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.

Cartilage repair rehabilitation guidelines.

Dr Karen Hambly from the University of Kent shares her opinion on rehabilitation guidelines following knee cartilage repair in soccer players. The presentation was given at the 2012 Football Medicine Strategies for Knee Injuries Conference in London.

All rights resevered to the isokineticbologna.

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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). 

BJSM Podcast: Professor Richard Frobell on his ACL study.

For those who got their ACL ruptured and consider to try rehabiliation rather than early reconstruction, in these three parts BJSM podcast, Professor Richard Frobell from the Lund University, discusses his RCT ACL study comparing early reconstrcution vs rehabilitation at 5 years follow - up. 
Part 1
Part 2
Part 3
More on this study you will find here .

All rights reserved to British Journal of Sports Medicine and British Journal of Medicine.

ACL rupture: reconstruction vs. rehabilitation at 5 years.

Treatment for acute anterior cruciate ligament tear: five year outcome of randomised trial. 
Frobell, R., Roos, H., Roos, E., Roemer, F., Ranstam, J. and Lohmander, S. British Medical Journal; 2013; 346, 1 – 12.
http://www.bmj.com/content/346/bmj.f232

No consensus exists in the literature in regards to ACL rupture treatment. Generally held opinion advocates ACL reconstruction as a first – line treatment approach in young active adults. Reason for that is to prevent further damage to the menisci and cartilage and in result early OA onset. On the other hand, no evidence is present to support that notion. In addition, more research findings prove that ACL reconstruction is no better treatment than rehabilitation in regards to early OA development. Lack high quality research is present though. To fill that gap, authors conducted this randomised trial to compare 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.

ACL rupture - Conservative vs Surgical at 10-year follow up.

Ten year follow-up study comparing conservative versus operative treatment of anterior cruciate ligament ruptures. A matched-pair analysis of high level athletes. 
Meuffels, D., Favejee, M., Vissers, M.,  Heijboer, P.,  Reijman, M., Verhaar, J. British Journal of Sports Medicine, 2009; 43, 347–351. 
http://bjsm.bmj.com/content/43/5/347.abstract

Treatment of ruptured ACL should focus on restoring functional knee stability and thus preventing new injuries or degenerative changes within knee joint. There is no consensus existing on whether ACL should be treated conservatively or surgically. Generally held opinion is that to recommend early reconstruction in the highly active patients and to start with a non-surgical treatment for the less active patients. ACL reconstruction is suggested to prevent from later injuries to meniscus and cartilage and hence decreasing the risk of knee OA. However, there appears to be lack of research supporting that notion. Moreover, insufficient evidence is present to show that reconstructing the ACL is better than conservative treatment. The purpose of this study was to compare conservative and surgical treatment in high level athletes who had sustained an ACL rupture.

Patient Profiling in Cartilage Regeneration.

Patient Profiling in Cartilage Regeneration. Prognostic Factors Determining Success of Treatment for Cartilage Defects.
Windt, T., Bekkers, J., Creemers, L., Dhert, W., Saris, D. American Journal of Sports Medicine; 2009, 37, 58 – 62.
www.ncbi.nlm.nih.gov/pubmed/19934438

Cartilage lesions are considered to be one of starting points for knee OA development. Cartilage injuries are usually treated with one of currently available surgical procedures. Treatment approach is usually dependent on patient’s history, patient’s expectation and preferences of the surgeon. The identification of patient characteristics that predict clinical outcome could be helpful in the development of patient-specific treatment strategies. Therefore, the aim of this study was to determine prognostic factors for knee articular cartilage lesion successful treatment.

Walking knee biomechanics after matrix - induced ACI.

Knee biomechanics during walking gait following matrix – induced autologous chondrocyte implantation.

Ebert J, Lloyd D, Ackland T, Wood D. Clinical Biomechanics, 2010; 25, 1011 – 1017.

http://www.ncbi.nlm.nih.gov/pubmed/20692745

Matrix – induced autologous chondrocyte implantation (MACI) is a two – stage procedure with an initial arthroscopic harvest of healthy cartilage, isolation and expansion of chondrocytes ex-vivo, and subsequent re-implantation of cells into the chondral defect. Literature proves its positive effect on reducing pain and improving knee function, however still little is known how it influences walking gait and normal knee biomechanics. Therefore, authors analyzed knee joint kinematics and kinetics during walking in 61 patients following MACI, in combination with either conservative or accelerated post-operative WB rehabilitation. Evaluation was performed three, six and twelve months post – surgery in both groups and two matched, healthy control groups for comparison.

Return to sport after articular cartilage repair.

Return to Sports Participation after Articular Cartilage Repair in the Knee. Scientific evidence.

Mithoefer K, Hambly K, Della Villa S, Silvers H, Mandelbaum B. American Journal of Sports Medicine; 2009, 37, 167 – 176.

http://www.ncbi.nlm.nih.gov/pubmed/19861696

Knee articular cartilage injury is a common complaint among those participating in sport, both recreationally and as professionals. Rarely occurs in isolation, most often is associated with other injuries e.g.  ACL tear, meniscal lesion. Sports medicine physician are aware that repaired cartilage requires enough quality to withstand significant stresses related with high impact sports. Current cartilage repair techniques (microfracture, osteochondral autograft transfer, osteochondral allograft transplantation and autologous chondrocyte transplantation) are successful in reducing pain and improving knee function. Nevertheless, ability to return to sports activity is the most important outcome measure for the injured athlete. Mithoefer et al. systematically reviewed available literature on return to sports activity following knee cartilage repair and tried to determine influencing factors.

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.