Objective To investigate the effectiveness of double-needle suture for mixed meniscus tear repair under arthroscope. Methods Between April 2006 and January 2011, 22 patients with mixed meniscus tear were treated with double-needle suture under arthroscope. There were 14 males and 8 females, aged 18-41 years (mean, 31.3 years). All injuries were caused by sports. The time between injury and admission ranged from 2 days to 4 years (median, 11 months). International Knee Documentation Committee (IKDC) score was 42.5 ± 15.2, Lysholm score was 45.5 ± 13.5, and Tegner score was 2.9 ± 1.6. Seventeen cases complicated with anterior cruciate ligament injury. Results Healing of incision by first intention was achieved in all patients. No injury of nerve and blood occurred. The patients were followed up 12-48 months with an average of 27.6 months. According to Barrett et al. standard, 19 cases (86%) got clinical healing. The IKDC, Lysholm, and Tegner scores were improved to 77.1 ± 8.9, 79.8 ± 9.9, and 6.8 ± 1.6 respectively at last follow-up, showing significant differences when compared with preoperative scores (P lt; 0.05). Conclusion Arthroscopic meniscus repair using double-needle suture can provide good effectiveness because it has high firmness.
Objective To observe the outcome of arthroscopic meniscal plasty and suture repair to treat torn discoid lateral meniscus involving popl iteal hiatus. Methods Between January 2008 and May 2009, 21 cases of torn discoid lateral meniscus involving popl iteal hiatus were treated by arthroscopic surgery. There were 9 males and 12 females with an average ageof 22.5 years (range, 12-45 years), including 12 left knees and 9 right knees. Seven cases had the history of injury and other 14 cases had uncertain trauma. The average disease duration was 6.4 months (range, 3 months to 2 years). All patients complained knee pain or locking with positive McMurray test and mill ing test before surgery. All cases had torn discoid lateral meniscus, and the tear extended to the popl iteal hiatus, including 17 cases of complete type and 4 cases of incomplete type according to the Watanabe classification. After meniscal plasty, suture repair of torn popl iteal lateral hiatus was performed. The anterior part to hiatus was repaired by the outside-in technique, and the posterior part underwent repair of all inside technique by FasTFix. Results All wounds healed by first intention with no compl ications such as infection, stiffness of knee, or injury of common peroneal nerve. All patients were followed up 12-28 months with an average of 18 months. The symptoms of knee pain or locking disappeared postoperatively with negative McMurray test and mill ing test in all patients. The Lysholm score was improved from 54.0 ± 13.4 to 90.0 ± 6.6 at 12 months postoperatively, showing significant difference (t=— 12.00, P=0.00). Based on the improved Lysholm classification standard, the results were excellent in 14 cases, good in 5, and fair in 2; the excellent and good rate was 90.5%. Conclusion For torn discoid lateral meniscus involving popl iteal hiatus, based on meniscal plasty, suture repair of the popl iteal hiatus would contribute to preserve the peripheral part and restore its stabil ity.
ObjectiveTo investigate the effectiveness of arthroscopic bipolar radiofrequency energy (bRFE) and lateral partial meniscectomy for lateral meniscus tear and cartilage lesion. MethodsBetween January 2011 and December 2012, 40 eligible patients with lateral meniscus tear and cartilage injury in the lateral knee compartment underwent arthroscopic treatment, and the clinical data were analysed retrospectively. There were 21 males and 19 females, aged 15-65 years (mean, 42.1 years). The left knee was involved in 22 cases and the right knee in 18 cases. The causes of injury included sport injuries in 5 cases and sprain of knee joints in 8 cases, the remaining patients had no history of trauma. The disease duration ranged from 1 month to 10 years (median, 10 months). The Lysholm score and Japanese Orthopaedic Association (JOA) score of the knee were 59.9±8.2 and 69.6±5.3. According to the Outerbridge classification, 2 cases were rated as grade I, 21 cases as grade II, 17 cases as grade III, and 10 cases as grade IV. The scores described by Noyes were 1-16 (mean, 6.52). The Noyes scores were from 1 to 6 points in 20 patients (group A) and 7 to 16 points in 20 patients (group B). During surgery, all patients underwent partial meniscectomy, and radiofrequency-based chondroplasty was used. Knee joint function was assessed using the Lysholm score and JOA score of the knee, and the clinical outcomes between different degrees of cartilage lesions were also compared. ResultsAll incisions healed primarily without complication. All the patients were followed up 8-31 months (mean, 18.1 months). The Lysholm and JOA scores of the knee at last follow-up (92.2±7.2 and 92.9±7.9, respectively) were significantly higher than those at preoperation (P<0.05). There was no significant difference in preoperative Lysholm and JOA scores of the knee between groups A and B (P>0.05), but significance difference was found between 2 groups at last follow-up (P<0.05). ConclusionArthroscopic bRFE and lateral partial meniscectomy have good effectiveness in treating lateral meniscus tear and cartilage lesion. The effectiveness is better in patients with mild cartilage lesion than in patients with severe cartilage lesion.
ObjectiveTo explore the association of anterior cruciate ligament (ACL) degeneration with intercondylar notch impingement and the medial meniscus tear in knee osteoarthritis (KOA). MethodsBetween July 2014 and February 2016, 55 KOA patients (55 knees) with ACL degeneration (degeneration group) and 55 KOA patients (55 knees) without ACL degeneration (control group) were included in the study. No significant difference was found in gender, age, body mass index, and side between 2 groups (P > 0.05). The notch width index was measured on preoperative MRI to evaluate whether the intercondylar notch was narrow. The location of the medial and lateral meniscus tear and osteophyte of the ACL tibial insertion were observed under arthroscopy, and the incidences of the meniscus tear and osteophyte were calculated. ResultsThere was no significant difference in anterior horn and body tear of the medial meniscus and in anterior horn, body, posterior horn, and root tear of the lateral meniscus (P > 0.05). Significant difference was found in the posterior horn and root tear of the medial meniscus, osteophyte of the ACL tibial insertion, narrow intercondylar notch, and the notch width index between 2 groups (P < 0.05). The incidence of root tear of the medial meniscus was 53.8% (7/13) in 13 knees with osteophyte of the ACL tibial insertion and was 16.5% (16/97) in 97 knees without osteophyte, showing significant difference (χ2=9.671, P=0.002). ConclusionThere is a strong association of ACL degeneration with posterior horn and root tear of the medial meniscus and intercondylar notch impingement in KOA. And the high incidence of root tear of the medial meniscus in knee is correlated with osteophyte of the ACL tibial insertion.
ObjectiveTo establish a classification model based on knee MRI radiomics, realize automatic identification of meniscus tear, and provide reference for accurate diagnosis of meniscus injury. Methods A total of 228 patients (246 knees) with meniscus injury who were admitted between July 2018 and March 2021 were selected as the research objects. There were 146 males and 82 females; the age ranged from 9 to 76 years, with a median age of 53 years. There were 210 cases of meniscus injury in one knee and 18 cases in both knees. All the patients were confirmed by arthroscopy, among which 117 knees with meniscus tear and 129 knees with meniscus non-tear injury. The proton density weighted-spectral attenuated inversion recovery (PDW-SPAIR) sequence images of sagittal MRI were collected, and two doctors performed radiomics studies. The 246 knees were randomly divided into training group and testing group according to the ratio of 7∶3. First, ITK-SNAP3.6.0 software was used to extract the region of interest (ROI) of the meniscus and radiomic features. After retaining the radiomic features with intraclass correlation coefficient (ICC)>0.8, the max-relevance and min-redundancy (mRMR) and least absolute shrinkage and selection operator (LASSO) were used for filtering the features to establish an automatic identification model of meniscus tear. The receiver operator characteristic curve (ROC) and the corresponding area under the ROC curve (AUC) was obtained; the model performance was comprehensively evaluated by calculating the accuracy, sensitivity, and specificity. Results A total of 1 316-dimensional radiomic features were extracted from the meniscus ROI, and the ICC within the group and ICC between the groups of the 981-dimensional radiomic features were both greater than 0.80. The redundant information in the 981-dimensional radiomic features was eliminated by mRMR, and the 20-dimensional radiomic features were retained. The optimal feature subset was further selected by LASSO, and 8-dimensional radiomic features were selected. The average ICC within the group and the average ICC between the groups were 0.942 and 0.920, respectively. The AUC of the training group was 0.889±0.036 [95%CI (0.845, 0.942), P<0.001], and the accuracy, sensitivity, and specificity were 0.873, 0.869, and 0.842, respectively; the AUC of the testing group was 0.876±0.036 [95%CI (0.875, 0.984), P<0.001], and the accuracy, sensitivity, and specificity were 0.862, 0.851, and 0.845, respectively. ConclusionThe model established by the radiomics method has good automatic identification performance of meniscus tear.