Acute knee MRI and x-ray pictures.

Great video presenting x-ray and MRI examination of an acute knee injury.
All rights reserved to the Radiology Channel.

Risk Factors for Meniscectomy After Meniscal Repair.

Risk Factors for Meniscectomy After Meniscal Repair.
Lyman, S., Hidaka, C., Valdez, A., Hetsroni, I., Jung Pan, T., Do, H., Dunn, W., and Marx, R. American Journal of Sports Medicine; 41: 2772 – 2778.
http://ajs.sagepub.com/content/41/12/2772.abstract

There is lack of clear evidence indicating rate of and risk factors for meniscectomy in patients following meniscal repair. This study was conducted to investigate these factors. Data including information on nearly 10 000 patients were retrospectively analyzed.
Authors found that overall frequency of subsequent meniscectomies was 8.9%. Patients who underwent concomitant ACL surgery were less susceptible to undergo meniscectomy. In patients who had isolated meniscal repair, older age, lateral meniscus injury and being operated by surgeon with a higher annual meniscal repair volume were factors decreasing risk of subsequent meniscectomy procedure.
All rights reserved to the American Journal of Sports Medicine.

Factors predicting meniscal repair success.

Pathologic Characteristics of the Torn Human Meniscus.
Mesiha, M., Zurakowski, D., Soriano, J., Nielson, J., Zarins, B. and Murray, M. American Journal of Sports Medicine, 2007; 35: 103 – 112.
http://www.ncbi.nlm.nih.gov/pubmed/17092929

Due to its avascularity, meniscus has poor healing characteristics. Currently, surgeons opt to preserve as much meniscus tissue as possible to prevent early OA changes in the knee joint therefore one of the surgical methods to deal with this type of lesion, is meniscal repair. However, lack of information exists on patient related factors that could help identify tears at higher risk for repair failure. Cellularity of the meniscus is one of the factors that determine repair failure or success. The study was conducted to investigate whether specific patients related factors including patient age, time since injury, and tear type are related to the cellularity of torn meniscus tissue.

BJSM podcast: Acute knee examination.

Professor Mark Hutchinson shares his views on acute knee examination in this BJSM podcast. He addresses wide range of issues regarding diagnosis of acute knee involving anatomy, ACL testing, meniscus testing, patellar dislocation, neurovascular examination, timing of diagnosis, imaging, differentiation and other. Definitely worth listening if you want to improve your diagnostic skills.

Listen here 

All rights reserved to the British Journal of Sports Medicine.

Surgery versus Physical Therapy for a Meniscal Tear and Osteoarthritis.

Surgery versus Physical Therapy for a Meniscal Tear and Osteoarthritis. 
Katz, J. et al. The New England Journal of Medicine, 2013. 
http://www.nejm.org/doi/full/10.1056/NEJMoa1301408

While much attention has been recently brought to whether surgery is better than rehabilitation alone in case of ACL injury, there appears lack of research investigating the same in patients with meniscal tear and knee OA. Authors conducted this multicenter, randomized, controlled trial to check whether arthroscopic partial meniscectomy for symptomatic patients with a meniscal tear and knee osteoarthritis is better than physical therapy with an option of delayed surgery. 351 patients participated in the study. The primary outcome measure, evaluated at 6 and 12 months, was Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). 

Meniscal examination: palpation & bounce home test.

Dr Mark Hutchinson is presenting how to palpate meniscus and how to perform bounce home test. These tests are used to evaluate individuals for tears in the meniscus of the knee.
All rights reserved to BJSM videos.

Anterior Knee Laxity Increases Gapping of Posterior Horn Medial Meniscal Tears.

Anterior Knee Laxity Increases Gapping of Posterior Horn Medial Meniscal Tears.
Dürselen, L., Vögele, S., Seitz, A., Ignatius, A., Friederich, N., Bauer, G. and Majewski, M. American Journal of Sports Medicine, 2011; 39: 1749-1755. 
http://www.ncbi.nlm.nih.gov/pubmed/21550989

Meniscal lesions are commonly associated with ACL tears. Lack of appropriate surgical and/or conservative treatment after ACL rupture, may lead to meniscal tears, especially in chronic conditions. Despite this, there is some evidence that ACL-deficient knees might be dynamically stable. However, inconsistency exists in which kind of knee motion or knee loading may place increased stress and loading on the meniscus/meniscal repair site. The main purpose of this study was to test the effect of different knee joint motion and loading conditions on the gapping behavior of longitudinal posterior horn meniscal tears in stable and ACL-deficient knee joints.

Effect of functional rehabilitation after meniscectomy.

Effects of functional exercise training on performance and muscle strength after meniscectomy: a randomized trial. 
Ericsson, Y., Dahlberg, L. and Roos,  E. Scandinavian Journal of Medicine and Science in Sports; 2009: 19, 156 – 165. 
http://www.ncbi.nlm.nih.gov/pubmed/18397193

Meniscectomy is one of the most commonly used surgical procedures in case of degenerative meniscal tears. Despite it is considered that one will fully recover within 3 months after meniscectomy, knee symptoms and functional limitations are reported by a lot of patients, years after the procedure. It can be due to impairment of the sensorimotor control associated with meniscal tear and/or removal. Rehabilitation programs focusing on functional exercises and neuromuscular training have been designed to counteract these changes. Due to lack of evidence, this study was conducted to examine the effect of functional exercise training on functional performance and isokinetic thigh muscle strength in middle-aged patients subsequent to meniscectomy for a degenerative tear.

Meniscal examination: McMurray test.

Dr Mark Hutchinson is presenting how to perform the McMurray test. The test is used to evaluate individuals for tears in the meniscus of the knee and along with the Apley's test, seems to be most commonly used in the clinical settings. Recent research findings suggest moderate sensitivity and high specificity of the test.
All rights reserved to BJSM videos.

Meniscal examination: Apley's Test.

Dr Mark Hutchinson is presenting how to perform the Apley's test. The Apley's test is an orthopedic test used for examining both meniscus in the knee for patients where there is a suspicion of a meniscal lesion.
All rights reserved to BJSM videos.

Factors which increase the risk of meniscus/cartilage lesions after ACL tear.

Are Meniscus and Cartilage Injuries Related to Time to Anterior Cruciate Ligament Reconstruction? 
Chhadia, A., Inacio, M., Maletis, G., Csintalan, R., Davis, B., Funahashi, T. American Journal of Sports Medicine, 2011, 39; 1894 – 1899.
http://www.ncbi.nlm.nih.gov/pubmed/21705649

ACL rupture results in knee instability which places articular structures, like meniscus and cartilage, at increased injury risk. It can be avoided with ACL reconstruction surgery which restores knee stability and allows subject to return to high-demand activities. Meniscus and cartilage lesions may occur at the time of ACL tear or may occur due to present instability (giving – way) episodes. This could indicate that late ACL reconstruction might be associated with increased amount of meniscal and/or cartilage lesions. However, research is somehow inconsistent. Therefore, authors decided to conduct this study with purpose of determining relationships between time to surgery, age, and gender with meniscus injury, cartilage injury, and combined meniscus and cartilage injury pattern.

Andrew Dawson on proprioception.

Andrew Dawson, a performance artist, presents an experience of one man's loss of proprioception. This is an interesting view, also relevant to knee joint as proprioception, by no means, plays a crucial role in knee functionality and knee injury prevention. 
All rights reserved to Andrew Dawson.

How runners might prevent overuse knee injuries?!

Knee joint biomechanics after meniscal tear and meniscectomy

Finite element analysis of the effect of meniscal tears and meniscectomies on human knee biomechanics.

Pena E, Calvo B, Martinez M, Palanca D, Doblare M. Clinical Biomechanics, 2005; 20, 498 – 507.

http://www.ncbi.nlm.nih.gov/pubmed/15836937

Previous post focused on the relationship between knee joint position sense and meniscal transplantation. There is a suggestion in the literature that knee proprioception is affected by meniscectomy or meniscal tears and meniscus transplantation seems to restore knee proprioceptive sensibility. This post is going to describe and analyze effect of meniscectomy and meniscal tear on knee joint biomechanics. 

Knee proprioception after meniscal transplantation.

A prospective study on knee proprioception after meniscal allograft transplantation.

Thijs Y, Witrouv E, Evens B, Coorevits P, Almqwist F, Verdonk R. Scandynavian Journal of Medicine&Science in Sport, 2007; 17, 223 – 229.

http://www.ncbi.nlm.nih.gov/pubmed/16787443

Knee menisci act to disperse the weight of the body and to reduce friction between femur and tibia during movement. It also functions as a knee joint stabilizer, mechanical and proprioceptive since three types of mechanoreceptors have been identified in both of menisci horns at the beginning of 90’. Previous research has shown proprioception deterioration in meniscectomised knee as well as in the knee with torn meniscus. Lack of papers had existed on knee joint proprioceptive ability after meniscal transplantation therefore authors prospectively assessed knee joint position sense before and after meniscus replacement.