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The discoid meniscus is a rare anomaly of the knee that affects mostly the lateral meniscus and is often asymptomatic. The osteochondritis dissecans is a disorder of the subchondral bone and articular cartilage and occurs frequently associated with the discoid lateral meniscus. In the present case, we showed the evolution of this association relate...
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The extent to which resection of unstable leaf should be performed in horizontal cleavage meniscus tear has not yet been elucidated. The purpose of this study was to compare the clinical outcomes of partial meniscectomy for horizontal cleavage tear of medial meniscus between complete resection of inferior leaf including the periphery up to the join...
Objective
To estimate the risk of magnetic resonance imaging (MRI)–based structural changes in knee osteoarthritis (OA) among individuals with meniscal tear and knee OA, using MRIs obtained at baseline and 18 and 60 months after randomization in a randomized controlled trial of arthroscopic partial meniscectomy (APM) versus physical therapy (PT)....
Meniscal tears are among the most common injuries in the knee, and partial as well as total meniscectomy has been advocated as the treatment for meniscal injury. Over the years, the role of the meniscus as a shock absorber, load transmitter, and secondary anterior stabilizer, along with its proprioceptive and lubrication role, has been well establi...
Aim:
The aim of our study was to assess the therapeutic effects of platelet-rich plasma (PRP) and bone marrow aspirate concentrate (BMAC) in an animal knee lesion complex associating a large osteochondral defect and meniscal defect resulted from partial meniscectomy, a clinical situation that occurs quite often in orthopedic practice.
Materials a...
Objective: The aim of this study was to evaluate the meniscal regeneration and arthritic changes after partial meniscectomy and application of either polyurethane scaffold or novel multilayer meniscal scaffold in a rabbit model.
Methods: Sixteen NewZealand rabbits were randomly divided into three groups. A reproducible 1.5-mm cylindrical defect was...
Citations
... It has been reported that 17% of patients after surgery for DLM will ultimately undergo surgery on the contralateral knee [11]. Additionally, DLM does seem to does seem to have a variable association with osteochondritis dissecans of the lateral femoral condyle [14][15][16][17][18]. ...
Purpose of Review
Discoid lateral meniscus (DLM) is a well-known meniscus variant, and comprises excess and thickened meniscal tissue, altered collagen ultrastructure, and peripheral instability. This article presents a comprehensive review on current knowledge of DLM, focusing on pathology in parallel with surgical techniques and outcomes.
Recent Findings
A paradigm shift in surgical management of DLM is taking place as knee surgeons are seeing more patients with long-term sequelae of partial lateral meniscectomy, the standard treatment for DLM for many years. Surgical treatment has evolved alongside the understanding of DLM pathology. A new classification system has been proposed and optimal surgical techniques described in recent years. This article highlights up-to-date evidence and techniques in management of both acute DLM tears and joint restoration following subtotal meniscectomy for DLM.
Summary
Surgical management of DLM must be tailored to individual pathology, which is variable within the diagnosis of DLM. We present an algorithm for management of DLM and discuss future directions for the understanding and treatment of this debilitating condition.
... La etiología de la OCD es poco comprendida, debido a los múltiples factores que parecen estar involucrados en su desarrollo (Edmonds y Polousky, 2013;Ortner, 2003;Vikatou et al., 2017). Las causas propuestas son la existencia de un componente genético hereditario que aumenta la predisposición a padecer esta patología (Padgett et al., 1995), posibles variaciones anatómicas en algunas articulaciones que provocan anormalidades en la transmisión de cargas mecánicas (Bulgheroni et al., 2017) y la isquemia del cartílago articular durante el crecimiento o la vejez de un individuo (Carlson et al., 1991;Ytrehus et al., 2004). ...
URL: http://repositorio.filo.uba.ar/handle/filodigital/16367
(Abstract below) RESUMEN:
Uno de los diversos aspectos analizados por la bioarqueología es el estudio de los patrones de actividad física en restos humanos, en particular a través del análisis de patologías degenerativas articulares y variables morfológicas óseas. La comprensión de estos patrones en cazadores-recolectores se encuentra en general restringida a poblaciones de Europa y Norteamérica, y por lo tanto es necesario generar una mayor cantidad de información para comprender la variabilidad de adaptaciones relacionadas con estrategias económicas terrestres, marítimas y mixtas. El objetivo de esta tesis es evaluar la existencia de patrones de actividad física y uso del cuerpo asociados a los modos de vida de las sociedades cazadoras-recolectoras del Holoceno tardío en Patagonia Austral mediante el análisis de variables morfológicas (i.e., cambios entésicos, asimetría bilateral de longitud de huesos largos) y patologías articulares (i.e., osteocondritis disecante) presentes en restos humanos arqueológicos. La muestra está conformada por 62 individuos adultos de ambos sexos y los resultados se evaluaron de acuerdo al sexo, la edad, el tamaño corporal, la dieta, la cronología y la procedencia geográfica de los individuos. Los resultados logrados muestran que las actividades de individuos con estrategias marítimas requirieron mayores cargas mecánicas en los miembros superiores, generadas por acciones de flexión y extensión de la mano. En contraste, los individuos con estrategias terrestres y mixtas estuvieron más expuestos a microtraumatismos articulares por estrés en el hombro y codo. Los femeninos experimentaron elevadas cargas asociadas a la flexión y extensión de la muñeca y mano en ambas extremidades, mientras que los masculinos estuvieron expuestos a cargas intensas en el hombro y codo del lado derecho. Las variaciones en la dinámica social producidas durante el periodo de contacto con los europeos afectaron la distribución de cargas en miembros superiores, posiblemente por una reducción de niveles de actividad física y/o la introducción de nuevas actividades. *ABSTRACT*: The study of physical activity patterns in human remains is one of the many topics covered by bioarchaeology, particularly when analyzing morphological bone characteristics and degenerative joint diseases. Since research on hunter-gatherer populations outside of Europe and North America has mostly been limited, additional data must be produced in order to fully understand the diversity of adaptations relating to terrestrial, maritime, and mixed economic strategies. This thesis evaluates morphological variables (i.e., entheseal changes, upper limb length asymmetry) and joint pathologies (i.e., osteochondritis dissecans) in archaeological human remains in order to assess the existence of patterns of physical activity and body use associated with the lifestyles of Late Holocene hunter-gatherer societies in Southern Patagonia. The sample consists of 62 adult individuals of both sexes, and the results were evaluated according to sex, age, body size, diet, chronology, and geographic origin of the individuals. The results show that individuals with maritime strategies required higher mechanical loads on their upper limbs, generated by hand flexion and extension actions. In contrast, individuals with terrestrial and mixed strategies were more exposed to joint microtraumas due to stress on the shoulder and elbow. Females experienced elevated loads associated with wrist and hand flexion and extension in both extremities, while males were exposed to intense loads on the right shoulder and elbow. Females experienced elevated loads associated with wrist and hand flexion and extension in both extremities, while males were exposed to intense loads on the right shoulder and elbow. The distribution of loads on the upper limbs was modified by changes in social dynamics throughout the period of contact with Europeans, presumably as a result of a decline in levels of physical activity and/or the introduction of new activities.
... Of lateral femoral condyle lesions, 33% were seen with a discoid meniscus in the affected compartment, an association described in the literature that may require concurrent or secondary arthroscopic treatment. 9,23,45 The need for realignment procedures in this population was consistent with a significant association demonstrated between mechanical axis deviation and osteochondral defect presence in the affected compartment. 28 Malalignment has been demonstrated as a risk factor for graft failure. ...
... 28 Malalignment has been demonstrated as a risk factor for graft failure. 9 Both growth modulation and realignment osteotomies, for patients with open and closed physes, respectively, may result in additional planned reoperations for elective hardware removal, as is routine practice in the pediatric population. Planned removal in this cohort also included both extra-articular and intra-articular (headless graft compression screws) hardware. ...
Background
While an excellent option for osteochondral defects in the adult knee, fresh osteochondral allograft (FOCA) in the skeletally immature adolescent knee has been infrequently studied.
Purpose
To compare radiographic and patient-reported outcomes (PROs) in skeletally mature and immature adolescents after FOCA in the knee for treatment of unsalvageable osteochondritis dissecans (OCD).
Study Design
Cohort study; Level of evidence, 3.
Methods
Included were 34 patients (37 knees) who underwent size-matched FOCA of the knee for unsalvageable OCD lesions. All patients were aged ≤19 years and had a minimum of 12 months of follow-up. Patient characteristics, lesion characteristics, reoperations, and PROs were evaluated and compared between patients with open physes (skeletally immature; n = 20) and those with closed physes (skeletally mature; n = 17). Graft failure was defined as the need for revision osteochondral grafting. Postoperative radiographs were analyzed at 1 year and the final follow-up for graft incorporation and classified as A (complete), B (≥50% healed), or C (<50% healed).
Results
The mean patient age was 15.4 years (range, 9.6-17.6 years), and the mean follow-up was 2.1 years (range, 1-5.3 years). The mean graft size was 5.0 cm ² and did not differ significantly between the study groups. Patients with open physes were younger (14.7 vs 16.2 years; P = .002) and more commonly male (80% vs 35%; P = .008). At the 1-year follow-up, 85% of immature patients and 82% of mature patients had radiographic healing grades of A or B. Patients with open physes were more likely to achieve complete radiographic union at 1 year (65% vs 15%; P = .007) and demonstrated better Knee injury and Osteoarthritis Outcome Score (KOOS) Daily Living (96.8 vs 88.5; P = .04) and KOOS Quality of Life (87.0 vs 56.8; P = .01) at the final follow-up. Complications were no different in either group, and graft failure occurred in only 1 skeletally mature patient with a trochlear lesion.
Conclusion
FOCA treatment for unsalvageable OCD in the young knee may be expected to yield excellent early results. Despite the presence of open physes and immature epiphyseal osteochondral anatomy, equivalent or improved healing and PRO scores compared with those of skeletally mature patients may be expected.
... They emphasized that meniscal stabilization was effective in the treatment of OCD. Bulgheroni et al. reported a case of OCD development after re-tear of DLM [17]. They mentioned the importance of preserving the peripheral meniscal rim. ...
Background:
The treatment strategy for osteochondritis dissecans (OCD) with discoid lateral meniscus (DLM) in adults remains unclear.
Case presentation:
A 22-year-old man presented with left knee pain after spraining his knee. Physical examination revealed lateral joint line tenderness and a positive McMurray test. Radiographic imaging showed OCD of the lateral femoral condyle classified as stage 3 on Brückl's classification. Magnetic resonance imaging showed complete DLM with anterocentral shift based on Ahn's classification and an OCD of 11 mm × 8 mm, grade 2 based on Nelson's classification. On computed tomography (CT), a demarcated fragment was observed in the lesion. Based on these findings, saucerization with meniscal repair was performed for unstable DLM. The OCD lesion presented with softening without any fissure and was diagnosed as grade 1. No surgical procedure was added. One year after surgery, the union of the fragment was confirmed on radiograph and CT. At the final follow-up five years after surgery, the Lysholm score had improved from 58 to 100 points.
Conclusions:
We experienced an adult case of stable OCD with concurrent DLM that achieved spontaneous healing after undergoing reshaping surgery for DLM, mimicking normal meniscal morphology, without additional treatment for the stable OCD lesion.
... Ha sido comúnmente estudiada en bioarqueología como un indicador asociado con la actividad física, aunque otros componentes etiológicos pueden estar involucrados (e.g. factores genéticos-hereditarios, variaciones anatómicas de las articulaciones, isquemia del cartílago durante el crecimiento o la vejez de un individuo; Bulgheroni et al. 2017;Bullough 2004;Ytrehus et al. 2007). ...
... La etiología de la OCD es poco comprendida, debido a los múltiples factores que parecen estar involucrados en su desarrollo (Edmonds y Polowsky 2013;Ortner 2003;Vikatou et al. 2017). Las causas propuestas son la existencia de un componente genético hereditario que aumenta la predisposición a padecer esta patología (Padgett et al. 1995), posibles variaciones anatómicas en algunas articulaciones que provocan anormalidades en la transmisión de cargas mecánicas (Bulgheroni et al. 2017) y la isquemia del cartílago articular durante el crecimiento o la vejez de un individuo (Carlson et al. 1991;Ytrehus et al. 2004), aunque la mayor parte de los autores sostiene que la principal causa son los microtraumas repetitivos asociados con la actividad física (Edmonds y Polousky 2013;Ytrehus et al. 2007). Estos últimos explicarían la alta prevalencia de este tipo de lesiones en atletas de alto rendimiento (Aichroth 1971;Cahill 1995;Takahara et al. 1999). ...
... Esta hipótesis podría ser sustentada a su vez por los reportes recientes que señalan que las poblaciones de Santa Cruz/Magallanes y el Norte de Tierra del Fuego habrían estado afectadas por mayores acciones mecánicas sobre la columna vertebral que en las poblaciones del Sur de Tierra del Fuego, posiblemente asociadas a la actividad física (D´angelo del Campo et al. 2017;Suby 2014b). De todas formas, no se descartan otros posibles factores como componentes genéticos hereditarios (Padgett et al. 1995), variaciones anatómicas en las articulaciones (Bulgheroni et al. 2017) o isquemia de los cartílagos articulares durante el período de crecimiento y vejez de los individuos (Carlson et al. 1991;Ytrehus et al. 2004). ...
La osteocondritis disecante (OCD) es una patología que afecta el cartílago articular y el hueso subcondral en las epífisis articulares de humanos y otros mamíferos. A pesar de que su etiología es multifactorial, la presencia de esta lesión ha sido frecuentemente atribuida a microtraumatismos reiterados por los efectos de la actividad física sobre las articulaciones afectadas. Este trabajo involucra un primer paso en el estudio de esta patología en restos humanos de Patagonia Austral, la cual no fue analizada en forma sistemática. El objetivo es analizar la variabilidad de la OCD en un conjunto de restos humanos de 26 individuos adultos pertenecientes a sociedades de cazadores-recolectores de esta región durante el Holoceno medio-tardío (ca. 5200-70 años AP) y su posible relación con la edad, el sexo, la dieta, la cronología y el geográfica de procedencia. Se discute si su expresión está vinculada con los patrones de actividad física desarrollados por los grupos, en función de las prácticas económicas llevadas a cabo. La prevalencia general observada en esta muestra (42,3%), mayor a la reportada para poblaciones actuales, sugiere que la actividad física habría desempeñado un rol importante en el desarrollo de la OCD en al menos parte de las personas afectadas.
... Ha sido comúnmente estudiada en bioarqueología como un indicador asociado con la actividad física, aunque otros componentes etiológicos pueden estar involucrados (e.g. factores genéticos-hereditarios, variaciones anatómicas de las articulaciones, isquemia del cartílago durante el crecimiento o la vejez de un individuo; Bulgheroni et al. 2017;Bullough 2004;Ytrehus et al. 2007). ...
... La etiología de la OCD es poco comprendida, debido a los múltiples factores que parecen estar involucrados en su desarrollo (Edmonds y Polowsky 2013;Ortner 2003;Vikatou et al. 2017). Las causas propuestas son la existencia de un componente genético hereditario que aumenta la predisposición a padecer esta patología (Padgett et al. 1995), posibles variaciones anatómicas en algunas articulaciones que provocan anormalidades en la transmisión de cargas mecánicas (Bulgheroni et al. 2017) y la isquemia del cartílago articular durante el crecimiento o la vejez de un individuo (Carlson et al. 1991;Ytrehus et al. 2004), aunque la mayor parte de los autores sostiene que la principal causa son los microtraumas repetitivos asociados con la actividad física (Edmonds y Polousky 2013;Ytrehus et al. 2007). Estos últimos explicarían la alta prevalencia de este tipo de lesiones en atletas de alto rendimiento (Aichroth 1971;Cahill 1995;Takahara et al. 1999). ...
... Esta hipótesis podría ser sustentada a su vez por los reportes recientes que señalan que las poblaciones de Santa Cruz/Magallanes y el Norte de Tierra del Fuego habrían estado afectadas por mayores acciones mecánicas sobre la columna vertebral que en las poblaciones del Sur de Tierra del Fuego, posiblemente asociadas a la actividad física (D´angelo del Campo et al. 2017;Suby 2014b). De todas formas, no se descartan otros posibles factores como componentes genéticos hereditarios (Padgett et al. 1995), variaciones anatómicas en las articulaciones (Bulgheroni et al. 2017) o isquemia de los cartílagos articulares durante el período de crecimiento y vejez de los individuos (Carlson et al. 1991;Ytrehus et al. 2004). ...
