Dataset Information

Incisionless Partial Medial Meniscectomy.

ABSTRACT: Knee arthroscopy has evolved greatly from its inception in the twentieth century. Of the many arthroscopic knee surgeries, meniscectomy is the most commonly performed. Arthroscopic meniscectomy is the most common orthopaedic surgical procedure performed in the United States. We continue to develop more minimally invasive procedures, and the NanoScope has provided a new generation of possibilities. The system does not require the use of a standard incision or portal, and with the use of nanoinstruments, we can perform treatments as well as diagnostic arthroscopy without incisions. This technique provides an updated incisionless option to perform a partial medial meniscectomy.

SUBMITTER: Lavender C

PROVIDER: S-EPMC7093705 | biostudies-literature | 2020 Mar

REPOSITORIES: biostudies-literature

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Incisionless Partial Medial Meniscectomy.

Lavender Chad C Lycans Dana D Sina Adil Syed Ali SA Kopiec Adam A Schmicker Thomas T

Arthroscopy techniques 20200214 3

Knee arthroscopy has evolved greatly from its inception in the twentieth century. Of the many arthroscopic knee surgeries, meniscectomy is the most commonly performed. Arthroscopic meniscectomy is the most common orthopaedic surgical procedure performed in the United States. We continue to develop more minimally invasive procedures, and the NanoScope has provided a new generation of possibilities. The system does not require the use of a standard incision or portal, and with the use of nanoinstr ...[more]

PMID: 32226745

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Project description:Objectives(i) To provide baseline knowledge of gene expression in macroscopically normal articular cartilage, (ii) to test the hypothesis that age, body-mass-index (BMI), and sex are associated with cartilage RNA transcriptome, and (iii) to predict individuals at potential risk for developing "pre-osteoarthritis" (OA) based on screening of genetic risk-alleles associated with OA and gene transcripts differentially expressed between normal and OA cartilage.DesignHealthy-appearing cartilage was obtained from the medial femoral notch of 12 knees with a meniscus tear undergoing arthroscopic partial meniscectomy. Cartilage had no radiographic, magnetic-resonance-imaging or arthroscopic evidence for degeneration. RNA was subjected to Affymetrix microarrays followed by validation of selected transcripts by microfluidic digital polymerase-chain-reaction. The underlying biological processes were explored computationally. Transcriptome-wide gene expression was probed for association with known OA genetic risk-alleles assembled from published literature and for comparison with gene transcripts differentially expressed between healthy and OA cartilage from other studies.ResultsWe generated a list of 27,641 gene transcripts in healthy cartilage. Several gene transcripts representing numerous biological processes were correlated with age and BMI and differentially expressed by sex. Based on disease-specific Ingenuity Pathways Analysis, gene transcripts associated with aging were enriched for bone/cartilage disease while the gene expression profile associated with BMI was enriched for growth-plate calcification and OA. When segregated by genetic risk-alleles, two clusters of study patients emerged, one cluster containing transcripts predicted by risk studies. When segregated by OA-associated gene transcripts, three clusters of study patients emerged, one of which is remarkably similar to gene expression pattern in OA.ConclusionsOur study provides a list of gene transcripts in healthy-appearing cartilage. Preliminary analysis into groupings based on OA risk-alleles and OA-associated gene transcripts reveals a subset of patients expressing OA transcripts. Prospective studies in larger cohorts are needed to assess whether these patterns are predictive for OA.

Project description:PurposeTo determine whether active smokers have different patient-reported outcomes relative to nonsmokers for pain, function, and overall health at baseline and 1 or 2 years after an arthroscopic partial meniscectomy.MethodsPatients who underwent arthroscopic partial meniscectomy were identified. Demographic data, including smoking status and patient-reported outcome measures (PROMs), were prospectively collected preoperatively and 3 months, 6 months, 1 year, and 2 years postoperatively. Statistical analysis was performed using the mixed-effects model to compare PROMs preoperatively and 1 or 2 years postoperatively between nonsmokers and active smokers.Results509 knees undergoing arthroscopic partial meniscectomy were divided into 2 cohorts: group I, nonsmokers (n = 470) and group II, active smokers (n = 39). There were statistically significant baseline differences in PROMs for nonsmokers versus smokers: visual analog scale (VAS), 5.0 ± 0.4 versus 6.3 ± 0.7, respectively (P = .001); Knee Injury and Osteoarthritis Outcome Score (KOOS) Pain scale, 50.3 ± 3.2 versus 42.5± 5.5 (P = .005); KOOS Symptoms scale, 50.0 ± 3.2 versus 43.6 ± 5.4 (P = .019); and Western Ontario and McMaster Universities Arthritis Index (WOMAC) Pain scale, 57.5 ± 3.4 versus 48.2 ± 6.1 (P = .003). There were also statistically significant differences in nonsmokers versus smokers regarding knee function at baseline shown by the KOOS Activites of Daily Living (ADL) scale: (61.1 ± 3.3 versus 53.5 ± 6.1; P = .015). Baseline mental health, as assessed by the Veterans Rand 12-Item Health Survey (VR-12) Mental Health questionnaire, was also statistically different between nonsmokers (55.4 ± 0.8) and smokers (51.5 ± 3.3; P = .020). Importantly, PROMs for pain and function were lower at all time points for smokers.ConclusionPatients who were active smokers at the time of partial meniscectomy had significantly worse baseline and postoperative PROMs compared with nonsmokers. Changes from baseline for smokers and nonsmokers were relatively consistent between groups 1 and 2 years postoperatively. Smokers will improve a relatively similar amount as nonsmokers after partial meniscectomy, but their overall PROM scores are lower.Level of evidenceIII, retrospective comparative study.

Project description:ObjectiveWe examined the cost-effectiveness of treatment strategies for concomitant meniscal tear and knee osteoarthritis (OA) involving arthroscopic partial meniscectomy surgery and physical therapy (PT).MethodsWe used the Osteoarthritis Policy Model, a validated Monte Carlo microsimulation, to compare three strategies, 1) PT-only, 2) immediate surgery, and 3) PT + optional surgery, for participants whose pain persists following initial PT. We modeled a cohort with baseline meniscal tear, OA, and demographics from the Meniscal Tear in Osteoarthritis Research (MeTeOR) trial of arthroscopic partial meniscectomy versus PT. We estimated risks and costs of arthroscopic partial meniscectomy complications and accounted for heightened OA progression post surgery using published data. We estimated surgery use rates and treatment efficacies using MeTeOR data. We considered a 5-year time horizon, discounted costs, and quality-adjusted life-years (QALYs) 3% per year and conducted sensitivity analyses. We report incremental cost-effectiveness ratios.ResultsRelative to PT-only, PT + optional surgery added 0.0651 QALY and $2,010 over 5 years (incremental cost-effectiveness ratio = $30,900 per QALY). Relative to PT + optional surgery, immediate surgery added 0.0065 QALY and $3080 (incremental cost-effectiveness ratio = $473,800 per QALY). Incremental cost-effectiveness ratios were sensitive to optional surgery efficacy in the PT + optional surgery strategy. In the probabilistic sensitivity analysis, PT + optional surgery was cost-effective in 51% of simulations at willingness-to-pay thresholds of both $50,000 per QALY and $100,000 per QALY.ConclusionFirst-line arthroscopic partial meniscectomy has a prohibitively high incremental cost-effectiveness ratio. Under base case assumptions, second-line arthroscopic partial meniscectomy offered to participants with persistent pain following initial PT is cost-effective at willingness-to-pay thresholds between $31,000 and $473,000 per QALY. Our analyses suggest that arthroscopic partial meniscectomy can be a high-value treatment option for patients with meniscal tear and OA when performed following an initial PT course and should remain a covered treatment option.

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Incisionless Partial Medial Meniscectomy.

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Incisionless Partial Medial Meniscectomy.

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