膝骨关节炎临床症状与X线表现相关性研究

目的:探讨膝骨关节炎临床症状与X线片表现的相关性,为临床诊疗提供依据.方法:收集门诊78例(108膝)膝骨关节炎患者,年龄41～77岁;女65例(89膝),男13例(19膝).对所有病例进行严重性指数(Lequesne膝关节指数)问卷调查,计算严重性指数,并将病例分成轻度组(Lequesne指数≤8)和重度组(Lequesne指数>8).摄负重站立位膝关节正侧位、髌股关节Skyline位X线片,分部位观察评价关节间隙狭窄、骨赘生成、软骨下骨硬化、软骨下囊变,测量下肢力线角及外侧髌股角.对膝骨关节炎严重性与各X线表现进行相关性及回归分析.结果:膝骨关节炎轻度组和重度组在外侧胫股关节间隙、内侧髌股关节间隙狭窄程度、内侧胫骨骨赘、内侧股骨骨赘、外侧胫骨骨赘、外侧股骨骨赘、内侧滑车骨赘、外侧髌骨骨赘、外侧滑车骨赘、胫骨髁问骨赘程度等方面的差异有统计学意义(P<0.05).Logistic回归分析结果显示外侧股骨骨赘的相伴概率(0.009)最小,Wald值最大(6.779),提示外侧股骨骨赞为判断膝骨关节炎严重性最重要的放射学表现.结论:评价膝骨关节炎严重性时,关节间隙狭窄与骨赘生成是最有意义的X线表现,其中外侧胫股关节间隙狭窄、内侧髌股关节间隙狭窄、内侧胫骨骨赘、内侧股骨骨赘、外侧胫骨骨赘、外侧股骨骨赘、内侧滑车骨赘、外侧髌骨骨赘、外侧滑车骨赘、胫骨髁问骨赘更加应该予以重视.     

前十字韧带断裂继发半月板损害的临床研究

目的研究前十字韧带(anteriorcruciateligament,ACL)断裂对半月板的影响。方法回顾分析1984年12月～1999年12月间收治的419例ACL断裂患者半月板的损伤情况及其与软骨损伤的关系。结果外侧半月板的损伤率随病程增加无显著变化,而内侧半月板的损伤率随病程增加显著增加,由急性期的31.1%增至亚慢性期的48.2%(P<0.01),又增至慢性期的78.8%(P<0.001)。内侧半月板后角损伤率较前角高,差异有显著性意义(P<0.05)。损伤形态以纵裂最常见,随着病程的增加,半月板损伤也越发复杂。内侧半月板损伤患者的内髁软骨损伤的发生率要高于内侧半月板正常者的内髁软骨损伤发生率,但差异无显著性意义(P>0.05);而外侧半月板损伤患者的外髁软骨损伤的发生率却显著高于外侧半月板正常者,差异有非常显著性意义(P<0.01)。结论ACL断裂可伴发和继发半月板的损害,ACL断裂时伴发的多为外侧半月板的损伤,而继发的半月板损害却以内侧为重。内髁软骨损害主要由股胫关节前后向不稳、异常活动增加造成,而与内侧半月板的损伤关系不大。     

胫骨高位截骨联合关节镜手术治疗膝内翻骨关节炎的近期疗效及二次关节镜探查结果北大核心CSCD

目的 探讨胫骨高位截骨术(high tibial osteotomy,HTO)联合关节镜手术治疗内侧间室膝关节骨关节炎(knee osteoarthritis,KOA)的近期疗效,并二次关节镜探查评估软骨及半月板转归。方法 回顾分析2014年8月—2018年10月收治的57例合并膝内翻畸形的内侧间室KOA患者临床资料。男23例,女34例;年龄41~63岁,平均51.2岁。病程2~8年,平均4.7年。术前股胫角为(179.86±4.69)°,下肢机械轴通过胫骨平台的相对位置为24.21%±6.98%,胫骨平台后倾角为(5.23±1.45)°。膝关节Kellgren-Lawrence分级为Ⅱ级22例、Ⅲ级35例。术前美国特种外科医院(HSS)膝关节评分为(59.1±7.3)分,Lysholm评分为(48.8±7.6)分,疼痛视觉模拟评分(VAS)为(6.2±1.1)分。术中关节镜探查记录内侧胫骨平台负重区软骨退变(Outerbridge分级为Ⅰ级18例、Ⅱ级30例、Ⅲ级9例)及内侧半月板损伤情况并行相应治疗;HTO术中根据术前膝关节Kellgren-Lawrence分级调整冠状面力线。术后测量下肢机械轴通过胫骨平台的相对位置、股胫角和胫骨平台后倾角;记录术后膝关节Kellgren-Lawrence分级;结合术后1年膝关节MRI以及内固定物取出时二次关节镜探查,评估关节软骨退变Outerbridge分级及半月板转归;膝关节功能和疼痛程度采用Lysholm评分、HSS评分和VAS评分进行评价。结果57例患者均获随访,随访时间36~58个月,平均42.1个月。切口均Ⅰ期愈合,术中无神经血管损伤、关节内及合页骨折,术后无下肢深静脉血栓形成、内固定失效等并发症发生;术后3个月截骨部位均获骨性愈合。术后1年取出内固定物,二次关节镜探查示内侧间室负重区软骨退变Outerbridge分级为Ⅰ级15例、Ⅱ级31例、Ⅲ级11例,与术中比较差异无统计学意义(Z=31.992,P=0.997);其他间室未见软骨退变。损伤半月板可见半月板愈合表现,正常半月板未见损伤进展。末次随访时,Kellgren-Lawrence分级为Ⅱ级19例、Ⅲ级38例,与术前比较差异无统计学意义(Z=49.049,P=0.764)。下肢机械轴通过胫骨平台的相对位置为59.16%±2.87%,股胫角为(171.54±3.39)°,均较术前显著改善(P<0.001);胫骨平台后倾角为(5.65±1.22)°,与术前比较差异无统计学意义(t=-1.673,P=0.096)。HSS评分、Lysholm评分和VAS评分分别为(82.3±7.7)、(83.4±6.4)、(1.6±1.1)分,均较术前显著改善(P<0.001)。结论 HTO联合关节镜手术治疗合并膝内翻畸形的内侧间室KOA,可有效改善下肢力线、缓解疼痛症状、改善关节功能,近期疗效满意,术后关节软骨退变及半月板损伤未见明显进展。     

胫骨内侧高位楔形截骨治疗膝内翻畸形的临床疗效观察

[目的]探讨胫骨内侧高位楔形截骨治疗膝内翻畸形的疗效.[方法]1998年7月～2007年10月,采用胫骨内侧张开式高位楔形截骨结合植骨钢板内固定术治疗膝内翻畸形共49例72个膝关节.患者术前、术后8周、术后1.5年行患肢全长X线片检查,测量胫股角、胫股内侧关节间距大小.按HSS膝关节功能评定标准评定术前、术后膝关节功能.[结果]72膝术后随访18～128个月,平均58个月;胫股角术前187.5°±5.3°,术后172.6°±3.6°,膝关节功能由(47.2±17.6)分增至(83.2±15.3)分,胫股内侧关节间距由(2.4±1.2)mm增至(4.3±1.2)mm.植骨均愈合满意,无膝内翻复发.术后疼痛缓解及行走功能改善显著.术中出现关节内骨折3例,无神经血管损伤.术后皮肤感染切口延迟愈合2例.[结论]胫骨内侧高位楔形截骨结合植骨钢板内固定术,可作为治疗膝内翻畸形的有效方法之一.     

同种异体半月板联合骨软骨移植的实验研究

目的:探讨新鲜同种异体半月板骨软骨联合移植治疗胫骨平台毁损伤后骨关节炎的疗效。方法:成年新西兰大白兔36只,随机分为A、B、C3组,各12只。A组行右膝内侧半月板连同胫骨平台骨软骨移植,克氏针交叉固定骨块。B组行右膝内侧半月板移植,左膝内侧半月板取出制备新鲜冷冻半月板。C组行左膝内侧新鲜冷冻半月板移植。术后4、8、12周分批取材行大体观察、组织学检查和胫骨平台软骨氨基己糖(GAG)测定。结果:12周时A组移植胫骨平台软骨与B、C组半月板移植术后的内侧胫骨平台软骨氨基己糖含量差异无统计学意义;A、B组移植的半月板纤维软骨细胞数差异无统计学意义;A组半月板移植的纤维软骨细胞数多于C组。结论:新鲜同种异体半月板骨软骨联合移植能修复胫骨平台毁损伤。     

胫骨内侧高位楔形截骨治疗膝关节骨性关节炎

目的　探讨胫骨内侧高位楔形截骨治疗伴有膝内翻畸形的膝关节骨性关节炎的疗效。方法　对 1996年 7月～ 1999年 9月 ,采用胫骨内侧高位楔形截骨结合髂骨植骨钢板内固定术治疗 19例 (2 6膝 )膝关节骨性关节炎伴膝内翻畸形 ,病程 1～ 2 4年 ,平均 6 .3年 ,按 Ahlback分类 度 10膝 , 度 9膝 , 度 6膝 , 度 1膝。患者术前、术后 8周和术后 2年进行患肢全长 X线片检查 ,测量胫股角、胫骨角、股骨角、胫股关节面切线夹角及胫股内侧关节间距大小。按膝关节功能评定标准 ,评定术后膝关节功能恢复情况。　结果　 19例 (2 6膝 )术后获随访 2 4～ 4 5个月 ;术后 2年随访膝关节功能自 (4 8.6± 16 .6 )分增至 (81.7± 14 .8)分 ,胫股内侧关节间距自 (2 .2± 1.6 ) mm增至 (4 .9± 1.5 ) mm,胫股关节面切线夹角自 7.4°± 3.1°减少至 1.7°± 3.1°。植骨愈合满意 ,无膝内翻复发。术中出现关节内骨折 1例 ;皮肤感染 2例。结论　胫骨内侧高位楔形截骨结合植骨钢板内固定 ,可作为治疗伴有膝内翻畸形的膝关节骨性关节炎的有效方法之一。     

内侧撑开和外侧闭合胫骨高位截骨术治疗膝内翻骨关节炎

目的 比较两种胫骨高位截骨术的手术方法和临床结果.方法 膝内翻骨关节炎患者68例,其中37例采用外侧闭合胫骨高位截骨术(closed wedge high tibial osteotomy,CWO),31例采用内侧撑开胫骨高位截骨术(open wedge high tibial osteotomy,OWO).术后摄X线片测量胫骨平台后倾角、髌骨高度、胫骨股骨角、内侧胫股关节间隙宽度,并行HSS和Lysholm功能评分.结果 患者均随访24个月以上.术前、术后两组HSS和Lysholm评分差异均无统计学意义.(1)CWO组术前胫骨平台后倾角8.57°±1.63°、术后5.03°±1.24°,OWO组术前8.71°±1.66°、术后10.10°±1.30°,差异均有统计学意义.(2)CWO组术前Insall-Salvati指数0.880±0.053、术后0.820±0.049,差异有统计学意义;OWO组术前0.892±0.043、术后0.897±0.042,差异无统计学意义.CWO组术前Blackburne-Peel指数0.804±0.040、术后0.801±0.339,差异无统计学意义;OWO组术前0.815±0.039、术后0.766±0.037,差异有统计学意义.(3)术后CWO组外翻8.06°±2.75°,OWO组外翻8.65°±1.46°.结论 膝内翻骨关节炎的内侧撑开和外侧闭合胫骨高位截骨术有相似的手术效果,内侧撑开截骨术截骨角度更加准确.外侧闭合胫骨高位截骨术后可出现胫骨后倾减小和髌韧带短缩,内侧撑开截骨术后易出现胫骨后倾增加和髌骨至关节线距离减小.     

单髁置换术后内侧间室关节线改变与股胫角及术后功能关系的研究

目的 :通过影像学资料测量膝关节单髁关节置换术后内侧间室关节线改变情况,研究其与术后股胫角改变之间的关系,同时研究其与术后关节功能之间的关系,探讨关节线改变的意义。方法:对2012年7月至2015年8月56例接受膝关节单髁置换术的患者进行回顾性研究。其中男21例,女35例;年龄50~82岁,平均62.3岁。BMI指数18.3~30.1,平均23.5。取前后位膝关节负重全长X线片,测量术后关节线改变值。分别测量术前术后股胫角,计算股胫角改变值。术后随访时使用膝关节HSS评分对膝关节功能进行评估。分析关节线改变与股胫角改变、术后膝关节功能的相互关系。结果:胫骨内侧间室关节面抬高(2.2±2.0)mm(-3.3~7.0 mm),股胫角改变(2.3±3.0)°(-4.5°~9.6°),胫骨内侧关节面抬高值与股胫角改变值间有显著相关性(P0.05)。术后随访12.2个月(10~16个月),关节面抬高值与术后HSS评分间无明显相关性(P0.05)。结论 :膝关节单髁置换术后内侧间室关节线的改变与股胫角的改变呈显著相关性,术中胫骨侧截骨是同时关系这两者的关键因素,关节线的改变与术后短期临床功能之间无明显相关性,这可能与单髁关节的假体设计有关。     

合并半月板损伤的胫骨平台骨折的预后分析

目的 通过对合并有半月板损伤的胫骨平台骨折与单纯胫骨平台骨折术后随访结果进行比较,分析半月板损伤对胫骨平台骨折预后及骨折对半月板愈合可能的影响. 方法回顾性分析2004年1月至2006年6月内固定治疗的胫骨平台骨折57例,其中34例为单纯胫骨平台骨折行内固定术,23例合并有半月板损伤行内固定术并术中修补.两组的膝关节功能评价采用美国特种外科医院(HSS)临床膝关节评分方案;半月板查体采用关节线压痛、Mcmurray、Apley及Thessaly等方法;X线片分析胫股角、胫骨平台内翻角和后倾角等影像学指标. 结果 57例患者平均随访15个月(6～24个月).单纯胫骨平台骨折者与合并有半月板损伤骨折者HSS评分分别为87.9和87.1分,差异无统计学意义(t=0.351,P=0.727);而后者在随访中并未发现半月板阳性体征的增加,两组在HSS评分、胫股角、胫骨平台内翻角和后倾角等影像学评估方面差异均无统计学意义(P>005). 结论合并半月板损伤的胫骨平台不影响术后膝关节功能的康复,且骨折也不会影响半月板的愈合.     

关节镜加胫骨高位截骨钢板内固定治疗内翻性膝关节骨关节炎

目的探索关节镜探查加内侧开放胫骨高位截骨Tomo Fix锁定钢板内固定治疗内翻性膝关节骨关节炎的初步临床效果。方法 2015年10月至2016年4月,北京市昌平区医院骨科共对16例(18膝)膝关节内翻畸形骨性关节炎患者。纳入标准:明确诊断是膝关节骨关节炎,膝内翻畸形,无年龄限制,术后康复依从性好;排除标准:膝关节活动性感染,有症状的外侧间室关节炎,膝外翻畸形。进行了关节镜探查、内侧开放性楔形胫骨高位截骨及Tomo Fix锁定钢板内固定手术。男性5例6膝,女性11例12膝;年龄48~82岁,平均年龄(60±16)岁。手术前后常规拍摄双膝关节负重正侧位X线片和下肢全长X线片,对手术前后股胫角(FTA)的变化和疼痛减轻程度视觉模拟评分(VAS)的改变,应用配对t检验做统计学分析,记录并发症的发生及处理。结果关节镜下见到6膝有半月板损伤,行半月板成形术;3例有软骨剥脱,行软骨修整术;2例有脱落的软骨碎片,予以清除;未行微骨折手术。随访6个月,所有患者的膝内翻畸形得到纠正。手术前后FTA(t=15.18,P0.05)和VAS评分(t=7.0,P0.05)组间差异有统计学意义;其中,FTA矫正度数7°~15°,VAS评分降低3~8分,均有明显改善。未见内固定失效的情况发生,3例患者发生皮下血肿,但是没有发生伤口感染。结论关节镜探查加内侧开放性胫骨高位截骨Tomo Fix锁定钢板内固定手术,是治疗膝关节内翻性骨关节炎的一种安全有效的治疗方法。     

内侧半月板退变性损伤的关节镜下分型

 目的 探讨内侧半月板退变性损伤的关节镜下分型及其临床意义。方法 2012年1至12月因内侧半月板退变性损伤接受关节镜手术者122例,不包括因重度滑膜炎需做滑膜切除者。男27例,女95例;年龄37~80岁,平均（61.8±8.9）岁。左膝63例,右膝59例。BMI平均（26.5±3.4） kg/m2,术前Lysholm评分（47.2±15.0）分。关节镜术中依据Outerbridge软骨损伤分级对软骨损伤进行评估,比较不同分型者（后角水平撕裂、后角根部损伤和复杂严重损伤）Ⅳ度软骨退变性损伤所累及的关节面数量及术前Lysholm评分。结果 后角水平撕裂33例,Ⅳ度软骨退变性损伤累及的关节面（1.24±1.48）个,术前Lysholm评分（52.5±14.4）分,其中疼痛评分（7.7±6.5）分;后角根部损伤16例,Ⅳ度软骨退变性损伤累及的关节面（1.13±1.26）个,术前Lysholm评分（37.5±8.4）分,其中疼痛评分（3.1±4.0）分;复杂严重损伤73例,Ⅳ度软骨退变性损伤累及的关节面平均（2.26±1.61）个,术前Lysholm评分平均（46.9±15.3）分,其中疼痛评分（6.8±5.4）分。后角根部损伤者术前Lysholm评分低于后角水平撕裂和复杂严重损伤者,差异有统计学意义;其中疼痛评分的差异也有统计学意义。后角根部损伤者Ⅳ度软骨退变性损伤累及的关节面数量与后角水平撕裂者的差异无统计学意义;均小于复杂严重损伤者,差异有统计学意义。结论 关节镜下内侧半月板退变性损伤可分为三种类型。后角根部损伤和后角水平撕裂的软骨退变性损伤相对较轻,是较早期的关节退变;其中后角根部损伤的临床症状和功能减退较为明显。复杂严重损伤的软骨退变性损伤相对较重,是较晚期的关节退变,但临床症状和功能减退却相对较轻。     

Magnetic resonance image analysis of meniscal translation and tibio‐menisco‐femoral contact in deep knee flexion

The purpose of this study was to clarify meniscal displacement and cartilage–meniscus contact behavior in a full extension position and a deep knee flexion position. We also studied whether the meniscal translation pattern correlated with the tibiofemoral cartilage contact kinematics. Magnetic resonance (MR) images were acquired at both positions for 10 subjects using a conventional MR scanner. Subjects achieved a flexion angle averaging 139° ± 3°. Both medial and lateral menisci translated posteriorly on the tibial plateau during deep knee flexion. The posterior translation of the lateral meniscus (8.2 ± 3.2 mm) was greater than the medial (3.3 ± 1.5 mm). This difference was correlated with the difference in tibiofemoral contact kinematics between medial and lateral compartments. Contact areas in deep flexion were approximately 75% those at full extension. In addition, the percentage of area in contact with menisci increased significantly due to deep flexion. Our results related to meniscal translation and tibio‐menisco‐femoral contact in deep knee flexion, in combination with information about force and pressure in the knee, may lead to a better understanding of the mechanism of meniscal degeneration and osteoarthritis associated with prolonged kneeling and squatting. © 2008 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 26:673–684, 2008     

Editorial Commentary: Combined Anterior Cruciate Ligament Reconstruction and Medial Meniscal Transplantation Improve Functional Outcomes When Properly Indicated

The anterior cruciate ligament (ACL) and medial meniscus both contribute to anteroposterior translation of the tibia. Biomechanical studies have found increased translation at both 30° and 90° when transecting the posterior horn of the medial meniscus, and clinically, medial meniscal deficiency has been shown to have a 46% increase in ACL graft strain at 90°. Medial meniscal deficiency is a risk factor for failure after ACL reconstruction, with a hazard ratio of 15.1. The combination of meniscal allograft transplantation and ACL reconstruction is technically demanding but results in mid- to long-term clinical improvement in well-indicated patients. Patients with medial meniscal deficiency and failed ACL reconstruction or with ACL deficiency and medial-sided knee pain due to meniscal deficiency are candidates for combined procedures. On the basis of our experience, acute meniscal injury is not an indication for primary meniscal transplantation in any setting. Surgeons should repair the meniscus if reparable or perform partial meniscectomy and see how the patient responds. There is insufficient evidence to show that early meniscal transplantation will be chondroprotective. We reserve this procedure for the indications previously described. Severe osteoarthritis (Kellgren-Lawrence grades III and IV) and Outerbridge grade IV focal chondral defects of the tibiofemoral compartment that are not amenable to cartilage repair are absolute contraindications to the combined procedure.     

Tensile forces at the porcine anterior meniscal horn attachment

Tibiofemoral compression causes circumferential tension in the knee meniscus, which is transferred to the tibial bone at the anterior and posterior attachments. The objective of the study was to measure the resulting tensile forces at the horn attachment in a porcine model. The anterior horn attachment of the porcine medial meniscus (n = 10) was separated from the surrounding bone with a core reamer. A force transducer was installed such that tensile forces acting upon the now mobile horn attachment could be measured. The tibiofemoral joint was loaded in compression, starting at a preload of 30 N, with three 150‐N increments, giving 180, 330, and 480 N load. Flexion angles of 0, 30, and 60° were investigated. The average resultant tension at the horn attachment was 26.3, 40.6, and 55.4 N with full extension, 29.2, 47.8, and 62.2 N at 30° flexion and 30.1, 49.6, and 68.1 N at 60° flexion. The tibiofemoral compression had a significant effect on the tension (p < 0.001), whereas no influence of the flexion angle was found (p = 0.291). The study demonstrates that tibiofemoral compressive loads cause considerable tensile forces at the anterior meniscal horn attachment. The data are of interest for models of the repair or replacement of the knee menisci. © 2009 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 27:1619–1624, 2009     

Extrusion of the medial meniscus.

Disruption of the anchoring points of the menisci of the knee has been hypothesized to result in subluxation of the affected meniscus from the articular surface. A case report of such an extrusion of the medial meniscus is presented. Medial subluxation of the meniscus from the tibiofemoral articulation occurred as a result of avulsion of the posterior horn with concomitant medial collateral and posterior cruciate ligament injuries.     

Aggravation of Ankle Varus Incongruency Following Total Knee Replacement Correcting ≥10° of Genu Varum Deformity: A Radiographic Assessment

BackgroundThis study aimed to investigate the change in ankle varus incongruencies following total knee replacement (TKR) in patients with preoperative genu varum deformity of ≥10°.MethodsThe study cohort was composed of patients who underwent TKR in a single institution for knee osteoarthritis with preoperative genu varum deformity of ≥10° and concomitant varus ankle incongruencies. Eight radiographic measurements were evaluated preoperatively and postoperatively: mechanical tibiofemoral angle, mechanical lateral distal femoral angle, medial proximal tibial angle, lateral distal tibial angle, tibial plafond inclination, talar inclination, tibiotalar tilt angle (TTTA), and tibia-mechanical axis angle. Of these, TTTA represented the quantitative degree of ankle joint incongruency.ResultsA total of 110 patients (male = 2; female = 108) were included in the analysis. The mean patient age was 68.9 (standard deviation [SD] 7.2) years at the time of TKR. All radiographic measurements showed significant changes postoperatively, representing the appropriate correction of genu varum deformity and restoration of the mechanical axis. Nineteen patients (17.3%) showed postoperative decrease in TTTA, 2 (1.8%) remained the same, and 89 (80.9%) showed increase. Overall, mean preoperative and postoperative TTTA were 3.3° (SD 2.2°) and 4.7° (SD 2.9°), respectively (P < .001), representing the aggravation of varus ankle incongruencies.ConclusionVarus ankle incongruencies showed aggravation following TKR despite correction of genu varum deformity and restoration of the mechanical axis. This could be an important cause of postoperative increase or development of ankle pain following TKR. Therefore, patients with preoperative varus ankle incongruencies need to be warned of possible aggravation of ankle symptoms and be evaluated before TKR.Level of EvidencePrognostic level III.     

Meniscal Root Tears

Meniscus root tears are a specific type of meniscal injury that have gained attention over the past 5 years and have been reported to account for 10% to 21% of all meniscal tears, affecting nearly 100,000 patients annually. Meniscal root tears either are defined as an avulsion of the insertion of the meniscus attachment or complete radial tears that are located within 1 cm of the meniscus insertion. Biomechanical studies have demonstrated that meniscal root injuries interrupt the continuity of the circumferential fibers, and hence lead to failure of the normal meniscal function to convert axial loads into transverse hoop stresses. The most common presenting symptoms in meniscal root tears are posterior knee pain and joint line tenderness, especially with deep squatting.Another common symptom is a popping sound heard while participating in light activities such as ascending stairs or squatting. Magnetic resonance imaging signs of medial meniscus root tears include: (1) medial meniscal extrusion of ≥3 mm in a coronal section; (2) high signal indicating a disruption of the posterior meniscal root region in an axial view; and (3) a “ghost sign,” which is the absence of an identifiable meniscus in the sagittal plane, or increased signal replacing the normally dark meniscal tissue signal at the posterior root attachment. Active patients, regardless of age, should be referred early and considered for a meniscal root repair. Indications for a meniscal root repair include acute, traumatic root tears in patients with nearly normal or normal cartilage and chronic symptomatic root tears in young or middle-aged patients without significant preexisting osteoarthritis.Meniscal root repair has been demonstrated to have high satisfaction rates and superior outcomes to arthroscopic meniscectomy for root tears. To restore the function of the meniscus after medial meniscus root tears, a transosseous meniscal root repair technique is most commonly used. The advantage of this technique is the ability to reduce and fix the meniscal root to the broad anatomic footprint to maximize its healing potential. In addition, the transtibial tunnels may contribute to the release of biological factors that can enhance the healing of the meniscal root repair.     

Combined Injury to the ACL and Lateral Meniscus Alters the Geometry of Articular Cartilage and Meniscus Soon After Initial Trauma

Combined injury to the anterior cruciate ligament (ACL) and meniscus is associated with earlier onset and increased rates of post-traumatic osteoarthritis compared with isolated ACL injury. However, little is known about the initial changes in joint structure associated with these different types of trauma. We hypothesized that trauma to the ACL and lateral meniscus has an immediate effect on morphometry of the articular cartilage and meniscus about the entire tibial plateau that is more pronounced than an ACL tear without meniscus injury. Subjects underwent magnetic resonance imaging scanning soon after injury and prior to surgery. Those that suffered injury to the ACL and lateral meniscus underwent changes in the lateral compartment (increases in the posterior–inferior directed slopes of the articular cartilage surface, and the wedge angle of the posterior horn of the meniscus) and medial compartment (the cartilage-to-bone height decreased in the region located under the posterior horn of the meniscus, and the thickness of cartilage increased and decreased in the mid and posterior regions of the plateau, respectively). Subjects that suffered an isolated ACL tear did not undergo the same magnitude of change to these articular structures. A majority of the changes in morphometry occurred in the lateral compartment of the knee; however, change in the medial compartment of the knee with a normal appearing meniscus also occurred. Statement of clinical significance: Knee injuries that involve combined trauma to the ACL and meniscus directly affect both compartments of the knee, even if the meniscus and articular cartilage appears normal upon arthroscopic examination. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:759-767, 2020