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Peter Verdonk - One of the best experts on this subject based on the ideXlab platform.
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Treatment options for the symptomatic post-Meniscectomy knee
Knee Surgery Sports Traumatology Arthroscopy, 2019Co-Authors: Matej Drobnič, Ersin Ercin, Joao Gamelas, Emmanuel T. Papacostas, Konrad Slynarski, Urszula Zdanowicz, Tim Spalding, Peter VerdonkAbstract:Purpose To provide a current review on the evidence for management of the symptomatic meniscus-deficient knee. Methods A literature review was performed detailing the natural history and origin of symptoms in a meniscus-deficient knee, in addition to strategies for non-surgical management, meniscus scaffolds, meniscus allograft transplantation (MAT), isolated cartilage repair, unloading osteotomies, meniscus prosthesis, and joint replacements which were revealed as treatment possibilities. Results Meniscus deficiency was recognized to lead to an early onset knee osteoarthritis (OA). A subset of patients develop post-Meniscectomy syndrome: dull and nagging pain after a short pain-free interval subsequently to Meniscectomy, which can be accompanied by transient effusions. Evidence for non-surgical management of post-Meniscectomy knee pain is lacking. Two available meniscus scaffolds, indicated for symptomatic segmental meniscus deficiency, show pain relief at mid-term follow-up, and effect on joint preservation is unclear. MAT represents a durable solution for sub/total meniscus deficiency (80% survival at 10 years), but it is still considered a temporary solution for post-Meniscectomy pain. MAT may also reduce the progression of OA. Isolated cartilage repair without a meniscus reconstruction is commonly performed, but better results were reported with preserved or reconstructed menisci. Osteotomies are used in the combination of misaligned knee and meniscus reconstruction or as pain solution for irreversible unilateral knee structural changes following a Meniscectomy. Polycarbonate-urethane medial meniscus prosthesis is currently undergoing clinical trial. Joint replacements should be limited to later stages of post-Meniscectomy OA. Conclusions Post-Meniscectomy pain syndrome and post-Meniscectomy knee OA are common findings after meniscus resection. Short-term pain relief is provided by non-surgical management, mid-term pain relief by meniscus scaffolds, and long-term relief by MAT, though each has differing indications. In later stages, osteotomies and joint replacements are indicated. Level of evidence IV.
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Treatment options for the symptomatic post-Meniscectomy knee.
Knee surgery sports traumatology arthroscopy : official journal of the ESSKA, 2019Co-Authors: Matej Drobnič, Ersin Ercin, Joao Gamelas, Emmanuel T. Papacostas, Konrad Slynarski, Urszula Zdanowicz, Tim Spalding, Peter VerdonkAbstract:To provide a current review on the evidence for management of the symptomatic meniscus-deficient knee. A literature review was performed detailing the natural history and origin of symptoms in a meniscus-deficient knee, in addition to strategies for non-surgical management, meniscus scaffolds, meniscus allograft transplantation (MAT), isolated cartilage repair, unloading osteotomies, meniscus prosthesis, and joint replacements which were revealed as treatment possibilities. Meniscus deficiency was recognized to lead to an early onset knee osteoarthritis (OA). A subset of patients develop post-Meniscectomy syndrome: dull and nagging pain after a short pain-free interval subsequently to Meniscectomy, which can be accompanied by transient effusions. Evidence for non-surgical management of post-Meniscectomy knee pain is lacking. Two available meniscus scaffolds, indicated for symptomatic segmental meniscus deficiency, show pain relief at mid-term follow-up, and effect on joint preservation is unclear. MAT represents a durable solution for sub/total meniscus deficiency (80% survival at 10 years), but it is still considered a temporary solution for post-Meniscectomy pain. MAT may also reduce the progression of OA. Isolated cartilage repair without a meniscus reconstruction is commonly performed, but better results were reported with preserved or reconstructed menisci. Osteotomies are used in the combination of misaligned knee and meniscus reconstruction or as pain solution for irreversible unilateral knee structural changes following a Meniscectomy. Polycarbonate-urethane medial meniscus prosthesis is currently undergoing clinical trial. Joint replacements should be limited to later stages of post-Meniscectomy OA. Post-Meniscectomy pain syndrome and post-Meniscectomy knee OA are common findings after meniscus resection. Short-term pain relief is provided by non-surgical management, mid-term pain relief by meniscus scaffolds, and long-term relief by MAT, though each has differing indications. In later stages, osteotomies and joint replacements are indicated. IV.
Nicholas J Giori - One of the best experts on this subject based on the ideXlab platform.
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Meniscectomy alters the dynamic deformational behavior and cumulative strain of tibial articular cartilage in knee joints subjected to cyclic loads
Osteoarthritis and Cartilage, 2008Co-Authors: Y Song, Joan M Greve, Dennis R Carter, Nicholas J GioriAbstract:Summary Objective Meniscectomy-induced osteoarthritis may be mechanically based. We asked how Meniscectomy alters time-dependent deformation of physiologically loaded articular cartilage. We hypothesized that Meniscectomy alters nominal strain in tibial articular cartilage, and that Meniscectomy affects cartilage thickness recovery following cessation of loading. Methods A cyclic load simulating normal gait was applied to four sheep knees. A custom device was used to obtain MR images of cartilage at 4.7T during cyclic loading. Articular cartilage thickness and nominal strain were measured every 2.5min during 1h of cyclic loading, and during 2.5h after cessation of loading. Results Following Meniscectomy the loaded joints rapidly developed high strain centrally and minimal strain peripherally. Maximum nominal strains after 1h of loading were about 55% in the intact knees and 72% in the meniscectomized knees. Nominal strains in the peripheral tibial cartilage were significantly reduced in the meniscectomized knees. Strain recovery was markedly prolonged in the meniscectomized knees. Conclusions With Meniscectomy, tibial articular cartilage in the central load bearing region remains chronically deformed and dehydrated, even after cessation of loading. Post-Meniscectomy osteoarthritis may be initiated in this region by direct damage to the cartilage matrix, or by altering the hydration of the tissue. In peripheral regions, reduced loading and strain may facilitate subchondral vascular invasion, and endochondral ossification. This is consistent with the central fibrillation and peripheral osteophyte formation seen in post-Meniscectomy osteoarthritis.
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articular cartilage mr imaging and thickness mapping of a loaded knee joint before and after Meniscectomy
Osteoarthritis and Cartilage, 2006Co-Authors: Y Song, Joan M Greve, Dennis R Carter, Nicholas J Giori, Seungbum KooAbstract:Summary Objective We describe a technique to axially compress a sheep knee joint in an MRI scanner and measure articular cartilage deformation. As an initial application, tibial articular cartilage deformation patterns after 2h of static loading before and after medial Meniscectomy are compared. Methods Precision was established for repeated scans and repeated segmentations. Accuracy was established by comparing to micro-CT measurements. Four sheep knees were then imaged unloaded, and while statically loaded for 2h at 1.5 times body weight before and after medial Meniscectomy. Images were obtained using a 3D gradient echo sequence in a 4.7T MRI. Corresponding 3D cartilage thickness models were created. Nominal strain patterns for the intact and meniscectomized conditions were compared. Results Coefficients of variation were all 2% or less. Root mean squared errors of MR cartilage thickness measurements averaged less than 0.09mm. Meniscectomy resulted in a 60% decrease in the contact area ( P =0.001) and a 13% increase in maximum cartilage deformation ( P =0.01). Following Meniscectomy, there were greater areas of articular cartilage experiencing abnormally high and low nominal strains. Areas of moderate nominal strain were reduced. Conclusions Medial Meniscectomy resulted in increased medial tibial cartilage nominal strains centrally and decreased strains peripherally. Areas of abnormally high nominal strain following Meniscectomy correlated with areas that are known to develop fibrillation and softening 16 weeks after medial Meniscectomy. Areas of abnormally low nominal strain correlated with areas of osteophyte formation. Studies of articular cartilage deformation may prove useful in elucidating the mechanical etiology of osteoarthritis.
Xin Tang - One of the best experts on this subject based on the ideXlab platform.
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partial Meniscectomy does not affect the biomechanics of anterior cruciate ligament reconstructed knee with a lateral posterior meniscal root tear
Knee Surgery Sports Traumatology Arthroscopy, 2020Co-Authors: Xin Tang, Brandon Marshall, Joon Ho Wang, Junjun Zhu, Monica A Linde, Patrick SmolinskiAbstract:The purpose of this study was to determine the effects of a lateral meniscus posterior root tear, partial Meniscectomy, and total Meniscectomy on knee biomechanics in the setting of anterior cruciate ligament (ACL) reconstruction. Thirteen fresh-frozen cadaver knees were tested with a robotic testing system under an 89.0-N anterior tibial load at full extension (FE), 15°, 30°, 60° and 90° of knee flexion and a simulated pivot-shift loading (7.0 Nm valgus and 5.0 Nm internal tibial rotation) at FE, 15° and 30° of knee flexion. Anterior tibial translation (ATT) and the in-situ force of ACL graft under the different loadings were measured in four knee states: (1) ACL reconstruction with intact lateral meniscus (Intact meniscus), (2) ACL reconstruction with lateral meniscal posterior root tear (Root tear), (3) ACL reconstruction with lateral posterior partial Meniscectomy (Partial Meniscectomy) and (4) ACL reconstruction with total lateral Meniscectomy (Total Meniscectomy). Under anterior tibial loading, compared with an intact meniscus, root tear significantly increased ATT at 15° and 30° of knee flexion (p < 0.05) and partial Meniscectomy had almost same increased ATT as with root tear at any knee flexion between FE and 90°. Under simulated pivot-shift loading, total Meniscectomy increased ATT compared with intact meniscus, root tear, partial Meniscectomy at FE (p < 0.05). Under anterior tibial and simulated pivot-shift loading, partial Meniscectomy has no significant effect on the stability of ACL-reconstructed knee with lateral meniscal posterior root tear, while total Meniscectomy increased laxity at less than 30° of knee flexion. Clinically, in cases of irreparable meniscal root tears or persistent pain a partial Meniscectomy can be considered in the setting of ACL reconstruction.
Matej Drobnič - One of the best experts on this subject based on the ideXlab platform.
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Treatment options for the symptomatic post-Meniscectomy knee
Knee Surgery Sports Traumatology Arthroscopy, 2019Co-Authors: Matej Drobnič, Ersin Ercin, Joao Gamelas, Emmanuel T. Papacostas, Konrad Slynarski, Urszula Zdanowicz, Tim Spalding, Peter VerdonkAbstract:Purpose To provide a current review on the evidence for management of the symptomatic meniscus-deficient knee. Methods A literature review was performed detailing the natural history and origin of symptoms in a meniscus-deficient knee, in addition to strategies for non-surgical management, meniscus scaffolds, meniscus allograft transplantation (MAT), isolated cartilage repair, unloading osteotomies, meniscus prosthesis, and joint replacements which were revealed as treatment possibilities. Results Meniscus deficiency was recognized to lead to an early onset knee osteoarthritis (OA). A subset of patients develop post-Meniscectomy syndrome: dull and nagging pain after a short pain-free interval subsequently to Meniscectomy, which can be accompanied by transient effusions. Evidence for non-surgical management of post-Meniscectomy knee pain is lacking. Two available meniscus scaffolds, indicated for symptomatic segmental meniscus deficiency, show pain relief at mid-term follow-up, and effect on joint preservation is unclear. MAT represents a durable solution for sub/total meniscus deficiency (80% survival at 10 years), but it is still considered a temporary solution for post-Meniscectomy pain. MAT may also reduce the progression of OA. Isolated cartilage repair without a meniscus reconstruction is commonly performed, but better results were reported with preserved or reconstructed menisci. Osteotomies are used in the combination of misaligned knee and meniscus reconstruction or as pain solution for irreversible unilateral knee structural changes following a Meniscectomy. Polycarbonate-urethane medial meniscus prosthesis is currently undergoing clinical trial. Joint replacements should be limited to later stages of post-Meniscectomy OA. Conclusions Post-Meniscectomy pain syndrome and post-Meniscectomy knee OA are common findings after meniscus resection. Short-term pain relief is provided by non-surgical management, mid-term pain relief by meniscus scaffolds, and long-term relief by MAT, though each has differing indications. In later stages, osteotomies and joint replacements are indicated. Level of evidence IV.
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Treatment options for the symptomatic post-Meniscectomy knee.
Knee surgery sports traumatology arthroscopy : official journal of the ESSKA, 2019Co-Authors: Matej Drobnič, Ersin Ercin, Joao Gamelas, Emmanuel T. Papacostas, Konrad Slynarski, Urszula Zdanowicz, Tim Spalding, Peter VerdonkAbstract:To provide a current review on the evidence for management of the symptomatic meniscus-deficient knee. A literature review was performed detailing the natural history and origin of symptoms in a meniscus-deficient knee, in addition to strategies for non-surgical management, meniscus scaffolds, meniscus allograft transplantation (MAT), isolated cartilage repair, unloading osteotomies, meniscus prosthesis, and joint replacements which were revealed as treatment possibilities. Meniscus deficiency was recognized to lead to an early onset knee osteoarthritis (OA). A subset of patients develop post-Meniscectomy syndrome: dull and nagging pain after a short pain-free interval subsequently to Meniscectomy, which can be accompanied by transient effusions. Evidence for non-surgical management of post-Meniscectomy knee pain is lacking. Two available meniscus scaffolds, indicated for symptomatic segmental meniscus deficiency, show pain relief at mid-term follow-up, and effect on joint preservation is unclear. MAT represents a durable solution for sub/total meniscus deficiency (80% survival at 10 years), but it is still considered a temporary solution for post-Meniscectomy pain. MAT may also reduce the progression of OA. Isolated cartilage repair without a meniscus reconstruction is commonly performed, but better results were reported with preserved or reconstructed menisci. Osteotomies are used in the combination of misaligned knee and meniscus reconstruction or as pain solution for irreversible unilateral knee structural changes following a Meniscectomy. Polycarbonate-urethane medial meniscus prosthesis is currently undergoing clinical trial. Joint replacements should be limited to later stages of post-Meniscectomy OA. Post-Meniscectomy pain syndrome and post-Meniscectomy knee OA are common findings after meniscus resection. Short-term pain relief is provided by non-surgical management, mid-term pain relief by meniscus scaffolds, and long-term relief by MAT, though each has differing indications. In later stages, osteotomies and joint replacements are indicated. IV.
Bob Baumgarten - One of the best experts on this subject based on the ideXlab platform.
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to run or not to run a post Meniscectomy qualitative risk analysis model for osteoarthritis when considering a return to recreational running
Journal of Manual & Manipulative Therapy, 2007Co-Authors: Bob BaumgartenAbstract:The increased likelihood of osteoarthritic change in the tibiofemoral joint following Meniscectomy is well documented. This awareness often leads medical practitioners to advise patients previously engaged in recreational running who have undergone Meniscectomy to cease all recreational running. This literature review examines the following questions: 1) Is there evidence to demonstrate that runners, post-Meniscectomy, incur a great enough risk for early degenerative OA to cease all running? 2) Does the literature yield risk factors for early OA that would guide a physical therapist with regard to advising the post-Meniscectomy patient contemplating a return to recreational running? Current literature related to meniscal structure and function, etiology and definition of osteoarthritis, methods for assessing osteoarthritis, relationship between running and osteoarthritis, and relationship between Meniscectomy and osteoarthritis are reviewed. This review finds that while the probability for early osteoarthritis in the post-Meniscectomy population is substantial, it is a probability and not a certainty. To help guide a physical therapist with regard to advising the patient for a safe return to running following a Meniscectomy, a qualitative risk assessment based on identified risk factors for osteoarthritis in both the running and the post-Meniscectomy populations is proposed.