Dataset Information

A Special Tear Pattern of Anterior Horn of the Lateral Meniscus: Macerated Tear.

ABSTRACT:

Background

We describe a special, interesting phenomenon found in the anterior horn of the lateral meniscus (AHLM): most tear patterns in the AHLM are distinctive, with loose fibers in injured region and circumferential fiber bundles were separated. We name it as macerated tear. The goal of this study was to bring forward a new type of meniscal tear in the AHLM and investigate its clinical value.

Materials and methods

AHLM tears underwent arthroscopic surgery from January 2012 to December 2014 were included. Data regarding the integrity of AHLM were prospectively recorded in a data registry. Tear morphology and treatment received were subsequently extracted by 2 independent reviewers from operative notes and arthroscopic surgical photos.

Results

A total of 60 AHLM tears in 60 patients (mean age 27.1 years) were grouped into horizontal tears (n = 15, 25%), vertical tears (n = 14, 23%), complex tears (n = 6, 10%), and macerated tears (n = 25, 42%). There were 6 patients with AHLM cysts in macerated tear group and one patient in vertical tear group. 60 patients were performed arthroscopic meniscus repairs and were followed-up with averaged 18.7 months. Each group had significant postoperative improvement in Lysholm and IKDC scores (p < 0.05). However, the macerated tear group showed least functional recovery of Lysholm and IKDC scores compared to other groups (p < 0.05). In addition, there were no differences in postoperative range of motion, return to work, or return to sport/other baseline activities between the four groups (p > 0.05).

Conclusions

This study demonstrated that the macerated tear is common in the tear pattern of AHLM. However, feasibility of the treatment of this type of meniscal tear, especially the meniscus repairs still requires further study.

SUBMITTER: Zheng J

PROVIDER: S-EPMC5268414 | biostudies-literature |

REPOSITORIES: biostudies-literature

ACCESS DATA

Similar Datasets

Project description:BackgroundOnly limited data are available regarding postural stability between anterior cruciate ligament (ACL)-injured patients with medial meniscus (MM) tear and those with lateral meniscus (LM) tear. The purpose of this study was to compare preoperative postural stability for both involved and uninvolved knees in ACL rupture combined with MM and LM tears. It was hypothesized that there would be a significant difference in postural stability between these two groups.MethodsNinety-three ACL-injured patients (53 combined with MM tears vs. 40 combined with LM tears) were included. Static and dynamic postural stability were evaluated with the overall stability index (OSI), anterior–posterior stability index (APSI), and medial–lateral stability index (MLSI) using stabilometry. Knee muscle strength was evaluated using an isokinetic testing device.ResultsIn the static postural stability test, none of the stability indices showed significant differences between the two groups for both knees (p?>?0.05). In the dynamic postural stability test for involved side knees, the OSI and APSI were significantly higher in the LM tear group compared to the MM tear group (OSI: 2.0?±?0.8 vs. 1.6?±?0.5, p?=?0.001; APSI: 1.5?±?0.6 vs. 1.3?±?0.5, p?=?0.023), but not the MLSI (p?>?0.05). In the static and dynamic postural stability tests in each group, there were no significant differences between the involved and uninvolved side knees (p?>?0.05). There was no significant difference in the knee muscle strength between the two groups (p?>?0.05). All postural stability showed no significant correlation with knee muscle strength (p?>?0.05).ConclusionDynamic postural stability was poorer in patients with ACL rupture combined with LM tear than in those with MM tear. Therefore, close monitoring for postural stability would be necessary during preoperative and postoperative rehabilitation, especially for patients with ACL rupture combined with LM tear.Level of evidence: Level III

Project description:BackgroundThe success of anterior cruciate ligament (ACL) reconstruction relies on the accurate replication of the native ACL anatomy, including attachment shapes. The tibial attachment of the ACL exhibits significant shape variations with elliptical, C, and triangular shapes, highlighting the need for objective classification methods and additional information to identify individual anatomic variations.HypothesisThe location of the attachment of the anterior horn of the lateral meniscus (AHLM) may determine the shape of the ACL attachment.Study designCross-sectional study; Level of evidence, 3.MethodsThe study used 25 knees from 17 Japanese cadavers for macroscopic anatomic examination and quantitative analysis. The shape of the ACL attachment was quantified using principal component analysis with elliptical Fourier descriptors, whereas the AHLM location was quantified by measuring its mediolateral and anteroposterior positions on the superior surface of the tibia. Reliability was assessed statistically.ResultsThe shape of the tibial attachment of the ACL varied among individuals and was classified as elliptical, C-shaped, or triangular. Scatterplots of the principal components of the ACL attachment shape showed overlapping regions of elliptical, C-shaped, and triangular ACL attachments, indicating that a C-shaped attachment is intermediate between elliptical and triangular attachments. The location of the AHLM attachment also varied, with areas in the anterolateral, anteromedial, or posteromedial region. The ACL shape and AHLM location were related, with elliptical, C-shaped, and triangular ACL attachments corresponding to anterolateral, anteromedial, and posteromedial AHLM attachments, respectively.ConclusionThe AHLM attachment location influences the shape of the ACL attachment. Information on the location of the AHLM attachment can aid in predicting the shape of the ACL attachment during ACL reconstruction, potentially improving footprint coverage.

Project description:Arthroscopic repair of the posterior horn of the lateral meniscus (LM) from an anterolateral portal has a risk of popliteal artery injury. Here, we present an ultrasound-assisted, arthroscopic, all-inside repair technique for a posterior LM tear to reduce the risk of neurovascular injury. An ultrasound probe covered with a sterile sleeve is placed horizontally at the popliteal fossa by an assistant surgeon, and the popliteal artery and posterior LM are confirmed. From the anterolateral portal, an arthroscopic probe is inserted to push the posterior capsule of the lateral compartment, while an ultrasound image detects the tip of the probe. After the probe is confirmed not to be directed toward the popliteal artery, an all-inside suture device is introduced from the anterolateral portal. While the meniscus is penetrated, the surgeon can confirm by ultrasound images that the needle is directed away from the popliteal artery. The guide suture is pulled anteriorly to secure the anchors tightly, and an ultrasound confirms that the anchors are positioned behind the posterior portion of the LM. All sutures are secured under the assistance of ultrasound images, followed by arthroscopic confirmation of a properly secured LM by the all-inside repair technique. Technique Video Video 1 The arthroscopic view from the anterolateral portal shows a decreased volume of the lateral meniscus due to a previous surgical resection. The posterior lateral meniscus (LM) is pulled anteriorly over the center of the lateral compartment by probing. The posterior LM is repaired under the guidance of the ultrasound by having the assistant surgeon place the ultrasound probe, covered with a sterile sleeve, horizontally on the popliteal fossa to allow confirmation of the posterior portion of the LM and the popliteal artery. An all-inside suture device, the JuggerStitch, is introduced from an anterolateral portal, and the tip of the needle is observed in the ultrasound image. While penetrating the posterior LM, the direction of the needle is confirmed not to injure the neurovascular structures. The anchor of the JuggerStich is introduced at the posterior side of the LM and can be observed as a high echoic region. After introduction of two anchors, the sutures are pulled anteriorly through the anterolateral portal, and the knot is tightened. The ultrasound image shows that the two anchors are positioned on the capsule behind the posterior LM. The same procedures are then repeated. The location of the popliteal artery and the direction of the needle are confirmed by ultrasound every time. If the needle is directed toward the artery, it should be extracted and inserted again. A total of 4 sutures are performed to obtain stability of the LM under the assistance of ultrasound. The final arthroscopic examination shows the properly secured repair and the stabilized posterior LM by probing.