Search Results (65)

Background and Objectives: The relationship between posterior tibial slope (PTS) and isolated meniscal injuries remains a topic of debate. This study aimed to investigate whether an increased PTS was associated with a higher risk of isolated meniscal tears, using a case-control design with propensity score matching to minimize confounding factors. Materials and Methods: A retrospective case-control study was conducted at a University Hospital. A total of 294 patients who underwent arthroscopic surgery for meniscal injuries were compared to a matched control group without documented knee pathology. Two independent observers measured PTS on standardized lateral knee radiographs and assessed inter- and intra-rater reliability. Propensity score matching was performed to control for potential confounders. Statistical analysis included logistic regression to evaluate the association between PTS and isolated meniscal injuries. Results: A significantly increased mean PTS was observed in patients with isolated meniscal injuries compared to controls (p < 0.05). However, PTS was not significantly associated with the specific location of meniscal tears. Inter- and intra-rater reliability for PTS measurements was excellent (intraclass correlation coefficient > 0.75). Conclusions: An increased posterior tibial slope was associated with a higher risk of meniscal injury, even in the absence of ACL rupture. However, no significant association was found between PTS and specific tear patterns or locations. These findings support the role of posterior tibial slope as an independent anatomical risk factor for meniscal damage and underscore the importance of its early identification in clinical risk assessment and prevention strategies. Full article

Background/Objectives: This is the first study to examine age-related patterns of meniscal/chondral lesions in women undergoing first-time knee arthroscopy. Methods: We analyzed meniscal tear type/location and evaluated cartilage damage in femoral condyles and the tibial plateau in a medium-sized Romanian cohort (n = 241). Results: Age was associated significantly (p ≤ 0.004) with medial meniscal damage (O.R. = 1.04, 95% CI: 1.01–1.06), medial femoral condyle chondropathy (O.R. = 1.06, 95% CI: 1.03–1.10), and medial tibial plateau chondropathy (O.R. = 1.07, 95% CI: 1.02–1.12). Medial meniscus tear patterns differed significantly between age groups (p < 0.001, Cramér’s V = 0.32). Bucket-handle tears—the most common tear type—peaked in middle age (p < 0.001, Cramér’s V = 0.30). The two menisci showed different distributions of tear patterns in women aged ≥40 years (p ≤ 0.023, Cramér’s V ≤ 0.41). Meniscal tears most commonly involved the posterior third. The distribution of tear sites in menisci (medial vs. lateral) varied significantly in women aged 40–59 years (p = 0.020, Cramér’s V = 0.28). The medial femoral condyle and medial tibial plateau showed significant intergroup differences in ICRS scores (p ≤ 0.024, Cramér’s V ≤ 0.34). The frequency of ICRS grade 4 cartilage lesions increased markedly in the 40–59 age group at both sites, continuing to rise in older patients for the medial tibial plateau. Conclusions: Knee pathology in women worsens with age, especially in the medial compartment. Early screening (intervention) in middle-aged women may help prevent advanced joint damage. Full article

Background: Despite advances in repair techniques, the failure rates of meniscal surgery are still high. The seven most common tear types—horizontal cleavage tears (HCTs), radial tears (RTs), meniscal ramp lesions (MRLs), meniscal root tears (MRTs), longitudinal tears (LTs), bucket-handle tears (BHMTs), and complex meniscal tears (CMTs)—were reviewed. The present retrospective observational study aimed to analyze their characteristics, incidence, treatment approach and failure rates of a consecutive cohort of patients undergoing meniscal arthroscopic repair. Methods: The database of a high-volume meniscal suture center was examined for lesions managed by all-inside, inside-out, outside-in, or transtibial pull-out techniques from January 2018 to September 2022. Demographic (gender, age at surgery, laterality of the affected knee) and intraoperative data (tear type/site, repair technique, and suture number/combination) were collected in order to calculate the failure rates of the cohort and of each tear type and suture technique. Results: Altogether, 636 procedures met our criteria of having at least a 2-year follow-up. The overall failure rate was 1.98%. The most frequent lesions were HCTs (41.98%), with most injuries being in the body/posterior horn (88.52%) of the right knee (56.92%). Treatment predominantly (92.50%) included all-inside sutures. All-inside repair had the highest failure rate (2.98%), followed by inside-out (1.56%) repair (p = 1.0), whereas outside-in and pull-out techniques never failed. Failure rates by lesion included BHMTs (7.27%), HCTs (2.25%), CMTs (1.49%), and LTs (1.25%); RMT, RML, and MRT repair were always successful. Conclusions: Findings at two years suggest that 1–3 all-inside sutures minimize MRL failure, whereas three or more all-inside sutures or combined techniques seem to be effective for HCTs, LTs, and RTs but not BHMTs. Pull-out repair worked best for complete tears/avulsion types of MRTs, whereas all-inside sutures effectively managed partial lesions. Results for CMTs were inconclusive. Full article

Orthopedics is undergoing a transformative shift driven by personalized medical technologies that enhance precision, efficiency, and patient outcomes. Virtual surgical planning, robotic assistance, and real-time 3D navigation have revolutionized procedures like total knee arthroplasty and hip replacement, offering unparalleled accuracy and reducing recovery times. Integrating artificial intelligence, advanced imaging, and 3D-printed patient-specific implants further elevates surgical precision, minimizes intraoperative complications, and supports individualized care. In sports orthopedics, wearable sensors and motion analysis technologies are revolutionizing diagnostics, injury prevention, and rehabilitation, enabling real-time decision-making and improved patient safety. Health-tracking devices are advancing recovery and supporting preventative care, transforming athletic performance management. Concurrently, breakthroughs in biologics, biomaterials, and bioprinting are reshaping treatments for cartilage defects, ligament injuries, osteoporosis, and meniscal damage. These innovations are poised to establish new benchmarks for regenerative medicine in orthopedics. By combining cutting-edge technologies with interdisciplinary collaboration, the field is redefining surgical standards, optimizing patient care, and paving the way for a highly personalized and efficient future. Full article

Background and Objectives: Although gender and age are high-profile risk factors for meniscal injuries, their interplay is not yet fully understood. Little information is available about patients undergoing first-time meniscus surgery and the epidemiology of meniscus tears in Eastern Europe. This study investigated sex- and age-related trends in meniscal injuries (medial and/or lateral, with or without co-occurring knee chondropathy) in a substantial cohort of patients undergoing first-time meniscus surgery at a high-volume medical center in western Romania. Materials and Methods: This retrospective study included 488 patients of different ages. Logistic regression was applied across the age continuum, followed by analyses stratified by age quartiles to investigate age-related variations. Results: Increasing age was significantly associated with increased odds of having medial meniscus tears (O.R. = 1.04 (1.01–1.07)) and associated knee chondropathy (O.R. = 1.03 (1.00–1.05)). Women displayed significant, twofold lower odds of having lateral meniscus damage (O.R. = 0.54 (0.31–0.96)). Men tended to have a higher prevalence of associated knee chondropathy (O.R. = 1.71 (0.96–3.04)). The frequency of medial meniscus tears and patellar damage rose significantly, starting from the third age quartile (33–42 years) and the second quartile (23–32 years), respectively. Significant positive associations between medial and lateral meniscal damage were found across all age quartiles (r_s ≥ 0.42), with their magnitude increasing with age. Medial damage also correlated significantly with patellar damage, but weaker and only from the third quartile onward (r_s ≥ 0.30). Conclusions: Increasing age was linked to a higher risk of medial meniscal injuries and knee chondropathy, with the latter tending to occur earlier. Male sex was associated with a higher likelihood of lateral meniscal damage. These findings highlight the importance of considering age and sex in the diagnosis and management of meniscal injuries and provide valuable data for an Eastern European population. Full article

Background and Objectives: Knee joint injuries incur substantial healthcare and socioeconomic burdens worldwide. The connection between various demographic and clinical factors and meniscal injury patterns in patients undergoing surgery for meniscal rupture remains underexplored, especially in Eastern European cohorts. This study aimed to determine the influence of age, sex, and history of previous meniscal rupture on the patterns and types of knee joint injuries in adults aged 35 years and older undergoing surgery. Materials and Methods: A single-site exploratory retrospective analysis was conducted on 420 Romanian patients. The age of 35 years was selected as a cut-off for recruiting patients, as it marks the typical age at which early degenerative changes in the musculoskeletal system begin to emerge. Nonparametric/frequency analysis was applied to datasets stratified based on injury type—medial meniscal damage (MMD), lateral meniscal damage (LMD), and any patellar damage (APD). Logistic regression was used to determine influential predictors, including age, sex, and history of meniscal rupture. Results: Surgery was performed at a significantly younger age in patients with previous meniscus rupture (p < 0.001), but at a significantly older age in patients with co-occurring patellar lesions (p = 0.048). Men tended to be younger at the time of first surgery or any reoperations (p = 0.054) and displayed LMD significantly more often than MMD (p = 0.023). Significant differences existed in the distribution of different tear types in LMD (p < 0.001) and MMD (p < 0.001), with bucket handle tears and parrot beak tears being the most common. Male sex was associated with significantly higher odds of LMD (p = 0.046). Patients with previous meniscal rupture had a significantly and approximately threefold higher likelihood of presenting with MMD (p = 0.003). Conclusions: Age, sex, and history of meniscal rupture significantly influence the patterns and prevalence of knee injuries in adults aged 35 years and older. These findings reveal a dynamic interplay between demographic factors and knee joint pathologies, providing a foundation for targeted prevention and treatment strategies. Future studies should expand to larger, diverse populations to refine these insights. Full article

Orthopedic soft tissue injuries, such as those to the fibrocartilaginous meniscus in the knee, present a significant clinical challenge, impacting millions globally and often requiring surgical interventions that fail to fully restore mechanical function. Current bioengineered meniscal replacement options that incorporate synthetic and/or natural scaffolds have limitations in biomechanical performance and biological integration. This study introduces a novel scaffold fabrication approach, termed Hybrid Hydrogels Augmented via Additive Network Integration (HANI) with great potential for meniscal tissue engineering applications. HANI scaffolds combine cross-linked gelatin-based hydrogels with polycaprolactone (PCL) additive networks, created via Fused Deposition Modeling (FDM), to enhance mechanical strength and replicate the anisotropic properties of the meniscus. Custom Stereolithography (SLA)-printed molds ensure precise dimensional control and seamless incorporation of PCL networks within the hydrogel matrix. The mechanical evaluation of HANI scaffolds showed improvements in compressive stiffness, stress relaxation behavior, and load-bearing capacity, especially with circumferential and 3D PCL reinforcements, when compared to hydrogel scaffolds without additive networks. These findings highlight HANI’s potential as a cost-effective, scalable, and tunable scaffold fabrication approach for meniscal tissue engineering applications. Full article

The proper function and longevity of the knee joint are ensured by the knee menisci. Their susceptibility to damage and injury is one of the main risk factors for rapid cartilage loss and the development of osteoarthritis. The vascularization pattern and nutritional status of a torn meniscus determine its potential for healing and the success of meniscus surgery. Blood supply is a crucial factor in assessing healing potential. Knee cartilage volume loss and its modification often result from meniscal damage or excision, leading to osteoarthritis. Modern methods for preserving meniscal tissue are currently the treatment of choice. Magnetic resonance imaging (MRI) is the gold standard for assessing meniscus lesions. It provides a comprehensive evaluation of tear stability and progression risk. Additionally, it offers high sensitivity and specificity. Arthrography combined with computed tomography (CT) can be used for patients who are unable to undergo MRI. Other methods, such as X-ray and ultrasound, are not useful for the typical diagnosis of meniscal lesions. Minimally invasive surgery has become the gold standard for both treatment and diagnosis. Modern techniques, such as all-inside compression sutures and other suturing techniques, are also considered. In contrast, in the past, open total meniscectomy was routinely performed as the gold standard, based on the mistaken belief that the menisci were functionless. Currently, new treatment methods for meniscal lesions are being explored, including mesenchymal stem cells, synthetic implants, and platelet-rich plasma (PRP). The crucial role of the menisci in knee biomechanics drives the development of modern solutions focused on preserving meniscal tissue. Full article

Background: Inside-out meniscal repair is a widely adopted treatment for lateral meniscal injuries. A significant complication associated with this procedure is iatrogenic peroneal nerve (PN) injury, reported in approximately 9% of cases. The risk varies depending on the choice of surgical portals, curvature of repair devices, and anatomical landmarks. This study aimed to assess the risk of PN injury and define safe zones for inside-out lateral meniscal repair using different device curvatures and portal combinations. Methods: Axial MRI scans of knees positioned in the figure-of-four posture, with joint fluid distension and varus force applied, were analyzed in 29 adult patients. Transparent overlays representing the operative routes of the anterior-, middle-, and posterior-curved needles were superimposed on the MRI scans. Simulations of repair procedures were performed using the anteromedial, accessory anteromedial, anterolateral, and accessory anterolateral portals, targeting the medial and lateral borders of the popliteus tendon (PT). Instances where the needle path intersected or contacted the PN were recorded to delineate risk zones. Results: Repairs targeting the medial PT border with anterior-curved devices via the anteromedial or accessory anteromedial portals were identified as safe. At the lateral PT border, all device curvatures and portals were considered safe, except for middle- and posterior-curved devices used through the accessory anteromedial portal, which posed a risk of PN injury. Conclusions: The risk of iatrogenic PN injury in inside-out lateral meniscal repair depends on the curvature of the repair device and portal used. Adhering to the identified safe zones can substantially reduce this risk. Full article

The anterior cruciate ligament (ACL) is a major ligament in the knee joint, and its function is crucial for both the movement and stability of the knee. Our research takes a novel approach by investigating the effect of meniscus tears on the ACL, how such tears will impact the stress on the ACL, and its overall compensation in response to the changes in the meniscus. Hypothesis/Purpose: This study aims to investigate how the ACL compensates for the change in knee joint stability and contact pressures due to partial horizontal cleavage tears (HCTs) in the meniscus, such as partial meniscectomy and partial transplantation on knee joint stability and contact pressures. We hypothesize that HCTs will increase contact pressures and decrease joint stability, thereby inducing compensatory stress on the anterior cruciate ligament (ACL). Method: Seven freshly frozen human cadaveric knees were used in a study to investigate the effects of different meniscal conditions and surgical interventions on the meniscus itself. Four testing scenarios were established: intact knees, knees with partial horizontal cleavage tears (HCTs) of the meniscus, knees with partial meniscectomy, and knees with partial transplantation. Axial loading was applied, and the medial meniscus contact pressures were measured at 0° and 30° of flexion. Additionally, a mathematical 3D finite element model was created to evaluate the behavior of the ACL under different meniscus scenarios, which could not have been measured experimentally. Results: ACL contact pressure and stress analysis across various meniscal conditions demonstrated substantial variability. Horizontal cleavage tears (HCTs) resulted in heightened contact pressures and diminished joint stability, as evidenced by increased ACL stress attributed to compensatory mechanisms in the presence of meniscal tears. Conversely, transplantation procedures exhibited a mitigating effect, maintaining joint mechanics closer to intact conditions and minimizing alterations in ACL forces. These trends persisted at 30 degrees of knee flexion, where significant increases in ACL forces were observed in partial and complete HCT conditions. Conclusions: This study uncovers the biomechanical impacts of meniscal injuries, demonstrating how the ACL compensates for various meniscus conditions. In contrast, transplantation and repair conditions only slightly increase the stress on the ACL, putting much less strain on the ACL and supporting structures of the knee joint than an unrepaired tear. Full article

GRP78/BiP, a stress-induced protein and autoantigen in rheumatoid arthritis (RA), exhibits different expressions in various biological fluids and tissues, including blood, synovial fluid (SF), and synovium, all of which are pertinent to the disease activity and progression of RA; however, there is a scarcity of data linking both intracellular and extracellular GRP78/Bip to disease activity and progression of RA. This study was undertaken to investigate the differential expression of GRP78/Bip in blood, SF, and synovium, and to determine their association with disease activity and progression of RA. Patients with RA, osteoarthritis (OA), and traumatic meniscal injury (TMI) without radiographic OA were consecutively recruited for the study. Among patients with RA, six different subgroups were established based on their disease activity and progression. Disease activity was measured using the DAS28 (Disease activity scores in 28 joints) criterion, while disease progression was evaluated using the Steinbrocker classification grade. The levels of GRP78/Bip, TNF-α, and IL-10 were significantly elevated in the serum, SF, and synovium of patients with RA when compared to both the control (CON, TMI Patients) and the inflammation control (iCON, OA Patients) groups (p < 0.05). In terms of disease activity status, as opposed to remission status in RA, the levels of GRP78/Bip, TNF-α, and IL-10 were all elevated in serum and synovium (p < 0.05). However, GRP78/Bip and IL-10 levels were found to be reduced in SF, while TNF-α levels remained elevated. With respect to disease progression in RA, GRP78/Bip levels exhibited a positive correlation with both the stage of RA and the levels of TNF-α and IL-10 in serum and synovium. Nonetheless, a negative correlation was observed between GRP78/Bip levels and the stage of RA in SF, while positive correlations with the levels of TNF-α and IL-10 persisted. The differential expression of GRP78/Bip in blood, SF, and synovium indicated that the potential role and function of GRP78/Bip might vary depending on its specific location within these biological fluids and tissues. The presence of intracellular and extracellular GRP78/Bip was associated with disease activity and progression of RA, suggesting the involvement of GRP78/Bip in the pathogenesis and development of this debilitating autoimmune disorder, as well as its potential as a biomarker for monitoring disease activity and progression of RA. Full article

The management of anterior cruciate ligament (ACL) injuries in pediatric patients presents unique challenges due to the presence of open growth plates in the proximal tibia and distal femur. Delaying ACL reconstruction until skeletal maturity may protect the physes but increases the risk of secondary injuries, such as meniscal tears and chondral damage, due to prolonged joint instability. Conversely, early surgical intervention restores knee stability but raises concerns about potential growth disturbances, including leg-length discrepancies and angular deformities. This narrative review examines current approaches to pediatric ACL management, highlighting the risks and benefits of both conservative and surgical treatments. Additionally, it explores the role of finite element modeling (FEM) as an innovative tool for pre-surgical planning. FEM offers a non-invasive method to optimize surgical techniques, minimize iatrogenic damage to growth plates, and improve patient outcomes. Despite its potential, FEM remains underutilized in clinical practice. This review underscores the need to integrate FEM into pediatric ACL care to enhance surgical precision, reduce complications, and improve long-term quality of life for young patients. By synthesizing available evidence, this review aims to provide clinicians with a comprehensive framework for decision-making and identify future directions for research in pediatric ACL reconstruction. Full article

Background/Objectives: After anterior cruciate ligament reconstruction (ACLR), a 6-month composite test is recommended during rehabilitation before the return to sport, and the influence of a meniscal tear is not known. The hypothesis was that the location and treatment of meniscus injuries could influence the results of the composite test. Methods: A retrospective single-center study was carried out of prospectively collected data involving 504 patients who performed a composite test 6 months after ACLR. Isolated ACLR was compared to ACLR with medial meniscus injuries (MM), lateral meniscus injuries (LM), and bimeniscal injuries (BM) using a composite test including a single-leg squat (SLS), a single-leg landing (SLL), a single hop for distance (SHD), a triple hop for distance (THD) and a side-hop test (Side-HT), isokinetic strength tests, and an assessment of the anterior cruciate ligament—return to sport after injury (ACL-RSI). Results: Compared with isolated ACLR, MM injury was associated with a quadricipital deficit at a velocity of 240°/s (14% ± 14% vs. 18% ± 18%, p = 0.02), hamstring deficit at 30°/s (14% ± 18% vs. 18% ± 18%, p = 0.02) and an increase in the hamstring/quadricipital ratio at 240°/s (68% ± 27% vs. 80% ± 67% p = 0.02). Furthermore, ACLR + MM or ML injuries in the operated knee generated an increase in the dynamic valgus frequency detected by the SLS, respectively (40% ± 49% vs. 51% ± 50%, p = 0. 05) and (40% ± 49% vs. 54% ± 50%, p = 0.02). Meniscal repair and meniscectomies showed no differences. Conclusions: These results show that meniscal injuries lead to muscle imbalance for MM injuries and impaired neuromuscular control for MM and LM injuries and suggest that meniscal repairs should be done. Moreover, rehabilitation must be adapted to meniscus injuries. Full article

Background: The aim of this study was to substantiate the ability of noninvasive low-field magnetic resonance imaging (lfMRI) to accurately depict meniscal lesions, thereby establishing lfMRI as a viable option for the diagnosis of meniscal pathology. Study Design: This was a prospective, controlled study. Materials and Methods: In each of 57 stifle joints, 5 predefined lfMRI sequences using a 0.25 T lfMRI were used. The scans were evaluated by an experienced surgeon (DECVS) and through external assessment by a radiologist (DECVDI). The patients were divided into two groups depending on their meniscal status after lfMRI. Dogs (Group 1; n = 33) without lfMRI evidence of medial meniscal pathology underwent TPLO, whereas concurrent craniomedial mini-arthrotomy was performed in patients with suspected meniscal lesions (Group 2; n = 24). Gait assessment was performed 6 weeks later and 6 months postoperatively. Results: Cohen’s kappa value of 0.8571 corresponds to a high level of agreement between the observers. A significant correlation was found between preoperative lameness severity and intraoperative meniscal damage (p < 0.04). The results showed a highly significant correlation between meniscal injuries on MRI and intraoperative findings (p < 0.0001). Conclusions: LfMRI appears to be a noninvasive, reliable imaging tool for the detection of medial meniscal lesions in cranial cruciate-deficient stifle joints, aiming to avoid (minimally) invasive diagnostics in healthy menisci. Full article

The anterior cruciate ligament (ACL) is crucial for knee stability and is often injured in sports, leading to significant issues like degenerative changes and meniscal tears. ACL tears are prevalent in high-school sports injuries, accounting for 50% of knee injuries in the U.S. Surgical reconstruction, often involving bone-patellar tendon-bone (BPTB) or hamstring autografts, is common, with varying success rates and complications. Emerging alternatives like the peroneus longus tendon show promise but require further comparative studies. This prospective and multicentric study included 110 patients who underwent ACL reconstruction from 2020 to 2022. Fifty-five patients received hamstring tendon autografts (Group H) and fifty-five received peroneus longus tendon autografts (Group P). Surgeries were performed by experienced surgeons using standardized techniques. Patients were evaluated using clinical tests and functional scores including the Lysholm Knee Questionnaire and IKDC-2000 at various postoperative intervals up to 24 months. Data were analyzed using SPSS with a significance level set at p < 0.05. Group H showed superior knee function preoperatively and at 24 months postoperatively compared to Group P. Group H had higher Lysholm and IKDC scores consistently throughout the study period. The anterior drawer and Lachman’s tests indicated better knee stability for Group H. Complications were comparable between groups, with specific issues related to donor site morbidity and muscle weakness observed in each. The six-strand hamstring tendon autograft (Group H) demonstrated superior functional outcomes and knee stability compared to the peroneus longus tendon autograft (Group P) for ACL reconstruction. Despite some donor site morbidity, the hamstring tendon showed better long-term recovery and fewer complications. Future studies should explore larger, multicentric cohorts and integrate regenerative medicine techniques to further enhance ACL reconstruction outcomes. Full article