RESUMEN
The meniscus plays a crucial role in the proper functioning of the knee joint, and when it becomes damaged, partial removal or replacement is necessary to restore proper function. Understanding the stress and deformation of the meniscus during various movements is essential for developing effective materials for meniscus repair. However, accurately estimating the contact mechanics of the knee joint can be challenging due to its complex shape and the dynamic changes it undergoes during movement. To address this issue, the open-source software SCONE can be used to establish a kinematics model that monitors the different states of the knee joint during human motion and obtains relevant gait kinematics data. To evaluate the stress and deformation of the meniscus during normal human movement, values of different states in the movement gait can be selected for finite element analysis (FEA) of the knee joint. This analysis enables researchers to assess changes in the meniscus. To evaluate meniscus damage, it is necessary to obtain changes in its mechanical behavior during abnormal movements. This information can serve as a reference for designing and optimizing the mechanical performance of materials used in meniscus repair and replacement.
Asunto(s)
Análisis de Elementos Finitos , Marcha , Humanos , Marcha/fisiología , Fenómenos Biomecánicos , Menisco/fisiología , Menisco/fisiopatología , Articulación de la Rodilla/fisiología , Simulación por Computador , Meniscos Tibiales/fisiología , Meniscos Tibiales/fisiopatología , Modelos BiológicosRESUMEN
PURPOSE: Despite extensive literature available on the mechanical properties of knee ligaments and menisci, research on the mechanical properties of the meniscus-capsular junction (MCJ) is lacking. This study aims to investigate the biomechanical behavior of the MCJ of the medial meniscus using a tensile failure test. MATERIALS AND METHODS: Seven dissected cadaveric knees were used for biomechanical analysis. Tensile failure tests were performed using an INSTRON ElectroPuls E1000 stress system to measure stress/strain curves, maximum load at failure, elastic limit load, elongation at break, elongation at the elastic limit, and linear stiffness, were collected and analyzed. RESULTS: All ruptures occurred at the MCJ. The MCJ displayed similar mechanical properties to knee ligaments. Average values were: maximum load at failure (63.9 ± 3.2 N), yield load (52.9 N ± 2.6 N), elongation at break (2.5 mm ± 0.3 mm), elongation at the elastic limit (1.25 mm ± 0.15 mm), strain at break (47.0% ± 3.5%), strain at yield (23.2% ± 2.3%), and stiffness (56.6 ± 9. N/mm-1). CONCLUSION: The meniscus-capsular junction's mechanical properties are similar to other knee ligaments and may play a role in knee stability. The findings provide insights into the the behavior of the meniscus-capsular junction could have clinical implications for diagnosing and surgical treatment of meniscocapsular lesions.
Asunto(s)
Cadáver , Meniscos Tibiales , Humanos , Meniscos Tibiales/fisiología , Meniscos Tibiales/fisiopatología , Fenómenos Biomecánicos , Anciano , Masculino , Persona de Mediana Edad , Femenino , Resistencia a la Tracción/fisiología , Estrés Mecánico , Articulación de la Rodilla/fisiopatología , Articulación de la Rodilla/fisiología , Ligamentos Articulares/fisiología , Ligamentos Articulares/fisiopatologíaRESUMEN
PURPOSE: To evaluate the changes in contact characteristics of the tibiofemoral joint resulting from a meniscal ramp lesion in the medial meniscus. METHODS: Twelve cadaveric knees (six matched pairs) were subjected to a 600 N axial load using a custom testing jig, which allowed for knee positioning at 0°, 45°, and 90° of flexion without other constraints. The knees were randomly assigned to either a ramp lesion group (n = 6) or a posterior root lesion group (n = 6). Four testing conditions were examined: (1) intact, (2) isolated ramp lesion, (3) isolated posterior root tear of the medial meniscus, and (4) combined ramp lesion and posterior root tear of the medial meniscus. Contact characteristics were evaluated using a flexible pressure sensor, the I-Scan System. RESULTS: Peak contact pressure in isolated ramp lesions (4.15 ± 0.98 MPa, P = 0.206) showed non-significant increases compared to the intact condition (3.86 ± 1.32 MPa). Peak contact pressure in isolated posterior root tears (4.58 ± 1.70 MPa, P = 0.040) and, combined ramp and posterior root lesions (4.67 ± 1.47 MPa, P = 0.003) were significantly higher than that in the intact condition. The knee flexion position significantly affected the medial tibiofemoral joint's contact area, contact pressure, and peak contact pressure (P < 0.001 for all). CONCLUSION: Isolated ramp lesions did not significantly impact force transmission, contact area, or contact pressure. In contrast, isolated root lesions and combined ramp and posterior root tears of the medial meniscus significantly intensified the changes in contact characteristics in the medial tibiofemoral joint compared to the intact condition. LEVEL OF EVIDENCE: Level III.
Asunto(s)
Cadáver , Articulación de la Rodilla , Meniscos Tibiales , Lesiones de Menisco Tibial , Humanos , Lesiones de Menisco Tibial/fisiopatología , Lesiones de Menisco Tibial/cirugía , Fenómenos Biomecánicos , Articulación de la Rodilla/fisiopatología , Meniscos Tibiales/fisiopatología , Meniscos Tibiales/cirugía , Masculino , Lesiones del Ligamento Cruzado Anterior/fisiopatología , Lesiones del Ligamento Cruzado Anterior/cirugía , Persona de Mediana Edad , Femenino , Anciano , Soporte de Peso/fisiología , PresiónRESUMEN
INTRODUCTION: The purpose of this study was to determine how variations in lower limb alignment affect tibiofemoral joint contact biomechanics in the setting of medial meniscus posterior root tear (MMPRT) and associated root repair. METHODS: A finite-element model of an intact knee joint was developed. Limb alignments ranging from 4° valgus to 8° varus were simulated under a 1,000 N compression load applied to the femoral head. For the intact, MMPRT, and root repair conditions, the peak contact pressure (PCP), total contact area, mean and maximum local contact pressure (LCP) elevation, and total area of LCP elevation of the medial tibiofemoral compartment were quantified. RESULTS: The PCP and total contact area of the medial compartment in the intact knee increased from 2.43 MPa and 361 mm 2 at 4° valgus to 9.09 MPa and 508 mm 2 at 8° of varus. Compared with the intact state, in the MMPRT condition, medial compartment PCP was greater and the total contact area smaller for all alignment conditions. Root repair roughly restored PCPs in the medial compartment; however, this ability was compromised in knees with increasing varus alignment. Specifically, elevations in PCP relative to the intact state increased with increasing varus, as did the total contact area with LCP elevation. After root repair, medial compartment PCP remained elevated above the intact state at all degrees tested, ranging from 0.05 MPa at 4° valgus to 0.27 MPa at 8° of varus, with overall PCP values increasing from 2.48 to 9.09 MPa. For varus alignment greater than 4°, root repair failed to reduce the total contact area with LCP elevation relative to the MMPRT state. DISCUSSION: Greater PCPs and areas of LCP elevation in varus knees may reduce the clinical effectiveness of root repair in delaying or preventing the development of tibiofemoral osteoarthritis.
Asunto(s)
Análisis de Elementos Finitos , Articulación de la Rodilla , Meniscos Tibiales , Lesiones de Menisco Tibial , Humanos , Fenómenos Biomecánicos , Lesiones de Menisco Tibial/cirugía , Lesiones de Menisco Tibial/fisiopatología , Articulación de la Rodilla/fisiopatología , Articulación de la Rodilla/cirugía , Meniscos Tibiales/cirugía , Meniscos Tibiales/fisiopatología , Tibia/cirugía , Extremidad Inferior/fisiopatología , Extremidad Inferior/cirugía , Fémur/cirugía , Articulación TibiofemoralRESUMEN
BACKGROUND: Rupture of the knee menisci is a common injury that can have implications for other conditions, such as osteoarthritis. The fracture toughness of soft tissue (Jc) is a mechanical property that characterizes its resistance to tear extension. To date, Jc of the meniscus has not been quantified. METHODS: Cyclic tensile tests were conducted on meniscus samples to determine Jc and explore its characteristics. Initially, the study investigated the impact of an initial notch on the ultimate tensile stress. This allowed for an understanding of how the presence of a notch affects its structural integrity. Subsequently, Jc was measured in both the radial and circumferential directions to assess its loading direction dependency. Furthermore, the study assessed the effect of anatomical location by comparing samples collected from the femoral and tibial layers. RESULTS: Defect tolerance of the meniscus is influenced by the loading direction. In the circumferential direction, the presence of an initial notch did not affect the ultimate stress, and no crack expansion was observed. In radial samples with a notch length of 40% or more of the total width, crack propagation occurred, leading to a decrease in the ultimate stress (p< 0.01). Additionally, Jc was found to be higher in the femoral layer compared to the tibial layer (p= 0.017). CONCLUSION: The study also examined the failure patterns of the meniscus to enhance our understanding of its pathology. These insights contribute to a better comprehension of meniscus injuries and can aid in the development of more effective treatment strategies.
Asunto(s)
Meniscos Tibiales , Resistencia a la Tracción , Humanos , Resistencia a la Tracción/fisiología , Meniscos Tibiales/fisiopatología , Meniscos Tibiales/fisiología , Soporte de Peso/fisiología , Lesiones de Menisco Tibial/fisiopatología , Lesiones de Menisco Tibial/cirugía , Estrés Mecánico , Fenómenos Biomecánicos , Persona de Mediana Edad , Masculino , Cadáver , Anciano , FemeninoRESUMEN
BACKGROUND: The effects of anterior cruciate ligament (ACL) reconstruction on postoperative gait biomechanics remain controversial, and the influence of meniscus pathology on pre- and post-ACL reconstruction biomechanical changes has not yet been studied. Here, we aimed to clarify the difference in knee joint moment between pre- and post-ACL reconstruction conditions in subjects with and without meniscal pathology. METHODS: Twenty-four subjects with unilateral ACL reconstruction injuries participated in this study. A total of 13 of the subjects had concomitant meniscus injuries. Gait analysis was performed preoperatively and at 11 months postoperatively. Three-dimensional knee joint angles and moments were calculated based on motion-capture data. The total joint moment and contribution of individual moments during the stance phase were assessed. For statistical analysis, we compared pre- and postoperative alterations, and differences were assessed in subjects with and without meniscal pathology. RESULTS: Tibial rotation excursion was lower in subjects with meniscal pathology than in those with intact menisci postoperatively. An significant increase in the contribution of the knee flexion moment and a significant decrease in the contribution of the knee adduction moment postoperatively were observed in subjects with intact menisci. CONCLUSIONS: Patients with ACL injury showed different postoperative alterations in joint moments depending on the concomitant meniscal injury.
Asunto(s)
Lesiones del Ligamento Cruzado Anterior , Reconstrucción del Ligamento Cruzado Anterior , Articulación de la Rodilla , Rango del Movimiento Articular , Lesiones de Menisco Tibial , Humanos , Masculino , Femenino , Adulto , Lesiones del Ligamento Cruzado Anterior/cirugía , Lesiones del Ligamento Cruzado Anterior/fisiopatología , Lesiones de Menisco Tibial/cirugía , Lesiones de Menisco Tibial/fisiopatología , Articulación de la Rodilla/fisiopatología , Articulación de la Rodilla/cirugía , Adulto Joven , Rango del Movimiento Articular/fisiología , Fenómenos Biomecánicos , Meniscos Tibiales/cirugía , Meniscos Tibiales/fisiopatología , Marcha/fisiología , AdolescenteRESUMEN
BACKGROUND: In patients with medial knee osteoarthritis (OA), medial meniscus extrusion during gait is aggravated by mechanical stress, such as knee adduction moment (KAM). Conversely, the decrease in the range of knee rotation during stance phase is also one of the important issues in early knee OA, whereas the correlation between medial meniscus extrusion and knee rotation during gait are unclear. RESEARCH QUESTION: To investigate the correlation between increase in medial meniscus extrusion and range of knee rotation during gait in patients with early- and late-stage of knee OA. METHODS: Forty patients with medial knee OA were enrolled and divided into early- and late-OA group by Kellgren-Lawrence grading scale. During gait tasks, the extent of medial meniscus extrusion was measured using ultrasonography and kinetic/kinematic data were measured using three-dimensional motion analysis system. The correlation between medial meniscus extrusion and the range of knee rotation or KAM were evaluated in the overall, early-, and late- OA groups. RESULTS: A significant negative correlation was observed between an increase in medial meniscus extrusion and range of knee rotation angle in early-OA group only. However, an increase in medial meniscus extrusion significantly correlated with the second KAM peak in the overall and early-OA groups. SIGNIFICANCE: The decrease in range of knee rotation during stance phase may be associated with the increase in medial meniscus extrusion during gait in patients with early knee OA.
Asunto(s)
Marcha , Meniscos Tibiales , Osteoartritis de la Rodilla , Rango del Movimiento Articular , Humanos , Osteoartritis de la Rodilla/fisiopatología , Masculino , Femenino , Persona de Mediana Edad , Marcha/fisiología , Meniscos Tibiales/fisiopatología , Meniscos Tibiales/diagnóstico por imagen , Anciano , Rango del Movimiento Articular/fisiología , Fenómenos Biomecánicos , Rotación , Ultrasonografía , Articulación de la Rodilla/fisiopatologíaRESUMEN
AIMS: Knowledge of the micromechanical characteristics of the menisci is required to better understand their role within the stifle joint, improve early diagnosis of meniscal lesions, and develop new treatment and/or replacement strategies. The aim of the study was to determine the mechanical properties of the healthy medial canine meniscus and to evaluate the effect of regional (caudal, central, and cranial) and circumference (axial and abaxial) locations on these properties. METHODS: To study the micromechanical properties of the medial menisci in healthy (Beagle) dogs, the influence of regional (caudal, central, and cranial) and circumference (axial and abaxial) locations were evaluated. Nanoindentation-relaxation tests were performed to characterize the local stiffness and the viscoelastic properties at each region and specific circumference. Linear interpolation onto the indentation points was performed to establish a map of the micromechanical property heterogeneities. RESULTS: The results indicate that the cranial region was significantly stiffer and less viscous than the central and caudal regions. Within the central region the inner part (axial) was significantly stiffer than the periphery (abaxial). Within the caudal region the inner part was significantly less viscous than the periphery. CONCLUSION: Significant regional and radial variations were observed for both the stiffness and the viscoelastic properties. Moreover, a viscous behavior of the entire medial meniscus was observed (elastic fraction <0.5). These results deter the use of average elastic modulus to study the regional mechanical properties of healthy meniscus.
Asunto(s)
Perros/fisiología , Meniscos Tibiales/fisiología , Rodilla de Cuadrúpedos/fisiología , Animales , Fenómenos Biomecánicos , Meniscos Tibiales/patología , Meniscos Tibiales/fisiopatología , ViscosidadRESUMEN
The purpose of the present study was to analyze normal and degenerated menisci with Raman methodology on thin sections of formalin fixed paraffin embedding tissues and to correlate the Raman findings with the grade of meniscus degeneration. Menisci (n = 27) were removed from human knee joints after total knee replacement or meniscectomy. Following routine histopathological analysis to determine the grade of meniscal lesions obtained from healthy and degenerated formaline fixed paraffin embedded (FFPE) meniscal sections, Raman polarization approach was applied to evaluate the orientation of collagen fibrils in different levels of the same 5 µm thick FFPE meniscal tissue sections, used for histopathological assessment. We collected Raman spectra in two different polarization geometries, v-HH and v-VV, and calculated the mean value of the v-HH/v-VV intensity ratio of two Raman bands, sensitive and non-sensitive to the molecular orientation. The collagen specific amide I band at 1665 cm-1, has the higher sensitivity dependence on the Raman polarization. The mean values of ratio v-HH/v-VV of the 1665 cm-1 peak intensity was significantly higher in healthy, mean ± SD: 2.56 ± 0.46, compared to degenerated menisci, mean ± SD: 1.85 ± 0.42 (p = 0.0014). The mean values of v-HH/v-VV intensity ratio were 2.18 and 1.50 for low and high degenerated menisci, respectively (p < 0.0001). The difference of peak intensities in the two laser polarizations is decreased in the degenerated meniscus; this difference is diminishing as the degeneration increases. The v-HH/v-VV ratio was also of significant difference in low as compared to control and high grade meniscus lesions (p = 0.036 and p < 0.0001, respectively) offering valuable information for the approach of its biology and function. In the present study we showed that the 5 µm thick sections can be used for Raman analysis of meniscal tissue with great reliability, in terms of sensitivity, specificity, false-negative and false-positive results. Our data introduce the interesting hypothesis that compact portable Raman microscopy on tissue sections can be used intra-operatively for fast diagnosis and hence, accurate procedure design in the operating room.
Asunto(s)
Colágeno/química , Meniscos Tibiales/fisiopatología , Espectrometría Raman/métodos , Adulto , Anciano , Anciano de 80 o más Años , Algoritmos , Artroplastia de Reemplazo de Rodilla , Diagnóstico Diferencial , Matriz Extracelular , Reacciones Falso Positivas , Femenino , Humanos , Masculino , Meniscectomía , Menisco/cirugía , Microscopía , Persona de Mediana Edad , Ortopedia , Osteoartritis de la Rodilla/patología , Parafina/química , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
AIM: To compare and assess T1rho values of the femorotibial cartilage compartments and subregional menisci in patients with hyperuricaemia at 3 T. MATERIALS AND METHODS: Thirty-two patients were enrolled in the study and were subdivided into two subgroups: 15 healthy controls (three women, 12 men; mean age = 45.3 ± 10.9 years, age range 25-72 years) and 17 patients with asymptomatic hyperuricaemia (two women, 15 men; mean age = 44.4 ± 12.7 years, age range 26-77 years). All patients were evaluated using 3 T magnetic resonance imaging (MRI) using an eight-channel phased-array knee coil (transmit-receive). Wilcoxon's rank sum test and analysis of covariance (ANCOVA) were conducted to determine whether there were any statistically significant differences in the T1rho values of the femorotibial cartilage compartments and subregional menisci between the two subgroups. RESULTS: Lateral tibial cartilage (45.8 ± 2.9 ms) in the healthy subgroup had significantly lower (p<0.05) T1rho values than those of all subcompartments of the femorotibial cartilage in the hyperuricaemia subgroup. The lateral femoral cartilage (LF) in hyperuricaemia (54.6 ± 3.9 ms) subgroup had significantly higher (p<0.05) T1rho values than those of all subcompartments of the femorotibial cartilage except the LF in the healthy subgroup. Significantly higher (p<0.05) T1rho values existed in the LF of the healthy (54.6 ± 4.7 ms) subgroup in comparison with those of all subcompartments of femorotibial cartilage except the LF in hyperuricaemia subgroup. CONCLUSIONS: T1rho values in certain compartments of the femorotibial cartilage in patients with hyperuricaemia are elevated compared to those in healthy patients presumably due to reduced proteoglycan content, to which particular attention should be paid when diagnosing and treating the patients with hyperuricaemia in a clinical setting.
Asunto(s)
Cartílago Articular/diagnóstico por imagen , Hiperuricemia/complicaciones , Artropatías/complicaciones , Artropatías/diagnóstico por imagen , Articulación de la Rodilla/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Meniscos Tibiales/diagnóstico por imagen , Adulto , Anciano , Cartílago Articular/fisiopatología , Femenino , Humanos , Hiperuricemia/fisiopatología , Artropatías/fisiopatología , Articulación de la Rodilla/fisiopatología , Masculino , Meniscos Tibiales/fisiopatología , Persona de Mediana EdadRESUMEN
It has been suggested that mitochondrial dysfunction and mtDNA variations may contribute to osteoarthritis (OA) pathogenesis. However, the causative link to support this claim is lacking. Here, we surgically-induced OA in conplastic mice in order to evaluate the functional consequences of mtDNA haplotypes in their joint degeneration. BL/6NZB strain was developed with C57BL/6JOlaHsd nuclear genome and NZB/OlaHsdmtDNA while BL/6C57, which is the original, was developed with C57BL/6JOlaHsd nuclear genome and C57/OlaHsdmtDNA for comparison. The surgical DMM OA model was induced in both strains. Their knees were processed and examined for histopathological changes. Cartilage expression of markers of autophagy, apoptosis, oxidative stress and senescence were also analyzed by immunohistochemistry. The joints of BL/6NZB mice that were operated presented more cellularity together with a reduced OARSI histopathology score, subchondral bone, menisci score and synovitis compared to those of BL/6C57 mice. This was accompanied with higher autophagy and a lower apoptosis in the cartilage of BL/6NZB mice that were operated. Therefore, the study demonstrates the functional impact of non-pathological variants of mtDNA on OA process using a surgically-induced OA model. Conplastic (BL/6NZB ) mice develop less severe OA compared to the BL/6C57original strain. These findings demonstrate that mitochondria and mtDNA are critical targets for potential novel therapeutic approaches to treat osteoarthritis.
Asunto(s)
ADN Mitocondrial , Osteoartritis/genética , Osteoartritis/fisiopatología , Animales , Apoptosis/genética , Autofagia , Cartílago Articular/patología , Modelos Animales de Enfermedad , Masculino , Meniscos Tibiales/fisiopatología , Meniscos Tibiales/cirugía , Ratones Endogámicos C57BL , Ratones Endogámicos , Osteoartritis/etiología , Sinovitis/etiología , Sinovitis/genéticaRESUMEN
Posterior cruciate ligament (PCL) injuries commonly occur in association with participation in sporting or recreational activities or due to a direct trauma. Cartilage and meniscal lesions are prevalent in PCL-injured knees with increasing likelihood and severity based on extent and duration of trauma to the knee. As such, comprehensive diagnostics should be performed to ascertain all related pathology, and patients should be thoroughly educated regarding treatment options, likely sequelae including posttraumatic osteoarthritis, and associated outcomes. Treatments should address the joint as an organ, ensuring stability, alignment, and functional tissue restoration are optimized by the most efficient and effective means possible. Compliance with patient- and procedure-specific postoperative management protocols is critical for optimizing successful outcomes for these complex cases. The objectives of this review article are to highlight the likelihood and importance of osteochondral and meniscal pathology in the PCL-injured knee, and to provide the best current evidence regarding comprehensive evaluation and management for PCL-injured knees with cartilage and/or meniscal comorbidities.
Asunto(s)
Enfermedades de los Cartílagos , Cartílago Articular , Traumatismos de la Rodilla , Ligamento Cruzado Posterior/lesiones , Lesiones de Menisco Tibial , Algoritmos , Enfermedades de los Cartílagos/complicaciones , Enfermedades de los Cartílagos/diagnóstico , Enfermedades de los Cartílagos/fisiopatología , Enfermedades de los Cartílagos/cirugía , Cartílago Articular/lesiones , Cartílago Articular/fisiopatología , Cartílago Articular/cirugía , Humanos , Traumatismos de la Rodilla/complicaciones , Traumatismos de la Rodilla/diagnóstico , Traumatismos de la Rodilla/fisiopatología , Traumatismos de la Rodilla/cirugía , Articulación de la Rodilla/fisiopatología , Articulación de la Rodilla/cirugía , Meniscos Tibiales/fisiopatología , Meniscos Tibiales/cirugía , Osteoartritis/etiología , Ligamento Cruzado Posterior/fisiopatología , Ligamento Cruzado Posterior/cirugía , Lesiones de Menisco Tibial/diagnóstico , Lesiones de Menisco Tibial/fisiopatología , Lesiones de Menisco Tibial/cirugíaRESUMEN
The degeneration of radial tie fibres of the central meniscal layer, and thinning of its lamellar layer results in increased intensity signals on magnetic resonance imaging, making it difficult to differentiate from true meniscal tear. This study aimed to assess the rate of encountered MRI grades 1 and 2 intrasubstance meniscal changes, and to set guidelines to report these changes based on predicted clinical outcome. A systematic review approach was employed using search engines, libraries, and databases (Google Scholar, ERIC, PubMed, and Medline) to search for scholarly sources on meniscal lesions and their significance in MRI published between 1 January 2000 and 30 June 2019. It retrieved 2750 abstracts, out of which 2738 were excluded and 13 studies meeting inclusion criteria were meta-analysed. It found an association between intrasubstances meniscal changes and outcomes. It resulted that intrasubstance meniscal changes were preservable through the protective functioning of the meniscus. Other than weight gain, no other significant risk factor of developing true meniscal tears later in life was found. It is important to examine intrasubstance meniscal change when patients suffer from mechanical meniscal symptoms especially in old age.
Asunto(s)
Traumatismos de la Rodilla/fisiopatología , Meniscos Tibiales/fisiopatología , Menisco/diagnóstico por imagen , Lesiones de Menisco Tibial/fisiopatología , Anciano , Anciano de 80 o más Años , Artroscopía/métodos , Femenino , Humanos , Traumatismos de la Rodilla/diagnóstico por imagen , Traumatismos de la Rodilla/epidemiología , Imagen por Resonancia Magnética , Masculino , Meniscos Tibiales/diagnóstico por imagen , Menisco/fisiopatología , Persona de Mediana Edad , Lesiones de Menisco Tibial/diagnóstico por imagen , Lesiones de Menisco Tibial/epidemiologíaRESUMEN
OBJECTIVE: To assess whether quantitative changes in the meniscus predict progression from early knee osteoarthritis (OA) to knee replacement (KR). METHODS: A nested case-control study was conducted among Osteoarthritis Initiative participants: all 35 case knees with baseline Kellgren/Lawrence (K/L) grade ≤2 that had KR between 36 and 60 months were matched 1:1 by age, sex, and baseline K/L grade to 35 control knees without subsequent KR. Quantitative 3-dimensional medial meniscus position and morphologic measures were determined from magnetic resonance imaging at the visit just before KR and 2 years before. Paired t-tests and case-control odds ratios (ORs, standardized per SD of change in controls) were used to compare changes between groups. RESULTS: Cases (52% women, age 65 ± 7 years, body mass index [BMI] 30 ± 4 kg/m2 , K/L grades 0/1/2: 5/8/22 participants, respectively) and controls (52% women, age 64 ± 7 years, BMI 30 ± 5 kg/m2 , K/L grades 0/1/2: 9/4/22 participants, respectively) were similar. Compared to control knees, KR case knees displayed longitudinal changes, specifically, a decrease in tibial plateau coverage, an increase in meniscal extrusion, and a decrease in meniscal width. The odds for KR increased with greater reduction in the percentage of tibial plateau coverage (OR 2.28 [95% CI confidence interval (95% CI) 1.43, 3.64]), a greater increase in maximal extrusion (OR 1.40 [95% CI 1.12, 1.75]), and a greater reduction of mean meniscal width (OR 2.01 [95% CI 1.23, 3.26]). The odds for KR increased with medial compartment cartilage thickness loss (OR 2.86 [95% CI 1.51, 5.41]) for comparison. CONCLUSION: Quantitative measures of meniscal position and morphology are associated with subsequent KR in knees with rapidly progressing knee OA. These findings show that structural changes of the meniscus are related to an important clinical and economic outcome of knee OA.
Asunto(s)
Articulación de la Rodilla/diagnóstico por imagen , Imagen por Resonancia Magnética , Meniscos Tibiales/diagnóstico por imagen , Osteoartritis de la Rodilla/diagnóstico por imagen , Anciano , Artroplastia de Reemplazo de Rodilla , Fenómenos Biomecánicos , Estudios de Casos y Controles , Progresión de la Enfermedad , Femenino , Humanos , Articulación de la Rodilla/fisiopatología , Articulación de la Rodilla/cirugía , Masculino , Meniscos Tibiales/fisiopatología , Meniscos Tibiales/cirugía , Persona de Mediana Edad , Osteoartritis de la Rodilla/fisiopatología , Osteoartritis de la Rodilla/cirugía , Valor Predictivo de las Pruebas , Estudios Prospectivos , Factores de TiempoRESUMEN
PURPOSE: To compare the effect of the lateral meniscus (LM) complete radial tear at different tear sites on the load distribution and transmission functions. METHODS: A compressive load of 300 N was applied to the intact porcine knees (n = 30) at 15°, 30°, 60°, 90°, and 120° of flexion. The LM complete radial tears were created at the middle portion (group M), the posterior portion (group P), or the posterior root (group R) (n = 10, each group), and the same loading procedure was followed. Finally, the recorded three-dimensional paths were reproduced on the LM-removed knees. The peak contact pressure (contact area) in the lateral compartment and the calculated in situ force of the LM under the principle of superposition were compared among the four groups (intact, group M, group P, and group R). RESULTS: At all the flexion angles, the peak contact pressure (contact area) was significantly higher (lower) after creating the LM complete radial tear as compared to that in the intact state (p < 0.01). At 120° of flexion, group R represented the highest peak contact pressure (lowest contact area), followed by group P and group M (p < 0.05). The results of the in situ force carried by the LM were similar to those of the tibiofemoral contact mechanics. CONCLUSION: The detrimental effect of the LM complete radial tear on the load distribution and transmission functions was greatest in the posterior root tear, followed by the posterior portion tear and the middle portion tear in the deep-flexed position. Complete radial tars of the meniscus, especially at the posterior root, should be repaired to restore the biomechanical function.
Asunto(s)
Traumatismos de la Rodilla/fisiopatología , Meniscos Tibiales/fisiopatología , Lesiones de Menisco Tibial/fisiopatología , Animales , Fenómenos Biomecánicos , Humanos , Articulación de la Rodilla/fisiopatología , Persona de Mediana Edad , Presión , Rango del Movimiento Articular , Estrés Mecánico , Porcinos , Soporte de PesoRESUMEN
PURPOSE: To evaluate the results of the remodified Mason-Allen suture technique concomitant with high tibial osteotomy (HTO) for medial meniscal posterior root tears (MMPRTs). The hypothesis was that this procedure would improve clinical results, prevent progression of knee osteoarthritis and increase the healing rate of the repaired root. METHODS: Total 17 patients of mean 51.5 ± 4.4 years who were underwent this combined procedure for MMPRT completed this study. Lysholm and Hospital for Special Surgery (HSS) scores, Kellgren-Lawrence (KL) grade reflecting osteoarthritis progression were evaluated preoperatively and at the last follow-up. Medial meniscus extrusion (MME) was measured on magnetic resonance imaging preoperatively and at mean 26.1 ± 2.3 months postoperatively. Second-look arthroscopy was performed at mean 25.1 ± 5.3 months postoperatively. The healing status of the repaired root was classified as complete, partial and failed healing. The Outerbridge (OB) grade of the medial femoral condyle (MFC) was compared between index surgery and second-look arthroscopy. RESULTS: Mean follow-up duration was 66.4 ± 6.5 months. Mean Lysholm and HSS mean scores improved significantly from preoperatively to the last follow-up: Lysholm: 56.9 ± 5.4 to 83.5 ± 6.0 (P < 0.001); HSS: 56.1 ± 6.0 to 81.7 ± 7.7 (P < 0.001). The mean mechanical alignment of the lower extremity was corrected from varus to the neutral range at the last follow-up. The preoperative KL grade was not significantly different from the KL grade at the last follow-up (P = 0.071). On MRI, mean MME increased from 3.0 ± 0.7 mm to 3.1 ± 0.7 mm (P = 0.046). Second-look arthroscopy showed 64.7% complete, 29.4% partial and 5.9% failed healing of the repaired root. The initial OB grade of the MFC showed no progression (P = 0.103). CONCLUSIONS: The remodified Mason-Allen suture technique concomitant with HTO for MMPRTs significantly improved clinical outcomes and suppressed OA progression at 66.4 months. However, this procedure produced limited complete healing of the repaired roots in 64.7% of patients. LEVEL OF EVIDENCE: IV.
Asunto(s)
Osteoartritis de la Rodilla/prevención & control , Osteotomía/métodos , Técnicas de Sutura , Lesiones de Menisco Tibial/cirugía , Artroscopía , Progresión de la Enfermedad , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Meniscos Tibiales/diagnóstico por imagen , Meniscos Tibiales/fisiopatología , Meniscos Tibiales/cirugía , Persona de Mediana Edad , Estudios Retrospectivos , Segunda Cirugía , Lesiones de Menisco Tibial/diagnóstico por imagen , Lesiones de Menisco Tibial/fisiopatología , Cicatrización de HeridasRESUMEN
Given the prevalence and the scope of the personal and societal burden of osteoarthritis (OA), investigators continue to be deeply interested in understanding the pathogenic basis of disease and developing novel disease modifying OA therapies. Because joint trauma/injury is considered a leading predisposing factor in the development of OA, and since posttraumatic OA is one of the most common forms of OA in general, large animal and rodent models of knee injury that accurately recapitulate the OA disease process have become increasingly widespread over the past decade. To enable study in the context of defined genetic backgrounds, investigative teams have developed standardized protocols for injuring the mouse knee that aim to induce a reproducible degenerative process both in terms of severity and temporal pacing of disease progression. The destabilization of the medial meniscus (DMM) is one of the most commonly employed surgical procedure in rodents that reproducibly models posttraumatic OA and allows for the study of disease progression from initiation to end-stage disease. The description provided here sets the stage for both inexperienced and established investigators to employ the DMM procedure, or other similar surgical destabilization methods, to initiate the development of posttraumatic OA in the mouse. Successful application of this method provides a preclinical platform to study the mechanisms driving the pathogenesis of posttraumatic OA and for testing therapeutic strategies to treat it.
Asunto(s)
Cartílago Articular/crecimiento & desarrollo , Traumatismos de la Rodilla/cirugía , Meniscos Tibiales/cirugía , Osteoartritis/cirugía , Animales , Modelos Animales de Enfermedad , Progresión de la Enfermedad , Humanos , Traumatismos de la Rodilla/fisiopatología , Articulación de la Rodilla/fisiopatología , Articulación de la Rodilla/cirugía , Meniscos Tibiales/fisiopatología , Ratones , Osteoartritis/fisiopatologíaRESUMEN
OBJECTIVE: The aim of the study was to assess the peripheral rim instability and the clinical value of discoid meniscus. METHODS: We retrospectively studied 79 magnetic resonance imaging (MRI) examinations of discoid meniscus from May 2017 to September 2019. The patient symptoms and physical findings were documented. The patients underwent "dedicated" 0.25 T supine and weight-bearing MRI examination. Finally, all patients underwent arthroscopy. RESULTS: Sound/clicking during motion (P = 0.009) and limited extension (P = 0.044) of subjective symptoms, clunk during motion (P = 0.035), and flexion contracture (P = 0.012) of physical findings were significant predictors of peripheral rim instability. The comparison of the weight-bearing MRI with the supine position MRI demonstrated that the disformed discoid meniscus was shifted significantly and that no shift was displaced centrally (P = 0.001). A correlation between discoid meniscal displacement and the presence of peripheral rim instability in arthroscopy was noted (P < 0.001) using weight-bearing MRI. CONCLUSIONS: The clinical symptoms of the patients combined with weight-bearing MRI can determine peripheral rim instability optimally.
Asunto(s)
Inestabilidad de la Articulación/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Meniscos Tibiales/diagnóstico por imagen , Adolescente , Niño , Preescolar , Femenino , Humanos , Inestabilidad de la Articulación/patología , Inestabilidad de la Articulación/fisiopatología , Masculino , Meniscos Tibiales/patología , Meniscos Tibiales/fisiopatología , Estudios Retrospectivos , Soporte de Peso/fisiologíaRESUMEN
PURPOSE: 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. METHODS: 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). RESULTS: 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). CONCLUSION: 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.
Asunto(s)
Lesiones del Ligamento Cruzado Anterior/complicaciones , Inestabilidad de la Articulación/fisiopatología , Articulación de la Rodilla/fisiopatología , Meniscectomía/métodos , Lesiones de Menisco Tibial/cirugía , Adulto , Ligamento Cruzado Anterior/cirugía , Lesiones del Ligamento Cruzado Anterior/cirugía , Reconstrucción del Ligamento Cruzado Anterior/métodos , Fenómenos Biomecánicos , Cadáver , Femenino , Humanos , Inestabilidad de la Articulación/cirugía , Articulación de la Rodilla/cirugía , Masculino , Meniscectomía/efectos adversos , Meniscos Tibiales/fisiopatología , Meniscos Tibiales/cirugía , Persona de Mediana Edad , Rotación , Rotura/cirugía , Tibia/fisiopatología , Tibia/cirugía , Lesiones de Menisco Tibial/complicacionesRESUMEN
OBJECTIVES: In the treatment of osteoarthritis (OA), tramadol, a common weak opioid, has become popular due to its effectiveness in inhibition of pain. In the present study, we aimed to explore the effect of tramadol on subchondral bone, especially changes in the microstructure and mechanical properties. METHODS: A mouse model of OA was established in the present study by destabilization of the medial meniscus (DMM). A vehicle or drug was administered for 4 weeks. Specimens were harvested and analyzed radiologically and histologically using micro-computed tomography (micro-CT), scanning electron microscopy (SEM), atomic force microscopy (AFM) and histological staining to evaluate the knee joints of mice undergoing different forms of intervention. RESULTS: In the early stages of OA induced by DMM, the subchondral bone volume fraction in the OA group was significantly higher than in the sham+vehicle (sham+veh) group, while the volume in the treatment groups was lower than in the DMM+vehicle (DMM+veh) and sham+veh groups. In addition, the elastic moduli in the treatment groups clearly decreased compared with the DMM+veh and sham+veh groups. Observations of the subchondral bone surface by SEM indicated serious destruction, principally manifesting as a decrease in lacunae and more numerous and scattered cracks. Histological staining demonstrated that there was no difference in the degeneration of either the articular cartilage or synovial cells whether tramadol was used or not. CONCLUSION: Although tramadol is effective in inhibiting pain in early OA, it negatively regulates the microstructure and mechanical properties of subchondral bone in joints.