divided into development (n = 262) and validation (n = 238) cohorts. A total of 284 patients had meniscus injury, including 136 in the development cohort and 148 in the validation cohort We identified high-energy injuries as a risk factor (OR = 1.969, 95%CI 1.131–3.427). Compared with blood type A, patients with blood type B were more likely to experience tibial plateau fracture with meniscus injury (OR = 2.967, 95%CI 1.531–5.748), and office work was a protective factor (OR = 0.279, 95%CI 0.126–0.618). The C-index of the overall survival model was 0.687 (95% CI, 0.623–0.751). Similar C-indices were obtained for external validation [0.700(0.631–0.768)] and internal validation [0.639 (0.638–0.643)]. The model was adequately calibrated and its predictions correlated with the observed outcomes. The DCA curve showed that the model had the best clinical validity when the threshold probability was 0.40 and 0.82.ConclusionsPatients with blood type B and high-energy injuries are more likely to have meniscal injury. This may help in clinical trial design and individual clinical decision-making.

Romy Deviandri,1– 3 Hugo C van der Veen,1 Andri MT Lubis,4 Ghuna A Utoyo,5 Inge van den Akker-Scheek,1 Maarten J Postma6– 9 1Department of Orthopedic Surgery, University of Groningen/ University Medical Center Groningen, Groningen, the Netherlands; 2Department of Physiology-Faculty of Medicine, Universitas Riau, Pekanbaru, Indonesia; 3Department of Orthopedics-Sports Injury, Arifin Achmad Hospital, Pekanbaru, Indonesia; 4Department of Orthopedics-Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia; 5Department of Orthopedics-Faculty of Medicine, Universitas Padjadjaran/ Hasan Sadikin Hospital, Bandung, Indonesia; 6Department of Health Sciences, University of Groningen/ University Medical Center Groningen, Groningen, the Netherlands; 7Department of Economics-Faculty of Economics & Business, University of Groningen, Groningen, the Netherlands; 8Department of Pharmacology & Therapy, Universitas Airlangga, Surabaya, Indonesia; 9Department Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, IndonesiaCorrespondence: Romy Deviandri, Department of Orthopedic Surgery, University of Groningen/ University Medical Center Groningen, Hanzeplein 1, Groningen, 9713 GZ, the Netherlands, Email r.deviandri@rug.nl; romydeviandri@lecturer.unri.ac.idObjective: The number of anterior cruciate ligament reconstruction (ACLR) procedures is increasing. However, ACLR procedures are likely to be underbudgeted in a developing country like Indonesia. This study aimed to analyze costs for ACLR procedures in Indonesia’s resource-limited context, determine the burden of ACLR, and suggest national prices for ACLR reimbursement.Methods: A retrospective observational study was conducted between 1 January and 31 December 2019 on the cost of ACLR from a payer perspective using inpatient billing records in four hospitals. The national burden of ACLR was calculated, and projected national prices for reimbursement were determined.Results: Of 80 ACLRs, 53 (66%) were isolated ACLRs and 27 (34%) ACLRs were combined with meniscus treatment. Mean hospital costs incurred per ACLR procedure were US$ 2853, with the dominant cost relating to orthopedic implant prices (US$ 1,387.80). The costs of ACLR with combined meniscus treatment were estimated as being 35% higher than isolated ACLR. The national burden of ACLR showed a total budget of US$ 367.4 million per 100,000 patients (0.03% of GDP) for ACLR with additional meniscus treatment and US$ 271.3 million per 100,000 patients (0.02% of GDP) for isolated ACLR.Conclusion: ACLR procedures in Indonesia are likely underbudgeted. Adjustments of reimbursement prices for ACLR are needed to facilitate adequate access of Indonesians to the procedures. This study demonstrated varying costs determined for ACLR in Indonesia, which entails that a new reimbursement system with improvement of national prices should become the core of transformation.Keywords: ACL tear, meniscus injury, cost, developing countries, BPJS

BACKGROUND: The research on the effect of meniscus injury on knee osteoarthritis is mostly concentrated in the tibiofemoral compartment. There are reports on the correlation between meniscus extrusion and patellofemoral osteoarthritis outside China, but there are few related studies in China.OBJECTIVE: To explore the association between meniscus extrusion and patellofemoral osteoarthritis based on published data from the Osteoarthritis Initiative. METHODS: Totally 1 109 participants with complete MRI Osteoarthritis Knee Score and other clinical information at baseline were selected. Meniscal tear, maceration, extrusion, patellofemoral cartilage and bone marrow lesions were scored by MRI Osteoarthritis Knee Score semi-quantitative scoring system. Gender, age, race, body mass index, history of knee injury, and history of surgery were collected by questionnaire. Logistic regression analysis was used to determine the relationship between meniscal extrusion and patellofemoral osteoarthritis. RESULTS AND CONCLUSION: (1) The cross-sectional study showed that patients with medial and lateral meniscus extrusion had a high incidence of any cartilage injury, full-thickness cartilage injury, and bone marrow lesions in medial and lateral patellofemoral joint. (2) Logistic regression analysis showed that after adjusting for confounding factors (adjustment model 2), the medial meniscus extrusion was positively correlated with any cartilage injury of the medial patellofemoral joint [OR: 2.4(95% CI: 1.6, 3.6)] and full-thickness cartilage injury [OR: 1.5(95% CI: 1.0, 2.1)]; there was no correlation between medial meniscus extrusion and medial patellofemoral joint bone marrow lesions without adjustment [OR: 0.8(95% CI: 0.6, 1.1)] and after adjustment for confounding factors [OR: 1.3(95% CI: 0.9, 1.8)]. (3) After adjusting for confounding factors (adjustment model 2), lateral meniscus extrusion was positively correlated with any cartilage injury of the lateral patellofemoral joint [OR: 2.1(95% CI: 1.0, 4.5)] and full-thickness cartilage injury [OR: 2.3(95% CI:1.1, 4.6)]; while without adjusting for confounding factors [OR: 1.7(95% CI: 1.0, 2.9)], lateral meniscus extrusion was positively correlated with bone marrow lesions of the lateral patellofemoral joint, but not after adjustment for confounding factors [OR: 1.1(95% CI: 0.6, 2.1)]. (4) Meniscus extrusion was positively correlated with cartilage injury of patellofemoral joint among Americans based on published data from the Osteoarthritis Initiative. [ABSTRACT FROM AUTHOR]

Purpose: The Pivot Shift (PS) test is a complex clinical sign that assesses the internal rotation and anterior tibial translation, which occurs abnormally in ACL deficient-knees. Because of the high inter-observer variability, different devices have been designed to characterize this complex movement in quantitative variables. The objective of this pilot study is to validate the reproducibility of intraoperative quantitative assessment of the PS with a smartphone accelerometer. Methods: Twelve ACL-injured knees were included and compared with the contralateral uninjured side. The PS was measured by two independent observers utilizing a smartphone accelerometer and graded according to the IKDC classification. Measurements were taken preoperatively, intraoperatively and postoperatively. Intraoperative readings were taken during each stage of reconstruction or repair of meniscoligamentous lesions including meniscal lesions, ramp lesions, ACL reconstruction and lateral tenodesis. Reproducibility of the measurements were evaluated according to an intraclass correlation coefficient (ICC). Results: The intra-observer reliability was good for the first examiner and excellent for the second examiner, with the ICC 0.89 [0.67, 0.98] p < 0,001 and ICC 0.97 [0.91, 1.0] p < 0,001 respectively. The inter-observer reliability was excellent between the two observers with the ICC 0.99 [0.97, 1.0] p < 0,001. The mean tibial acceleration measured 3.45 m.s2 (SD = 1.71) preoperatively on the injured knees and 1.03 m.s2 (SD = 0.36) on the healthy knees, demonstrating a significant difference following univariate analysis p < 0.001. Postoperatively, no significant difference was observed between healthy and reconstructed knees The magnitudes of tibial acceleration values were correlated with the PS IKDC grade. Conclusion: The smartphone accelerometer is a reproducible device to quantitatively assess the internal rotation and anterior tibial translation during ACL reconstruction surgery. The measurements are influenced by the different surgical steps. Other larger cohort studies are needed to evaluate the specific impact of each step of the ACL reconstruction and meniscal repair on this measurement. An external validation using other technologies are needed to validate the reliability of this device to assess the PS test. Level of evidence: Level IV, case series, pilot study. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to generate more information on the etiology and pathogenesis of medial (MM) and lateral (LM) meniscus root tears. Our hypothesis was that root tears of the MM predominantly result from degenerative damage, whereas root injuries of the LM are mainly of traumatic origin. Methods: Consecutively, 53 patients with a root tear of the medial meniscus (MMRT) and 51 patients with a root tear of the lateral meniscus (LMRT) were included in this study. The diagnosis was confirmed radiologically by MRI as well as arthroscopically. In addition to patient-specific data such as age, BMI and trauma history, the leg axis was determined and accompanying injuries (ligamentous and chondrogenic) were documented. Results: The mean age of the MMRT group was 57.2 (± 11.2) years, and that of the LMRT group 33.9 (± 11.4) years. The BMI was significantly higher in the MMRT group compared to the LMRT (30.5 vs. 25.1). 82.4% of patients in the LMRT group demonstrated an accompanying anterior cruciate ligament (ACL) rupture, whereas only 5.7% of the MMRT were associated with an ACL injury. A trauma was described in only 13.2% of patients of the MMRT group in contrast to 88.2% of the LMRT group. An extrusion > 3 mm of the MM in the coronal plane of MRI images could be detected in 86.8% of patients, whereas in the LMRT group, it was 15.7%. The mechanical varus angle was 5.6° in the MMRT group and 2.4° in the LMRT group. The rate and degree of concomitant cartilage damage in the affected compartment was significantly higher in the group with medial root injuries than in the group with lateral root tears. Conclusions: The root injuries of the MM and LM show significant differences in terms of patient age, etiology and accompanying injuries. Root injuries to the medial meniscus are mostly of non-traumatic origin and more likely to occur in the context of medial osteoarthritis and varus deformity of the knee. Lateral root tears tend to be predominantly traumatic and are frequently associated with ACL ruptures. However, in the MMRT group, a small subgroup with a traumatic etiology and in the LMRT group a small subgroup of patients with non-traumatic etiology could be identified. Level of evidence: III. [ABSTRACT FROM AUTHOR]

BACKGROUND: Current surgical methods do not provide a long-term solution for meniscus regeneration and replacement, but tissue engineering techniques can provide alternative therapeutic strategies. OBJECTIVE: To review the clinical strategy and tissue engineering research status of meniscus injury repair. METHODS: The literature collected on PubMed database, Medline database, Google academic database, CNKI, and Wanfang was searched by computer. Keywords were “meniscus injury; tissue engineering; meta-analysis; allografts; meniscus repair; scaffold; polymers; hydrogels; polyurethane; intestinal submucosa; polycaprolactone; polylactic; self-assembly; bone marrow MSC; meniscus derived stem cells; synovium derived MSCs; adipose derived MSC; coculture; growth factor; transforming growth factor beta; basic fibroblast growth factor; insulin growth factor” in English, and “meniscus; mesenchymal stem cells; scaffold; growth factor; tissue engineering; compression modulus; tensile modulus; hydrogels; electrospinning” in Chinese. Retrieval period was from January 1, 2005 to October 1, 2020. RESULTS AND CONCLUSION: As a hot research direction of meniscus treatment, meniscus tissue engineering has achieved abundant research results in all aspects, but there is a lack of a large number of long-term clinical trials to verify the accuracy of the conclusions. Biomolecules are indispensable tools in tissue engineering. At present, more human or animal experiments are needed to determine the exact action signal pathway of different biomolecules, the optimal concentration and combination mode of application, and the delivery mode of biomolecules. Although many kinds of stem cells with the phenotypic differentiation potential of meniscus have been found, the role of various stem cells in tissue engineering is still to be further studied, and the most dominant stem cell type or most suitable for meniscus tissue engineering is still controversial. Simultaneously, meniscus is similar to articular cartilage and intervertebral disc in terms of cell composition, extracellular matrix composition and biomechanical properties, and the repair and regeneration strategies of articular cartilage and intervertebral disc have also attracted much attention. Research progress in similar fields can learn from each other and promote each other. [ABSTRACT FROM AUTHOR]

Introduction: Knee injuries largely vary including cartilaginous, ligamentous, bony, and tendinous injuries. Greatest of the reported knee injuries associated with in a non-contact method includes mainly the anterior cruciate ligament (ACL). Additionally, medial and lateral menisci act as shock absorbers with an additional role in stabilizing the joint which can be or partially or totally torn. The current study aimed to assess athletes' knowledge and attitude concerning the meniscus, meniscal injury, and management. Methodology: A descriptive cross-sectional study was conducted to achieve the objectives. A pre-structured electronic questionnaire was used to collect the data, covered participants socio-demographic data, personal and family history of meniscus injury and surgery, physical activity during past year, and also knowledge regarding the meniscal injury and management. Results: A total of 448 athletes fulfilling the inclusion criteria completed the study questionnaire. Participants 'age ranged from 18 to 60 years with mean age of 26.7 ± 7.7 years old. A total of 256 (57.1%) participants were males. Exact of 21 participants had meniscus surgery. As for family history, 75 (16.7%) had family history of meniscus injury. Exact of 95 (21.2%) athletes had good knowledge level, while vast majority (78.8%; 353) had poor knowledge level. Conclusions: In conclusion, the study showed that the estimated rate of meniscus injury and surgery was not high (within the international range). The participants' knowledge regarding meniscus injury and meniscus surgery with its related management was unsatisfactory, where 1 out of each 5 was knowledgeable. [ABSTRACT FROM AUTHOR]

Objective: Meniscus tear is a common problem in sports trauma, and its imaging diagnosis mainly relies on MRI. To improve the diagnostic accuracy and efficiency, a deep learning model was employed in this study and the identification efficiency was evaluated. Methods: Standard knee MRI images from 924 individual patients were used to complete the training, validation and testing processes. Mask regional convolutional neural network (R–CNN) was used to build the deep learning network structure, and ResNet50 was adopted to develop the backbone network. The deep learning model was trained and validated with a dataset containing 504 and 220 patients, respectively. Internal testing was performed based on a dataset of 200 patients, and 180 patients from 8 hospitals were regarded as an external dataset for model validation. Additionally, 40 patients who were diagnosed by the arthroscopic surgery were enrolled as the final test dataset. Results: After training and validation, the deep learning model effectively recognized healthy and injured menisci. Average precision for the three types of menisci (healthy, torn and degenerated menisci) ranged from 68% to 80%. Diagnostic accuracy for healthy, torn and degenerated menisci was 87.50%, 86.96%, and 84.78%, respectively. Validation results from external dataset demonstrated that the accuracy of diagnosing torn and intact meniscus tear through 3.0T MRI images was higher than 80%, while the accuracy verified by arthroscopic surgery was 87.50%. Conclusion: Mask R–CNN effectively identified and diagnosed meniscal injuries, especially for tears that occurred in different parts of the meniscus. The recognition ability was admirable, and the diagnostic accuracy could be further improved with increased training sample size. Therefore, this deep learning model showed great potential in diagnosing meniscus injuries. Translational potential of this article: Deep learning model exerted unique effect in terms of reducing doctors’ workload and improving diagnostic accuracy. Injured and healthy menisci could be more accurately identified and classified based on training and learning datasets. This model could also distinguish torn from degenerated menisci, making it an effective tool for MRI-assisted diagnosis of meniscus injuries in clinical practice.

Introduction: Knee injuries largely vary including cartilaginous, ligamentous, bony, and tendinous injuries. Greatest of the reported knee injuries associated with in a non-contact method includes mainly the anterior cruciate ligament (ACL). Additionally, medial and lateral menisci act as shock absorbers with an additional role in stabilizing the joint which can be or partially or totally torn. The current study aimed to assess athletes' knowledge and attitude concerning the meniscus, meniscal injury, and management. Methodology: A descriptive cross-sectional study was conducted to achieve the objectives. A pre-structured electronic questionnaire was used to collect the data, covered participants socio-demographic data, personal and family history of meniscus injury and surgery, physical activity during past year, and also knowledge regarding the meniscal injury and management. Results: A total of 448 athletes fulfilling the inclusion criteria completed the study questionnaire. Participants 'age ranged from 18 to 60 years with mean age of 26.7 ± 7.7 years old. A total of 256 (57.1%) participants were males. Exact of 21 participants had meniscus surgery. As for family history, 75 (16.7%) had family history of meniscus injury. Exact of 95 (21.2%) athletes had good knowledge level, while vast majority (78.8%; 353) had poor knowledge level. Conclusions: In conclusion, the study showed that the estimated rate of meniscus injury and surgery was not high (within the international range). The participants' knowledge regarding meniscus injury and meniscus surgery with its related management was unsatisfactory, where 1 out of each 5 was knowledgeable.

Abstract Purpose The Pivot Shift (PS) test is a complex clinical sign that assesses the internal rotation and anterior tibial translation, which occurs abnormally in ACL deficient‐knees. Because of the high inter‐observer variability, different devices have been designed to characterize this complex movement in quantitative variables. The objective of this pilot study is to validate the reproducibility of intraoperative quantitative assessment of the PS with a smartphone accelerometer. Methods Twelve ACL‐injured knees were included and compared with the contralateral uninjured side. The PS was measured by two independent observers utilizing a smartphone accelerometer and graded according to the IKDC classification. Measurements were taken preoperatively, intraoperatively and postoperatively. Intraoperative readings were taken during each stage of reconstruction or repair of meniscoligamentous lesions including meniscal lesions, ramp lesions, ACL reconstruction and lateral tenodesis. Reproducibility of the measurements were evaluated according to an intraclass correlation coefficient (ICC). Results The intra‐observer reliability was good for the first examiner and excellent for the second examiner, with the ICC 0.89 [0.67, 0.98] p

This review summarizes the literature of preclinical studies and clinical trials on the use of mesenchymal stem cells (MSCs) to treat meniscus injury and promote its repair and regeneration and provide guidance for future clinical research. Due to the special anatomical features of the meniscus, conservative or surgical treatment can hardly achieve complete physiological and histological repair. As a new method, stem cells promote meniscus regeneration in preclinical research and human preliminary research. We expect that, in the near future, in vivo injection of stem cells to promote meniscus repair can be used as a new treatment model in clinical treatment. The treatment of animal meniscus injury, and the clinical trial of human meniscus injury has begun preliminary exploration. As for the animal experiments, most models of meniscus injury are too simple, which can hardly simulate the complexity of actual meniscal tears, and since the follow‐up often lasts for only 4–12 weeks, long‐term results could not be observed. Lastly, animal models failed to simulate the actual stress environment faced by the meniscus, so it needs to be further studied if regenerated meniscus has similar anti‐stress or anti‐twist features. Despite these limitations, repair of the meniscus by MSCs has great potential in clinics. MSCs can differentiate into fibrous chondrocytes, which can possibly repair the meniscus and provide a new strategy for repairing meniscus injury.

This case study explores the use of super-dose platelet-rich plasma (PRP) in managing a meniscal tear in a 43-year-old woman with left knee pain. The patient was diagnosed with a vertical longitudinal tear of the body and posterior horn medial meniscus, confirmed through magnetic resonance imaging. Super-dose PRP, characterized by a higher platelet volume (8 ml), was administered intra-articular. Post-injection, the patient reported initial discomfort for a few days, but significant improvements in pain and range of motion (ROM) were observed within the first week. Over 12 weeks, her visual analog scale pain score decreased from 8/10 during activity to 2/10, and her ROM returned to full functionality. The case supports the hypothesis that super-dose PRP may enhance the healing process in meniscal injuries by promoting tissue healing and regeneration through the release of growth factors, angiogenesis, collagen synthesis, and inflammation modulation. This case highlights PRP's potential as a non-surgical treatment for meniscal tears. Further large-scale studies and randomized controlled trials are needed to validate these results, optimize dosing strategies, and determine which patient populations will benefit most from this innovative treatment approach., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Thirugnana Sambandam et al.)

Objective: The objective of this study is to develop a novel automatic convolutional neural network (CNN) that aids in the diagnosis of meniscus injury, while enabling the visualization of lesion characteristics. This will improve the accuracy and reduce diagnosis times. Methods: We presented a cascaded-progressive convolutional neural network (C-PCNN) method for diagnosing meniscus injuries using magnetic resonance imaging (MRI). A total of 1396 images collected in the hospital were used for training and testing. The method used for training and testing was 5-fold cross validation. Using intraoperative arthroscopic diagnosis and MRI diagnosis as criteria, the C-PCNN was evaluated based on accuracy, sensitivity, specificity, receiver operating characteristic (ROC), and evaluation performance. At the same time, the diagnostic accuracy of doctors with the assistance of cascade- progressive convolutional neural networks was evaluated. The diagnostic accuracy of a C-PCNN assistant with an attending doctor and chief doctor was compared to evaluate the clinical significance. Results: C-PCNN showed 85.6% accuracy in diagnosing and identifying anterior horn injury, and 92% accuracy in diagnosing and identifying posterior horn injury. The average accuracy of C-PCNN was 89.8%, AUC = 0.86. The diagnosis accuracy of the attending physician with the aid of the C-PCNN was comparable to that of the chief physician. Conclusion: The C-PCNN-based MRI technique for diagnosing knee meniscus injuries has significant practical value in clinical practice. With a high rate of accuracy, clinical auxiliary physicians can increase the speed and accuracy of diagnosis and decrease the number of incorrect diagnoses.

Fir bud powder has a regenerative, analgesic and anti-inflammatory action on all cartilages, being the most effective and fast natural remedy for joint pain. The treatment with fir bud powder is very well tolerated by the human body and has no side effects. The intra-articular menisci are part of the knee joint and are two fibrocartilages that have developed on the periphery of each of the tibial articular fossa. Their role is to contribute to a better concordance between the femoral condylar surfaces and the insufficiently excavated tibial articular fossae. [ABSTRACT FROM AUTHOR]

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Purpose: The purpose of this study was to determine the effect of meniscal repair on OA in the knee joint and patient-related outcomes. Methods: Three-hundred and sixteen meniscal repairs performed between 1999 and 2011 were analysed. Patient-related outcome measures were assessed through mailed questionnaires including KOOS, Lysholm score and Tegner activity level. Patients answering the questionnaires were encouraged to perform a radiographic evaluation with Rosenberg views, assessed according to Kellgren–Lawrence (KL) classification. The primary endpoint was to determine the effect of meniscal repair on the development of radiographic OA defined as a KL grade 2 or more. Results: Mean follow-up time was 9.3 years (SD 3.6), 162 (51%) patients answered the questionnaires, and 86 patients completed the X-ray. The odds ratio for OA with a failed meniscus repair was 5.1 (p = 0.007) adjusted for gender and age at time of follow-up. KOOS showed a clinically important difference in the sport and recreation subscale (p = 0.041). Conclusions: There was an increased risk for OA in the affected compartment with a failed meniscus fixation. This supports the fact that the meniscus is an important protector of the cartilage in the knee. The meniscus injury affects the long-term health-related quality of life according to KOOS and in light of this study we recommend repair of a torn meniscus whenever possible. Level of evidence: III. [ABSTRACT FROM AUTHOR]

This review summarizes the literature of preclinical studies and clinical trials on the use of mesenchymal stem cells (MSCs) to treat meniscus injury and promote its repair and regeneration and provide guidance for future clinical research. Due to the special anatomical features of the meniscus, conservative or surgical treatment can hardly achieve complete physiological and histological repair. As a new method, stem cells promote meniscus regeneration in preclinical research and human preliminary research. We expect that, in the near future, in vivo injection of stem cells to promote meniscus repair can be used as a new treatment model in clinical treatment. The treatment of animal meniscus injury, and the clinical trial of human meniscus injury has begun preliminary exploration. As for the animal experiments, most models of meniscus injury are too simple, which can hardly simulate the complexity of actual meniscal tears, and since the follow‐up often lasts for only 4–12 weeks, long‐term results could not be observed. Lastly, animal models failed to simulate the actual stress environment faced by the meniscus, so it needs to be further studied if regenerated meniscus has similar anti‐stress or anti‐twist features. Despite these limitations, repair of the meniscus by MSCs has great potential in clinics. MSCs can differentiate into fibrous chondrocytes, which can possibly repair the meniscus and provide a new strategy for repairing meniscus injury. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this review is to perform a meta-analysis of studies reporting meniscus repair outcomes. Pooled analyses of such studies will provide an accurate estimate of the outcomes that can be expected following meniscal repair at various postoperative time points.Methods: A meta-analysis of meniscal repair failure (defined as persistent symptoms, lack of healing on magnetic resonance imaging or revision surgery) and other clinical outcomes was performed following meniscal repair. Patients included had traumatic, nondegenerative meniscal tears, were skeletally mature, and had specific time-points after surgery. Repairs included were performed either in isolation, or with concomitant ACL reconstruction. Because of the inherent heterogeneity of single-arm meta-analyses, pooled analyses were performed using a random-effects model.Results: Rates of all-cause meniscal repair failure was pooled to be 12% at 0-1 years (95% CI: .09-.16), 15% at 2-3 years (95% CI: .11-.20), and 19% at 4-6 years (95% CI: .13-.24). Sensitivity analysis for studies performing meniscal repair entirely on patients with concomitant ACL reconstruction (ACLR) showed comparable rates of failure at similar time intervals. Development of osteoarthritis, in patients with knees previously free from articular pathologies, was 4% at 2-3 years (95% CI: .02-.07), and 10% at 4-6 years (95% CI: .03-.25).Conclusion: Meniscus repair for traumatic injuries have an all-cause failure rate that increases from 12% to 19% through a time period ranging from 1-6 years following surgery. The failure rates were comparable for patients with meniscal repairs performed with concomitant ACLRs.Level Of Evidence: IV; Systematic Review of Level II-IV Studies. [ABSTRACT FROM AUTHOR]

Abstract Background Meniscal repair has received increasing attention, but for inexperienced doctors, unilateral suture anchor pulling out may occur during all-inside meniscal repair, and the treatment outcome may be affected. When the errors happened intraoperatively, how to minimize the loss under guaranteeing of treatment effectiveness is a topic worth studying. Purpose To explore the practicability and effectiveness of the modified cross-suture method for arthroscopic remediation of unilateral suture anchor pulling out of an all-inside meniscal repair system. Methods From May 2014 to May 2017, 28 patients diagnosed with injuries of the meniscus and anterior cruciate ligaments (ACL) from the First Department of Orthopaedics of the Second Affiliated Hospital of Xi’an Jiaotong University were enrolled in the study as the observation group, including 18 males and 10 females with an average age of 25.5 ± 2.3 years (range 18–42 years). All patients underwent ACL reconstruction concurrently. All meniscus injuries were repaired with an all-inside meniscal repair technique, and 1–3 needles of unilateral suture anchor pulling out occurred intraoperatively. The modified cross-suture method was used to remedy the error of anchor pulling out and to eventually complete an effective repair. Another 30 patients who underwent ACL reconstruction and all-inside meniscal concurrently without unilateral suture anchor pulling out, including 20 males and 10 females with an average age of 26.3 ± 1.9 years (range 19–45 years), were enrolled as the control group. During postoperative follow-up, range of motion, Lachman test and pivot shift test were performed during the physical examination. The clinical healing of the meniscus was evaluated according to the Barrett standard. The meniscus healing status was also confirmed with magnetic resonance imaging (MRI). The function of the knee joint was evaluated according to the IKDC, Lysholm and Tegner scores. Results Twenty-five patients in the observation group and 28 patients in the control group completed the follow-up, with an average follow-up of 18.4 ± 5.2 months. All operations were performed by the same surgeon. At the follow-up 1 year after the operation, the average knee ROM of the two groups was 125.2 ± 4.3 degrees and 124.7 ± 3.8 degrees, the clinical healing rate of the meniscus of the two groups was 92.0% (23/25) and 92.9% (26/28), the MRI healing rate of the menniscus of the two groups was 72.0% (18/25) and 71.4% (20/28), and the IKDC, Lysholm and Tegner scores of the two groups were 90.52 ± 2.8, 89.17 ± 3.1, and 6.81 ± 1.7 and 91.42 ± 1.9, 90.32 ± 3.4, and 7.02 ± 1.4, respectively. The differences were not statistically significant (P > 0.05). Conclusions The modified cross-suture method is practicable and effective for arthroscopic remediation of unilateral suture anchor pulling out in an all-inside meniscal repair system.

Abstract Background An arthroscopic narrow posteromedial gap of the knee may cause failure of a meniscus operation. The posteromedial complex (PMC) of the knee, including the posterior part of the medial collateral ligament (MCL) and the posterior oblique ligament (POL), has a restrictive effect on the opening of the posteromedial gap of the knee in the half-extension position. Thus, we evaluated the radiological and clinical results of pie-crusting release of the PMC for arthroscopic meniscal surgery in tight knees. Methods Sixty patients with posterior injury of the medial meniscus were reviewed. All patients accepted arthroscopic pie-crusting release of the PMC. Fourty patients accepted meniscoplasty, and 20 patients accepted meniscal suturing. To evaluate the arthroscopic opening of the medial gap in 20° half-extension under 11-kg valgus stress, the width of the medial space before and after release were measured. During follow-up, the medial stability was evaluated by radiographic measurements of the joint space width (JSW) in 20° half-extension. Magnetic resonance imaging (MRI) was conducted to evaluate healing of the MCL and meniscus. Knee functions were evaluated using VAS (visual analogy score), Lysholm, IKDC (International Knee Documentation Committee) and Tegner scoring systems. Results In all patients, meniscus operations were performed without iatrogenic cartilage injury. After PMC release, the arthroscopic width of the medial space was 5.7 ± 0.5 mm, larger than that before release (2.5 ± 0.5 mm, p 0.05). For sutured meniscus, MRI showed healing in 15 patients while five had two-grade abnormal signals. VAS, Lysholm, IKDC and Tegner scores were 1.80 ± 0.51, 80.08 ± 3.74, 82.17 ± 4.64 and 5.48 ± 0.59, respectively, showing significant differences compared with the preoperative scores (5.57 ± 0.69, 48.17 ± 4.22, 51.42 ± 4.02 and 3.20 ± 0.68, respectively, p

Introduction: Applying rehabilitative exercise instructions before surgery is fundamental to minimize surgery complications and rehabilitation period as well. The aim of this research was to study the effects of 8 weeks of selected exercises on knee muscle torque and proprioception among the athletes with injured meniscus.Materials and Methods: This was an applied research with quasi-experimental method. Subjects were 24 athletes with injured meniscus who were selected through convenience judgmental sampling. Based on the orthopedic surgeon’s decision and their availability, subjects were divided equally into two experimental and control groups. Subject’s muscle torque and proprioception of the injured knee was recorded at the beginning and after eight weeks of selective exercises. The intervention was performed one hour a day on daily basis. Repeated measures variance ANOVA, within the 0.05 level of significance, was used for inferential data analysis and the probable differences between group means.Results: In both groups, maximum knee flexion and extension muscle torque and proprioception changed significantly (P < 0.001 for all three variables). Moreover, between groups differences were significant (P < 0.001).Conclusion: In this study, positive effects of exercise on torque and proprioception of knee in athletes with injured meniscus were reported. It seems that applying proper exercises challenging functional system can be an effective means of progressing knee motor function preoperatively.

Objective: To investigate application of the Codamotion 2CX1 three-dimensional dynamic joint motion capture system to analyze the kinematic characteristics of patients with different degrees of meniscus injury., Methods: From December 2020 to June 2022, 135 patients with meniscus injury and recruited normal people were collected, including 82 males and 53 females, aged 14 to 29 years old, with disease duration of 1 to 3 months. Combined with clinical symptoms and MRI examination, the diagnosis of meniscus injury was confirmed, and the patients were divided into stages, including 37 cases of grade 0(normal), 30 cases of gradeⅠ, 33 cases of gradeⅡ, 35 cases of grade Ⅲ according to Stoller grading standard. Subjects in each group were tested walking by using Codamotion 2CX1 three-dimensional dynamic joint motion capture system. Quantitative indexes of walking and kinematics were collected, including knee flexion and extension, internal and external rotation and internal and external turning, and their kinematics were analyzed., Results: In the distribution of knee flexion/extension, there were significant differences in maximum knee flexion, minimum knee extension and knee flexion and extension range among 4 groups( P <0.05). In the distribution of internal/external rotation of knee joint, there were significant differences in the range of internal rotation and rotation of knee joint among 4 groups( P <0.05). In the distribution of internal/external turning of knee joint, there were significant differences in the range of internal and external turning of knee joint among 4 groups( P <0.05). The clinical stage progression was positively correlated with the range of motion of knee extension, external rotation, internal and external turning and turning range( P <0.05). It was negatively correlated with knee flexion, internal rotation, flexion extension and rotation range( P <0.05). The internal and external rotation angles of knee joint could be used as independent factors influencing the clinical stage of meniscus injury ( P =0.006, 0.019<0.05)., Conclusion: The knee movement of patients with meniscus injury has obvious changes, and the changes are different under different clinical stages. Gait analysis provides a reliable basis for the kinematic analysis of meniscus injury, helps to better understand the kinematic indexes of joints, and provides a reliable auxiliary diagnosis and treatment plan, which provides a new direction for the follow-up medical research.

Objectives This study aimed to characterize and compare the features of traumatic and non-traumatic lesions causing knee pain through magnetic resonance imaging (MRI). Method The study was conducted at a tertiary care center, with data sourced from patients visiting the outpatient and in-patient departments. It involved a descriptive cross-sectional research design focusing on patients referred for knee MRI scanning. The sample size was calculated using Cochran's formula as 112 for symptomatic patients with knee pain with a 95% confidence interval. The MRI findings in 112 patients were analyzed and associated with a history of trauma. Results The average age recorded was 35.38 years. Females made up 41.07% (n=46) of the sample, while males accounted for 58.93% (n=66). Among the participants, the majority (n=82; 71.43%) had a history of trauma, and the most common MRI finding was joint effusion (n=74; 66.1%). The second most common was anterior cruciate ligament (ACL) injuries (n=71; 63.4%), followed by meniscus injury (n=40; 35.71%). The study confirms that those with history of trauma are at a higher risk (p<0.05) of sustaining injuries like meniscus and ACL tears, collateral ligament damage, bone contusions, chondromalacia patella, and joint effusion. Conclusion In conclusion, the consistency of our findings with existing studies reinforces the pivotal role of MRI in the evaluation of knee pain. Despite its limitations, including cost and accessibility, MRI remains a gold standard for diagnosing a wide range of knee pathologies, offering unparalleled detail and accuracy that significantly enhance clinical decision-making and patient outcomes., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Datta Meghe Institute of Higher Education and Research issued approval DMIMS(DU)/IEC/2022/31. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Shetty et al.)

Objective: To compare the short-term effectiveness of suture hook suture via double posteromedial approaches and Fast-Fix total internal suture in treatment of Ramp lesions., Methods: A clinical data of 56 patients with anterior cruciate ligament rupture combined with Ramp lesions, who met the selection criteria and admitted between December 2021 and February 2023, was retrospectively analyzed. The Ramp lesions were sutured using suture hook via double posteromedial approaches under arthroscopy in 28 cases (group A) and treated with Fast-Fix total internal suture under arthroscopy in 28 cases (group B). There was no significant difference in age, gender, cause of injury, type of injury, time from injury to operation, side of injury, body mass index, and preoperative Lysholm score, visual analogue scale (VAS) score, and Tegner score between the two groups ( P >0.05). The patients were followed up regularly after operation, and the clinical and imaging healing of the Ramp lesion was evaluated according to the Barrett clinical healing standard and the MRI evaluation standard. Lysholm score, VAS score, and Tegner score were used to evaluate the function and pain degree of knee joint, and the results were compared with those before operation., Results: The incisions of the two groups healed by first intention. All patients were followed up 12-18 months (mean, 14.9 months). Postoperative McMurray tests were negative in both groups. The clinical healing rates of group A and group B were 71.4% (20/28) and 64.3% (18/28) at 6 months after operation, and 92.9% (26/28) and 82.1% (23/28) at 12 months after operation, respectively. The differences between the two groups was not significant ( χ 2 =0.327, P =0.567; χ 2 =0.469, P =0.225). There was no significant difference in Lysholm score, VAS score, and Tegner score between the two groups at each time point after operation ( P >0.05). The postoperative scores in the two groups significantly improved when compared with those before operation, and the scores at 12 months after operation further improved when compared with those at 6 months after operation, showing significant differences between the different time points in the two groups ( P <0.05). At last follow-up, MRI examination of the knee joint showed that there were 26 (92.9%), 2 (7.1%), and 0 (0) cases of complete healing, partial healing, and nonunion in the Ramp lesion of group A, and 25 (89.3%), 1 (3.6%), and 2 (7.1%) cases in group B, respectively. There was no significant difference between the two groups ( Z =-0.530, P =0.596)., Conclusion: Suture hook suture via double posteromedial approaches and Fast-Fix total internal suture under arthroscopy are safe and reliable in the treatment of Ramp lesion, and the knee joint function significantly improves after operation.

Meniscal tears are associated with a high risk of osteoarthritis but currently have no disease-modifying therapies. Using a Gli1 reporter line, we found that Gli1+ cells contribute to the development of meniscus horns from 2 weeks of age. In adult mice, Gli1+ cells resided at the superficial layer of meniscus and expressed known mesenchymal progenitor markers. In culture, meniscal Gli1+ cells possessed high progenitor activities under the control of Hh signal. Meniscus injury at the anterior horn induced a quick expansion of Gli1-lineage cells. Normally, meniscal tissue healed slowly, leading to cartilage degeneration. Ablation of Gli1+ cells further hindered this repair process. Strikingly, intra-articular injection of Gli1+ meniscal cells or an Hh agonist right after injury accelerated the bridging of the interrupted ends and attenuated signs of osteoarthritis. Taken together, our work identified a novel progenitor population in meniscus and proposes a new treatment for repairing injured meniscus and preventing osteoarthritis.

Purpose: This study aimed to evaluate the excessive anterior tibial translation (ATT) and muscle strength of patients with ramp lesions. We hypothesised that the higher ATT, lower hamstring-to-quadriceps (HQ) ratio, and higher flexion peak torque influenced by semimembranosus would be associated with ramp lesions. Methods: One hundred and twenty-one patients who underwent anterior cruciate ligament (ACL) reconstruction were retrospectively evaluated. Clinical evaluation included ATT of the contralateral uninjured limb measured using a KT-1000 arthrometer, the knee flexor and extensor muscle strength of the contralateral uninjured limb at 60°/s and 180°/s of an angular velocity measured using an isokinetic dynamometer, and HQ ratio at 60°/s and 180°/s during the preoperative state. Binary stepwise logistic regression analysis was performed to evaluate the risk factors of ramp lesions. Results: Ramp lesions were found in 27 cases of ACL injuries (27/121, 22.3%). Male sex (odds ratio [OR], 2.913; 95% confidence interval [CI], 1.090–7.787; P = 0.033), longer time between injury to surgery (OR, 2.225; 95% CI, 1.074–4.608; P = 0.031), and higher ATT in the contralateral uninjured limb (OR, 1.502; 95% CI, 1.046–2.159; P = 0.028) were indicated as the independent risk factors of the presence of ramp lesion associated with an ACL injury. Conclusions: Male sex, longer period from injury to surgery, and higher ATT in the contralateral uninjured limb were significantly associated with ramp lesion. These findings are advantageous for identifying patients with a greater risk of developing a ramp lesion with an ACL injury in the clinical setting. Level of evidence: Level IV [ABSTRACT FROM AUTHOR]

Purpose: Anterior cruciate ligament (ACL) tears have a major impact on the individual and society. Long term effects may be mediated by injuries that occur concurrently to the ACL tear. The purpose of this study was to describe in a nationwide cohort the traumatic meniscal injuries and bone marrow lesions concomitant to ACL tears, their age and sex distribution and the rate any association with ACL reconstruction. Methods: All ACL tears in Iceland from 2006 to 2011 and their concomitant bone marrow lesions and meniscal injuries were identified from MRI reports. These injuries were further classified by location, sex and age. The cohort was divided into under 17, 17–29, 30–49 and above 50 to reflect likely differences in the mechanisms of injury and risk factors that may vary with age. Data from the Icelandic Social Insurance Administration were used identify all those who were operated. Descriptive analysis was performed to show the proportion of ACL injured knees sustaining concomitant injuries and how these injuries varied with age, sex, and subsequent treatment Results: 1365 knees with ACL ruptures were included. Only 13% of knees had no concomitant injury identified. Overall, 57% of knees had a bone marrow lesion in at least one location and 70% of knees had at least one traumatic meniscal injury. A greater number of combined lateral tibial and femoral bone marrow lesion was seen in younger age groups (χ2 (3) = 113.32, p < 0.0001). Bruises in the medial compartment were the least common concomitant injuries. More injuries were related to higher chances of ACL reconstruction (OR 1.6, 95% CI 1.4–1.7). Age was associated with risk of all injury types and locations with older age generally being associated with fewer injuries. Conclusion: In an ACL ruptured cohort, the overall incidence of BMLs may be lower and meniscus injuries higher than previously reported. However, these injuries are more prevalent in the younger cohort potentially resulting in a poorer long-term prognosis. Knowledge of the association between age and concomitant injuries will help guide rehabilitation. Level of evidence: II. [ABSTRACT FROM AUTHOR]