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The authors report a case of repetitive locking knee caused by a subluxation of the posterior horn of a normal lateral meniscus. The posterior horn was sutured to the posterior knee capsule and the athlete resumed complete sports activity 4 months after the surgery.

Objective People with meniscal tears are at high risk to develop or progress to knee osteoarthritis. Knee extensor weakness is considered a risk factor for osteoarthritis and is often reported in these individuals. The purpose of this systematic review and meta-analysis was to investigate knee extensor strength in people undergoing an arthroscopic partial meniscectomy (APM). Methods Six databases (Medline, CINAHL, SPORTDiscus, Embase, PEDro, and AMED) were searched up to June 22, 2014. Studies that measured knee extensor muscle strength in people age ≥30 years undergoing APM for a meniscal tear and used either a healthy control group or the contralateral leg to compare knee extensor muscle strength were included. Methodological quality was assessed using guidelines from the Centre for Reviews and Dissemination. Results Eleven studies, in which participants were predominantly male, were included (n = 596). A moderate reduction in muscle strength was observed prior to APM compared to controls (standardized mean difference [SMD] 0.58, 95% confidence interval [95% CI] 0.04, 1.13) and continued up to 6 months postsurgery (SMD range −2.42 to −0.47). There was no difference in muscle strength at 2 years post-APM (SMD −0.01 [95% CI −0.36, 0.35]), while a moderate reduction was again apparent at 4 years post-APM (SMD −0.56, [95% CI −1.20, 0.08]) compared to controls. Conclusion Our findings suggest that middle-aged and older individuals undergoing APM have reduced knee extensor muscle strength in the operated leg compared to control data. As meniscus pathology and knee extensor muscle weakness are risk factors for osteoarthritis, these results highlight the clinical importance of addressing muscle weakness in these individuals.

AB Purpose: This study aimed to evaluate the effects of a 12-wk, home-based, physiotherapist-guided neuromuscular exercise program on the knee adduction moment (an indicator of mediolateral knee load distribution) in people with a medial arthroscopic partial meniscectomy (APM) within the past 3-12 months. Methods: An assessor-blinded, randomized controlled trial including people age 30-50 yr with no to mild pain after medial APM was conducted. Participants were randomly allocated to either a 12-wk neuromuscular exercise program that targeted neutral lower limb alignment or a control group with no exercise. The exercise program included eight individual sessions with one of seven physiotherapists in private clinics, together with home exercises. Primary outcomes were the peak external knee adduction moment during normal-paced walking and during one-leg sit-to-stand. Secondary outcomes included additional measures of knee joint load distribution, patient-reported outcomes, maximal knee and hip muscle strength, and physical function measures. Results: Of 62 randomized participants, 60 (97%) completed the trial. There were no significant between-group differences in the change in peak knee adduction moment during normal-paced walking (mean difference (95% confidence interval), 0.22 (-0.11 to 0.55) N[middle dot]m/body weight x height %, P =0.19) or during one-leg sit-to-stand (-0.01 (-0.33 to 0.31) N[middle dot]m/body weight x height %, P = 0.95). There were also no significant between-group differences for any of the secondary outcomes. Conclusions: In patients 3-12 months after a medial APM, a neuromuscular exercise program did not alter the peak knee adduction moment, a key predictor of osteoarthritis structural disease progression. (Australia and New Zealand Clinical Trials Registry, #ACTRN12612000542897.)

BACKGROUND: The optimal rehabilitation program after meniscus repair has not been established. Numerous regimens have been suggested as beneficial for meniscus healing, but no controlled trials exist in the literature.HYPOTHESIS: The purpose of this prospective randomized trial was to investigate outcome with a free or a restricted rehabilitation regimen after isolated meniscus repair. The hypothesis was that free rehabilitation would result in increased failure of meniscus healing.STUDY DESIGN: Randomized controlled clinical trial; Level of evidence, 1.METHODS: A total of 60 patients were included in this study within 2 to 3 days after meniscus repair. No patients with concomitant ligament reconstruction or cartilage repair surgery were included. Meniscus repair was performed with the all-inside technique; only vertical meniscus lesions close to the capsule were repaired. Patients were randomized to free (n = 32) or restricted (n = 28) rehabilitation. Free rehabilitation consisted of 2 weeks (range of motion [ROM], 0°-90°, no brace) and touch weightbearing, with unrestricted activity and free ROM allowed thereafter. Restricted rehabilitation consisted of 6 weeks of hinged brace use with a gradual increase ROM to 90° and only touch weightbearing during the 6 weeks. Patients were seen for follow-up at 3 months, 1 year, and 2 years. Those patients with joint line pain at the 3-month follow-up underwent MRI scanning to evaluate meniscus healing; a subsequent arthroscopy was performed for final evaluation meniscus healing if the MRI indicated lack of meniscus healing. At follow-up, the Knee Osteoarthritis Outcome Score (KOOS), Tegner function score, pain assessment, and patient satisfaction were used to evaluate outcomes.RESULTS: Eleven patients were lost to follow-up. Repeat arthroscopy in patients with persistent symptoms demonstrated partial healing or lack of healing in 28% and 36% of patients in the free and the restricted rehabilitation groups, respectively (P = .53, nonsignificant). The KOOS and Tegner function scores were similar between groups at all follow-up times, as was patient satisfaction. Patients who underwent subsequent partial meniscectomy because of meniscus repair failure had lower KOOS score and Tegner function score than did patients without repair failure.CONCLUSION: Free rehabilitation after meniscus repair is safe and does not entail increased failure rates compared with restricted rehabilitation. Subjective and functional outcomes at 1- and 2-year follow-up were not affected by rehabilitation regimen. Clinical outcomes in patients with repair failure who underwent subsequent partial meniscectomy were poorer than in those with healed meniscus repairs. A concern is the 30% overall lack of healing for patients with isolated meniscus lesions repaired with the all-inside technique.

BACKGROUND: Functional limitations exist postmeniscectomy, but preoperative data are scarce.PURPOSE: To examine knee function, knee muscle strength and performance in middle-aged patients with degenerative meniscal tears, eligible for arthroscopic partial meniscectomy.STUDY DESIGN: Cross-sectional study.METHODS: Eighty-two participants with MRI verified degenerative meniscal tear (35% women, mean age 49 years) answered the Knee injury and Osteoarthritis Outcome Score (KOOS) and were tested for isokinetic knee muscle strength and lower extremity performance (one-leg hop for distance, 6 m timed hop and maximum number of knee-bends in 30 s). Limb Symmetry Index (LSI) was used to express side-to-side differences in per cent using the non-injured leg as the control. An LSI ≥90% was considered normal.RESULTS: Mean scores of the five subscales of the KOOS were from 13 to 36 points lower compared with a population-based reference group and similar to patients prior to anterior cruciate ligament reconstruction. Quadriceps strength and lower-extremity performance were impaired for the injured leg compared with the non-injured leg (pCONCLUSION: Middle-aged patients with a symptomatic degenerative meniscal tear experience functional knee problems when eligible for meniscectomy. Included participants reported difficulty with knee pain, symptoms, function and quality of life and quadriceps strength and lower-extremity performance were impaired. Approximately 50% of the study group had clinically relevant impairments in quadriceps strength and lower-extremity performance, defined as >10% differences between the injured and the non-injured leg.

Partial meniscectomy involves partial removal of the meniscus. This can vary from minor trimming of the damaged part of the meniscus to the removal of the rip from the meniscocapsular junction. Meniscus tears are the most common knee injury. They may occur in acute knee injuries in younger patients, or as part of a degenerative process in older individuals. The aim of the study was to demonstrate the method of choice for treatment of medial meniscus injuries that, in well selected cases, resulted in a small rate of complications and fast rehabilitation. The study analyzed the results of arthroscopic partial medial meniscectomy in 99 patients, in the period from 2005 to 2013, with follow up of 12-14 months. In our series of arthroscopically treated medial meniscus, tears were found in 29 patients with vertical complete bucket handle lesions, 14 with vertical incomplete lesions, 9 with longitudinal tears, 13 with oblique tears, 11 with complex, flap and degenerative lesions, 10 with radial lesions and 13 with horizontal lesions. The mean preoperative International Knee Documentation Committee score was 52.52%, then 81.81% at one month and 92.92% at six months of arthroscopic partial medial meniscectomy. Arthroscopic partial medial meniscectomy is a minimally invasive diagnostic and therapeutic procedure. This procedure is an acceptable and effective long-term treatment, particularly in patients without significant articular cartilage damage, and is associated with minimal morbidity., Parcijalna meniscektomija podrazumijeva djelomično uklanjanje meniskusa. Ovo može varirati od manje ekstirpacije oštećenog dijela meniskusa do uklanjanja rascjepa s meniskokapsularnog hvatišta. Ozljede meniskusa su najčešće ozljede koljena. One se mogu javiti kao akutne ozljede koljena kod mlađih bolesnika ili kao dio degenerativnog procesa u starijih osoba. Cilj studije bio je pokazati metodu izbora u liječenju ozljeda medijalnog meniskusa koja u dobro odabranim slučajevima dovodi do malog postotka komplikacija i brze rehabilitacije. U studiji su analizirani rezultati artroskopske parcijalne medijalne meniscektomije kod 99 bolesnika u razdoblju od 2005. do 2013. godine s praćenjem kroz 12-14 mjeseci. U našoj seriji bolesnika liječenih ovom metodom utvrđen je rascjep poput drške košarice (bucket handle) u 29, vertikalni nepotpuni rascjep u 14, uzdužni rascjep u 9, kosi rascjep u 13, degenerativna lezija u 11, radijalni rascjep u 10 i horizontalni rascjep u 13 bolesnika. Prosječni prijeoperacijski zbir IKDC (International Knee Documentation Committee) bio je 52,52%, jedan mjesec nakon parcijalne artroskopske medijalne meniscektomije IKDC je bio 81,81%, a šest mjeseci nakon parcijalne meniscektomije 92,92%. Artroskopska parcijalna medijalna meniscektomija je minimalno invazivan dijagnostički i terapijski zahvat. Ona je prihvatljiva i učinkovita kao liječenje, naročito kod bolesnika bez značajnog oštećenja zglobne hrskavice, a praćena je minimalnim pobolom.

We report nine cases of osteonecrosis of the knee after arthroscopic meniscectomy between 1992 and 1996. In five women and four men aged between 58 and 82 years (mean 69 years), magnetic resonance imaging (MRI) demonstrated a meniscal tear for which arthroscopic meniscectomy was performed. MRI was done between 3 days and 72 weeks after the onset of symptoms. Signs of osteonecrosis were not present on the initial MRI scan. Postoperatively, all patients experienced persistent knee pain and joint effusion. A repeat MRI scan 6-48 weeks after meniscectomy confirmed the diagnosis of osteonecrosis. In eight patients osteonecrosis was located on the medial, in one patient on the lateral femoral condyle. Our report supports the results of recent studies which have related osteonecrosis to arthroscopic meniscectomy. Further studies need to be undertaken to determine the aetiology of the osteonecrosis related to this procedure in the elderly. Until the results of these studies are available, we recommend considering carefully before performing arthroscopic procedures in the elderly.

Objective To compare, in young active adults with an acute anterior cruciate ligament (ACL) tear, the mid-term (five year) patient reported and radiographic outcomes between those treated with rehabilitation plus early ACL reconstruction and those treated with rehabilitation and optional delayed ACL reconstruction. Design Extended follow-up of prospective randomised controlled trial. Setting Orthopaedic departments at two hospitals in Sweden. Participants 121 young, active adults (mean age 26 years) with acute ACL injury to a previously uninjured knee. One patient was lost to five year follow-up. Intervention All patients received similar structured rehabilitation. In addition to rehabilitation, 62 patients were assigned to early ACL reconstruction and 59 were assigned to the option of having a delayed ACL reconstruction if needed. Main outcome measure The main outcome was the change from baseline to five years in the mean value of four of the five subscales of the knee injury and osteoarthritis outcome score (KOOS4). Other outcomes included the absolute KOOS4 score, all five KOOS subscale scores, SF-36, Tegner activity scale, meniscal surgery, and radiographic osteoarthritis at five years. Results Thirty (51%) patients assigned to optional delayed ACL reconstruction had delayed ACL reconstruction (seven between two and five years). The mean change in KOOS4 score from baseline to five years was 42.9 points for those assigned to rehabilitation plus early ACL reconstruction and 44.9 for those assigned to rehabilitation plus optional delayed reconstruction (between group difference 2.0 points, 95% confidence interval −8.5 to 4.5; P=0.54 after adjustment for baseline score). At five years, no significant between group differences were seen in KOOS4 (P=0.45), any of the KOOS subscales (P≥0.12), SF-36 (P≥0.34), Tegner activity scale (P=0.74), or incident radiographic osteoarthritis of the index knee (P=0.17). No between group differences were seen in the number of knees having meniscus surgery (P=0.48) or in a time to event analysis of the proportion of meniscuses operated on (P=0.77). The results were similar when analysed by treatment actually received. Conclusion In this first high quality randomised controlled trial with minimal loss to follow-up, a strategy of rehabilitation plus early ACL reconstruction did not provide better results at five years than a strategy of initial rehabilitation with the option of having a later ACL reconstruction. Results did not differ between knees surgically reconstructed early or late and those treated with rehabilitation alone. These results should encourage clinicians and young active adult patients to consider rehabilitation as a primary treatment option after an acute ACL tear. Trial registration Current Controlled Trials ISRCTN84752559.

PURPOSE: To assess the distal femoral cartilage after unilateral arthroscopic partial meniscectomy and to explore the relationship between cartilage thickness and various disease-/surgery-related parameters. METHODS: Eighty-nine patients (42 M, 47 F) who had undergone arthroscopic partial meniscectomy surgery were evaluated. Ultrasonographic distal femoral cartilage thicknesses were measured with a 5-13-MHz linear probe (General Electric, Logiq P5) on mid-points of the lateral condyle, intercondylar notch and medial condyle of operated and non-operated knees by a physician blinded to patients' data. Demographic features, duration after surgery, type of meniscal tear and site of meniscectomy were recorded. RESULTS: Mean age of the patients was 51.8 ± 12.8 years (range 18-88). Mean body mass index was 29.4 ± 4.4 kg/m2 (range 18-38). Overall, in patients with degenerative meniscal tears, femoral cartilage thicknesses pertaining to all the three measured sites (lateral, intercondylar and medial) were found to be decreased in the operated knees when compared with those of the non-operated knees (p = 0.004, p = 0.003, p = 0.041, respectively), whereas in patients with non-degenerative tears, this decrease was significant only in the intercondylar area (p = 0.038). When patients were grouped according to the duration (months) after their surgery (≤36, 37-48 and ≥49), cartilage thickness was similar between both knees in the first group, decreased at the lateral condyle (p = 0.008) and intercondylar area (p = 0.049) in the second group and decreased at all three sites (lateral, intercondylar and medial) in the third group (p = 0.015, p = 0.005 and p = 0.008, respectively). CONCLUSION: These findings would be considered as unfavourable with respect to weight-bearing, and thus, conservative measures to support relevant joints would strongly be kept in mind during clinical practice. Lastly, ultrasonography may be a convenient alternative imaging method for the evaluation of short- and medium-term cartilage loss in patients with arthroscopic partial meniscectomy. LEVELS OF EVIDENCE: III.

OBJECTIVE: To compare the effectiveness of electromyographic biofeedback training and electrical stimulation therapy for rehabilitation following arthroscopic partial meniscectomy. DESIGN: Randomized, prospective, controlled single-blind trial. SETTING: Department of physical medicine and rehabilitation, university hospital. SUBJECTS: Forty-five patients who had undergone surgery for arthroscopic partial meniscectomy were randomly divided into three groups with 15 patients in each group. INTERVENTIONS: The control group had home exercise, the second and third groups received electromyographic biofeedback training or electrical stimulation therapy to quadriceps muscle in addition to home exercise. MAIN MEASURES: The patients were evaluated for: visual analogue scale, gait velocity (m/s), time using a walking aid after surgery, Lysholm Knee Scoring Scale score, knee flexion-extension angle, maximum and average contraction powers of vastus medialis obliquus and vastus lateralis muscles on the day before the operation and two and six weeks after. RESULTS: The time using a walking aid was 8.3 ± 8.0, 1.5 ± 2.5 and 4.5 ± 5.5 days, respectively, for the home exercise, electromyographic biofeedback training and electrical stimulation groups, and significantly shorter in the electromyographic biofeedback training than in the home exercise group (P < 0.017). While significant progress was detected in Lysholm Knee Scoring Scale score in the second and sixth postoperative weeks compared to the preoperative within-group evaluation for each of the three groups (P < 0.017), there was significant difference in Lysholm Knee Scoring Scale in the second postoperative week in favour of electromyographic biofeedback training compared to home exercise (P < 0.017). There were significant differences in vastus medialis obliquus average and vastus lateralis maximum and average contractions in favour of electromyographic biofeedback compared to home exercise and electrical stimulation in the second postoperative week (P < 0.017). CONCLUSIONS: The addition of electromyographic biofeedback training to a conventional exercise programme following arthroscopic partial meniscectomy helps to speed up the rehabilitation process.

OBJECTIVES: This study aims to investigate the effects of clinical and demographic variables on functional status, patient satisfaction and quality of life following arthroscopic partial meniscectomy. PATIENTS AND METHODS: Between January 2001 and December 2010, 98 patients (44 males, 54 females; mean age 52.1±12.5 years; range 18 to 88 years) who underwent arthroscopic partial meniscectomy in our clinic and were eligible for the study. Demographic and clinical data of patients and surgical characteristics were recorded. Preoperative activity levels of patients were measured. Severity of activity pain and patient satisfaction following surgery were evaluated using Visual Analog Scale (VAS). Functional status was evaluated by Lysholm knee score and WOMAC (Osteoarthritis Index Western Ontario and McMaster Universities), while quality of life was evaluated by Short Form-36 (SF-36). RESULTS: Postoperative mean time from surgery was 62.5±26.1 (8-120) months, GAS score at rest was 1.7±2.6 (0-10), GAS activity score was 3.4±3.3 (0-10) and GAS patient satisfaction score was 7.0±3.0 (0-10). It was found that 68 of the patients (69.4%) were evaluated themselves as excellent or better than preoperative period with a mean Lysholm knee score of 73.8±17.4 (24-95). Significant influences of body mass index and preoperative symptom duration on evaluation parameters were not detected. Male gender, less than five years after surgery, less intraoperative joint degeneration and moderate to severe activity level before the onset of symptoms had a positive influence on the severity of pain, patient satisfaction and functional status. CONCLUSION: Our study provided critical data for optimal patient selection during the preoperative period to predict which patients may have better results in the mid-term follow-up after arthroscopic partial meniscectomy.

The continuous improvement of intrumentation and equipment is the reason for the steady increase in arthroscopic operations. As the technical equipment is becoming increasingly complicated, attention must be paid to training and standardized procedures in order to ensure that the arthroscopic operative procedure is fast, safe, and without complications. Special operative techniques and instruments have been approved for clinical use, depending on the arthroscopic operation.