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To introduce and evaluate the clinical results of a new arthroscopic technique for partial meniscectomy of symptomatic lateral discoid meniscus using a knife.
From March 2005 to October 2010, 60 knees of 58 patients underwent arthroscopic partial meniscectomies for lateral discoid meniscus. The average age was 28.9 years (range, 12 to 63 years), an...
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... shape of the tear in complete type lesions was horizontal cleavage in 17 knees (53.1%), flap or complex degenerated tear in 10 knees (31.2%) and radial tear in 5 knees (15.6%). Of the 28 knees that had an incomplete type lesion, 14 knees (50%) had a radial tear, 4 knees (14.3%) had a longitudinal tear and 10 knees (35.7%) had a complex degenerated tear (Table 3). Clinical results assessed using the Ikeuchi's grading system were excellent in 38 (63.3%), good in 13 (21.6%), ...Similar publications
This chapter mainly focuses on medial meniscus posterior root tear which is the point of attention nowadays because it is the common degeneration process and can lead to early-onset osteoarthritis of the knee without treatment. The biomechanics of the medial meniscus root tear is similar to total meniscectomy. Hence, early detection and diagnosis w...
Introduction. There are no studies in Mexico that describe the magnetic resonance (MR) imaging findings of meniscal tears associated with traumatic anterior cruciate ligament (ACL) injury. This study describes the MR characteristics of meniscal tears associated with different severity-based grades of acute or chronic traumatic ACL injuries in the M...
Preservation of the meniscal volume is crucial in meniscus repair. The goal of this study was to evaluate the clinical outcome of repeated intra-articular platelet-rich plasma (PRP) injections after arthroscopic repair of a traumatic meniscal tear. We retrospectively reviewed 61 primary meniscal repairs in 61 patients (PRP group: 30; non-PRP: 31) f...
Patient: Male, 32-year-old
Final Diagnosis: Iatrogenic lateral meniscal posterior root tear
Symptoms: Tenderness over the joint line of the knee along with a palpable subluxated medial meniscus
Medication:—
Clinical Procedure: Lateral meniscus root repair and medial femoral chondroplasty
Specialty: Orthopedics and Traumatology
Objective
Rare disea...
Meniscal root pathology has garnered increased attention over the past decade. Meniscal root tears are considered to essentially represent a meniscus-deficient state, which has led to a rise in the surgical fixation of this pathology. Meniscus root tears are classified as either radial tears within 1 cm of the root insertion, or a direct avulsion o...
Citations
... Although the extent of meniscal resection is determined by various factors, such as the pattern and location of tears, partial meniscectomy is generally recommended to preserve the meniscus [7,[9][10][11][12]. Many studies have reported satisfactory short-, mid-, or long-term clinical outcomes in 80-100% of patients after arthroscopic partial meniscectomy for symptomatic DLM [10,[13][14][15][16][17][18][19]. In addition, better radiological outcomes have been reported for partial meniscectomy than those for subtotal or total meniscectomy [9,10]. ...
Introduction:
The aim of this study is to evaluate mid-to-long-term clinical and radiological outcomes after an arthroscopic partial meniscectomy for symptomatic discoid lateral meniscus (DLM) in young patients and to determine whether degeneration of the residual meniscus and articular cartilage progresses during the follow-up period using magnetic resonance imaging (MRI).
Materials and methods:
We retrospectively reviewed patients aged ≤ 40 years at surgery who underwent arthroscopic partial meniscectomy for symptomatic DLM and were followed up for ≥ 5 years. Lysholm knee scores and reoperation rates were assessed as clinical outcomes. Factors that affect clinical outcomes were evaluated. Tapper-Hoover classification and femorotibial angle were used for radiological assessment. The degree of degeneration of articular cartilages and residual meniscus was evaluated using preoperative and follow-up MRIs.
Results:
A total of 73 knees (66 patients) were enrolled. The mean follow-up period was 10.0 years. The mean follow-up Lysholm knee score was 84.2 ± 14.5, and the reoperation rate was 32.9%. Follow-up Lysholm knee scores were related to duration of symptoms prior to surgery (β = - 0.129, P = 0.003) and femorotibial angle at the last follow-up (β = 1.362, P = 0.045). On simple radiographs, progression of arthritis of the lateral compartment was observed in 68.5% (49 knees). In MRI analyses, degeneration of the residual meniscus progressed in 52.9% (34 knees) (P < 0.001), and significant changes in modified Yulish scores were observed in both lateral femoral and tibial condyles (P < 0.001, both condyles).
Conclusions:
After an arthroscopic partial meniscectomy for symptomatic DLM, unfavorable clinical outcomes were shown in > 30% of the patients during a mean follow-up of 10.0 years. Clinical outcomes based on the patient-reported outcome measures were related to durations of symptoms prior to surgery and alignment at the last follow-up. In radiological and MRI assessments, progression of degeneration of articular cartilages in the lateral compartments of the knees and residual menisci was observed.
... Many authors have reported good clinical results after partial meniscectomy with or without meniscus repair over short-, mid-, and long-term follow ups 30,32,49,50,54,[56][57][58][59] (Table 1). Ahn et al. 32) reported in their study with a minimum 2-year follow-up (mean, 51 months) that arthroscopic partial meniscectomy with peripheral repair was effective for treating symptomatic discoid lateral menisci. ...
There is a greater incidence of discoid meniscus in Asian countries than in Western countries, and bilateral discoid menisci are also common. The discoid meniscus may be a congenital anomaly, and genetics or family history may play a role in the development of discoid menisci. Because the histology of discoid meniscus is different from that of normal meniscus, it is prone to tearing. Individuals with a discoid meniscus can be asymptomatic or symptomatic. Asymptomatic discoid menisci do not require treatment. However, operative treatment is necessary if there are symptoms. Total meniscectomy leads to an increased risk of osteoarthritis. Therefore, total meniscectomy is generally reserved for rare unsalvageable cases. Partial meniscectomy (saucerization) with preservation of a stable peripheral rim combined with or without peripheral repair is effective, and good short-, mid-, and long-term clinical results have been reported.
... Na druhou stranu, přestože dnes artroskopie představuje zásadní a základní metodu v diagnostice a léčení kloubních potíží, a to i v dětském věku, je v oblasti operativy diskoidního menisku, zvláště u věkově mladších dětí, některými autory připuštěna možnost otevřené meniskektomie z miniincize (6,16,21), a to především u třetího nestabilního typu. Existují i pracoviště, kde je otevřená meniskektomie doporučována jako primární metoda volby řešení tohoto problému (15). ...
Purpose of the study:
The aim of the study was to evaluate the outcomes of treatment in patients operated on in childhood for discoid meniscus, and to compare the results with those published in the relevant international literature.
Material and methods:
The group evaluated consisted of 15 patients, 10 girls and five boys, who underwent surgery for symptomatic discoid meniscus in the period from 2000 to 2010. The average age at the time of surgery was 9 years and 2 months. The diagnosis was based on the patient's history of complaints, physical examination, X-rays of the knee joint taken in two planes, and ultrasonographic and magnetic resonance imaging of the knee. Arthroscopic verification of the diagnosis was done in all patients. They all had fibular discoid meniscus classified as type 1 in six and type 2 in nine patients according to the Watanabe classification system. Type 3 (Wrisberg variant) discoid meniscus was not recorded in this group. In six (40%) patients, the discoid meniscus had a tear in it. The patients were followed up on average for 8 years and 4 months. In addition to subjective evaluation by patients, the treatment outcome was assessed using the Ikeuchi and Lysholm scoring systems.
Results:
Arthroscopic partial meniscectomy was performed in 10 patients. In five patients conversion to open surgery was necessary and partial or subtotal fibular meniscectomy was carried out by minimally invasive arthrotomy from the lateral approach. Total meniscectomy was not required in any of our patients. The average value for treatment evaluation by the patients was 2.25 on a 1-to-5 scale. The average Lysholm pre-operative score of 80.8 points increased to 95.4 points after surgery. The long-term results assessed by the Ikeuchi system were excellent in nine, good in four and satisfactory in two patients. None of the patients showed poor results and no intraoperative or post-operative complications were recorded.
Discussion:
Discoid meniscus is a painful condition affecting the knee, particularly when a tear is also present. Meniscal lesions are found intra-operatively in many symptomatic patients. The majority of international authors prefer arthroscopic management of discoid meniscus. The team of our department also support this procedure unanimously. Arthroscopy is used as the primary method with the aim of preserving the largest possible margin of the meniscus. Some literature data suggest that there are no statistically significant differences between an open and an arthroscopic procedure. Accordingly, in our patients no differences in the evaluation of treatment results were recorded. However, the advantages of minimally invasive arthroscopy for the management for discoid meniscus are beyond any doubt.
Conclusions:
The long-term results of discoid meniscus management reported in the international literature are very good. The results of long-term follow-up in our group give support to active surgical treatment. We take care to avoid total meniscectomy which often results in early development of secondary gonarthrosis.
... The ultrastructure of discoid meniscus is significantly different and the collagen fibrils are less in number and misaligned [51]. Discoid menisci cannot control the coordination of the tibiofemoral joint, absorb shock, or reduce mechanical pressure on articular cartilage; thus they quickly become worn and the incidence of tears is increased [52]. ...
The number of children and adolescents participating in sports has greatly increased in the last decades. In the USA, 25 % of girls and 50 % of boys between 8 and 16 years of age participate in sports, while in Europe up to 79 % of children participate in organized sports [1]. The age of initiation of intense training is decreasing and programs exposing children to excessive amounts of exercise increase the risk of injury [2]. This chapter
reviews acute lower limb injuries which most commonly affect young athletes, such as physeal fractures and apophyseal avulsion fractures, as well as knee, ankle, and foot injuries. Muscular injuries and acute compartment syndrome are also discussed.
... In our opinion, best results in patients treated with partial meniscectomy are also due to absence or low incidence of chondromalacia, which is more common and evident, on the other hand, in patients treated with total/subtotal meniscectomy. This evidence is supported by a work by Lee et al. (33), stating that partial meniscectomy (saucerization) had better prognosis as for movement function and pain symptoms, reducing progressive chondromalacia and ostheoartritis that is an unavoidable consequence of total/ subtotal meniscectomy. Considering clinical results, evaluated according to Ikeuchi scale, partial meniscectomy had better results than total/subtotal meniscectomy (21 excellent, 2 good, 0 average results in partial meniscectomy vs 1 excellent, 2 good, 2 average results in total/subtotal meniscectomy). ...
... 42 The therapy that is currently recommended in the case of a discoid meniscus is arthroscopic partial resection and reshaping. 43 The best results appear to be achievable when the partial resection and reshaping are completed soon after the first onset of symptoms. A root tear, which is similar to a complete radial tear, is a grave injury that leads to a complete loss of the meniscal function and therefore to the rapid development of OA; this is similar to the effects of a total meniscectomy. ...
Meniscal injuries are among the most frequent reasons for knee problems. The goal of this manuscript is to review the biomechanical relevance of the human knee’s menisci in relation to surgical indications, surgical techniques, rehabilitation, and outcomes. In order to identify the relevant literature, we performed a PubMed search for the years ranging from 1980–2013 using the following search terms: meniscus; biomechanical function; meniscectomy; meniscal repair; and clinical outcome. The meniscus helps to distribute the forces between the tibial and femoral articular cartilage layers in a load-sharing capacity. Meniscus damage or meniscectomy intuitively leads to an overloading of the cartilage and, hence, to the development of osteoarthrosis. Precise knowledge of meniscal shape and function, of the type of injury, of surgical techniques, as well as of postsurgical rehabilitative care are of decisive importance for an individually-adjusted treatment strategy. Other underlying coexisting knee pathologies also need to be considered. The diagnosis of a meniscal injury is based upon clinical history, physical examination, and imaging studies. The treatment of a meniscal lesion includes conservative, as well as operative, procedures. The goals of surgery are to reduce pain and disability, as well as to preserve meniscal function without causing additional cartilage damage. The resection of meniscal tissue should be restricted to as much as is necessary, and as little as is reasonably possible. Postoperative rehabilitation serves the purpose of improving functional deficits and pain, as well as of restoring a good range of motion and preventing secondary damage. It is the surgical therapy that dictates the aftercare, and with regards to the latter, there are clear differences between meniscectomy and meniscal repair.
... In our opinion, best results in patients treated with partial meniscectomy are also due to absence or low incidence of chondromalacia, which is more common and evident, on the other hand, in patients treated with total/subtotal meniscectomy. This evidence is supported by a work by Lee et al. (33), stating that partial meniscectomy (saucerization) had better prognosis as for movement function and pain symptoms, reducing progressive chondromalacia and ostheoartritis that is an unavoidable consequence of total/ subtotal meniscectomy. Considering clinical results, evaluated according to Ikeuchi scale, partial meniscectomy had better results than total/subtotal meniscectomy (21 excellent, 2 good, 0 average results in partial meniscectomy vs 1 excellent, 2 good, 2 average results in total/subtotal meniscectomy). ...
Objectives:
To evaluate clinical and radiographic mid-term outcomes and improvement in quality of life in pediatric patients affected by LDM and who underwent partial or total/subtotal meniscectomy.
Materials and methods:
28 patients (12 M, 16 F), mean age 8.3 years old (range: 6-13) affected by LDM with symptoms and/or meniscal tears, mean follow up: 2 years and 4 months (range: 24-52 months). Symptoms included: pain, swelling, articular block, limitation to knee extention, meniscal instability and formation of meniscal cysts. 23 patients treated with partial meniscectomy, 5 by total/subtotal meniscectomy. All of them have been clinically evaluated using the Ikeuchi scale and the POSNA questionnaire; for radiological evaluation we used the Tapper-Hoover grading scale.
Results:
Ikeuchi: In 23 patients underwent partial meniscectomy: 21 excellent and 2 good; in 5 patients underwent total/subtotal meniscectomy: 1 excellent, 2 good and 2 average. POSNA presurgical mean score: partial meniscectomy: 70 (range 66.8-73.6), total/subtotal meniscectomy: 58.7 (56.9-62.2). POSNA presurgical mean score: partial meniscectomy: 92.4 (range 88.7-98), total/subtotal meniscectomy: 81.2 (range 78.3-85.6). Tapper-Hoover: in 23 patients underwent partial meniscectomy: 17 were classified grade I, 5 grade II, 1 grade III; in 5 patients underwent total/subtotal meniscectomy: 2 were classified grade II and 3 grade III. These ones evidenced further signs of chondromalacia on articular surfaces, in the lateral area of knee joint.
Discussion:
Significant improvement in quality of life, evidenced in all patients (p = 0.048 in those underwent total/subtotal meniscectomy, p = 0.011 in those underwent partial meniscectomy), but especially in patients who underwent partial meniscectomy with absence of meniscal tears (p = 0.033), supports how important can be early diagnosis of LDM in childhood. We assert that early diagnosis and conservative treatment (partial meniscectomy) could reduce risks in development of chondromalacia, in those patients affected by LDM, because of its association with better clinical, radiographic and in quality of life mid-term results.
... In our opinion, best results in patients treated with partial meniscectomy are also due to absence or low incidence of chondromalacia, which is more common and evident, on the other hand, in patients treated with total/subtotal meniscectomy. This evidence is supported by a work by Lee et al. (33), stating that partial meniscectomy (saucerization) had better prognosis as for movement function and pain symptoms, reducing progressive chondromalacia and ostheoartritis that is an unavoidable consequence of total/ subtotal meniscectomy. Considering clinical results, evaluated according to Ikeuchi scale, partial meniscectomy had better results than total/subtotal meniscectomy (21 excellent, 2 good, 0 average results in partial meniscectomy vs 1 excellent, 2 good, 2 average results in total/subtotal meniscectomy). ...
Abstract
Objectives. To evaluate clinical and radiographic mid-term outcomes
and improvement in quality of life in pediatric patients affected
by LDM and who underwent partial or total/subtotal meniscectomy.
Materials and Methods. 28 patients (12 M, 16 F), mean age
8.3 years old (range: 6-13) affected by LDM with symptoms and/or
meniscal tears, mean follow up: 2 years and 4 months (range: 24-52
months). Symptoms included: pain, swelling, articular block, limitation
to knee extention, meniscal instability and formation of meniscal
cysts. 23 patients treated with partial meniscectomy, 5 by total/subtotal
meniscectomy. All of them have been clinically evaluated using the
Ikeuchi scale and the POSNA questionnaire; for radiological evaluation
we used the Tapper-Hoover grading scale.
Results. Ikeuchi: In 23 patients underwent partial meniscectomy:
21 excellent and 2 good; in 5 patients underwent total/subtotal meniscectomy:
1 excellent, 2 good and 2 average. POSNA presurgical
mean score: partial meniscectomy: 70 (range 66.8-73.6), total/subtotal
meniscectomy: 58.7 (56.9-62.2). POSNA presurgical mean score: partial
meniscectomy: 92.4 (range 88.7-98), total/subtotal meniscectomy:
81.2 (range 78.3-85.6). Tapper-Hoover: in 23 patients underwent partial
meniscectomy: 17 were classified grade I, 5 grade II, 1 grade III; in 5
patients underwent total/subtotal meniscectomy: 2 were classified grade
II and 3 grade III. These ones evidenced further signs of chondromalacia
on articular surfaces, in the lateral area of knee joint.
Discussion. Significant improvement in quality of life, evidenced in
all patients (p = 0.048 in those underwent total/subtotal meniscectomy,
p = 0.011 in those underwent partial meniscectomy), but especially in
patients who underwent partial meniscectomy with absence of meniscal
tears (p = 0.033), supports how important can be early diagnosis
of LDM in childhood. We assert that early diagnosis and conservative
treatment (partial meniscectomy) could reduce risks in development
of chondromalacia, in those patients affected by LDM, because of
its association with better clinical, radiographic and in quality of life
mid-term results. Clin Ter 2013; 164(5):e359-364. doi: 10.7417/
CT.2013.1613
Key words: arthroscopy, chondromalacia, early diagnosis, lateral
discoid meniscus, partial meniscectomy, total/subtotal meniscectomy
This study aims to examine the relationship between entrepreneurial mentality and social and regulatory environmental resources. Data was obtained using self-report analysis. Using a sample of 276 graduating and post-graduating students, the partial least squares method is used to examine the hypotheses. The findings indicate that the perceived worth of social-economic resources and entrepreneurial mindsets have a favorable indirect link. The study enhances its portion as an element that should be taken into contemplation to extend teaching programs for entrepreneurship and will support the developing research of entrepreneurship teaching in the entrepreneurship pitch. It is important for business and economic development that entrepreneurship education should be offered to the students. Although previous studies discover entrepreneurship learning others claim unfavorable outcomes and advise taking social and economic factors into account in order to have a major impact on entrepreneurial inclination.
