Background: Loss of meniscal tissue can be responsible for increased pain and decreased function.Hypothesis: At a minimum 10-year follow-up, patients receiving a medial collagen meniscus implant (MCMI) would show better clinical, radiological, and magnetic resonance imaging (MRI) outcomes than patients treated with partial medial meniscectomy (PMM).Study Design: Cohort study; Level of evidence 2.Methods: Thirty-three nonconsecutive patients (men; mean age, 40 years) with meniscal injuries were enrolled in the study to receive MCMI or to serve as a control patient treated with PMM. The choice of treatment was decided by the patient. All patients were clinically evaluated at time 0 and at 5 years and a minimum of 10 years after surgery (mean follow-up, 133 months) by Lysholm, visual analog scale (VAS) for pain, objective International Knee Documentation Committee (IKDC) knee form, and Tegner activity level scores. The SF-36 score was performed preoperatively and at final follow-up. Bilateral weightbearing r...

Prospective Long-Term Outcomes of the Medial Collagen Meniscus Implant Versus Partial Medial Meniscectomy: A Minimum 10-year Follow-Up Study

Purpose: To retrospectively compare the diagnostic performance of 1.5- and 3.0-T magnetic resonance (MR) imaging protocols for evaluating the articular cartilage of the knee joint in symptomatic patients. Materials and Methods: This HIPAA-compliant study was performed with a waiver of informed consent from the institutional review board. The study group consisted of 200 symptomatic patients undergoing MR examination of the knee at 1.5 T (61 men, 39 women; mean age, 38.9 years) or 3.0 T (52 men, 48 women; mean age, 39.1 years), who also underwent subsequent arthroscopic knee surgery. All MR examinations consisted of multiplanar fast spin-echo sequences with similar tissue contrast at 1.5 and 3.0 T. All articular surfaces were graded at arthroscopy by using the Noyes classification system. Three musculoskeletal radiologists retrospectively and independently graded all articular surfaces seen at MR imaging by using a similar classification system. The sensitivity, specificity, and accuracy of the 1.5- and 3....

Comparison of 1.5- and 3.0-T MR Imaging for Evaluating the Articular Cartilage of the Knee Joint

The purpose of this study was to determine if a correlation exists between magnetic resonance imaging (MRI) findings of bone marrow edema (BME) in osteoarthrosis (OA) of the knee joint and need for total knee arthroplasty (TKA) within a follow-up period of 3 years. The entire database of knee MR studies over a 3-year period was used to select individuals with knee OA. A chart review was conducted to identify and include only those who had a 3-year follow-up appointment from the time of the initial MR study. There were 25 patients in the OA-only group (four men and 21 women; age range, 28–75; average age, 49.3 years). The OA and BME group had 48 patients (23 men and 25 women; average age, 55.5 years). The MRs were reviewed and interpreted by a musculoskeletal radiologist and were classified into one of four patterns of BME: none, focal, global, or cystic pattern. Meniscal tear and degree of cartilage loss were also assessed. Subjects who had BME of any pattern type were 8.95 times as likely to progress rapidly to a TKA when compared to subjects with no BME (p = 0.016). Subjects with a global pattern of BME were 5.45 times as likely to have a TKA compared to subjects with focal, cyst, or no BME (p < 0.05). Subjects with a global edema pattern were 13.04 times as likely to have a TKA than subjects with no marrow edema in the knee (p < 0.01). There was no correlation of TKA with meniscal tear or cartilage loss. The group of subjects who had a TKA were 12.6 years older than those who did not have a TKA (p < 0.001). However, the BME results were still significant after accounting for the age difference. Our classification of patterns into global, focal, cystic, and absence of BME is an attempt to further define edema in osteoarthrosis and how it relates to clinical progression. Patients with BME and OA have an increased risk of TKA as opposed to OA and no marrow edema. The BME pattern with the worst prognosis for the knee is the global pattern.

/pdf/bone-marrow-edema-in-the-knee-in-osteoarthrosis-and-12n6deaf81.pdf

Bone marrow edema in the knee in osteoarthrosis and association with total knee arthroplasty within a three-year follow-up

This study investigated at medium term follow-up the clinical outcomes and any progression of knee osteoarthritis in a population of patients that underwent arthroscopic placement of a collagen meniscus implant. Thirty-four patients underwent arthroscopic placement of a collagen meniscus implant for a symptomatic deficiency of medial meniscal tissue. Follow-up evaluation included Lysholm II score and Tegner activity scores and MR arthrography of the knee at 2 and 5 years after surgery. Plain radiographs were also obtained at 5 years. Six patients were excluded. In eight cases arthroscopic second look evaluation was performed. Lysholm and Tegner activity scores at 2 and 5 years after surgery improved significantly compared to the preoperative score. These patients showed good to excellent clinical results after 5 years from a CMI placement. The chondral surfaces of the medial compartment had not degenerated further since placement of the CMI. MR signal had continued to mature between 2 and 5 years after implant, progressively decreasing signal intensity but in any case comparable to the low signal of a normal meniscus. In most of cases the CMI-new tissue complex had a slight reduction in size, compared to a normal medial meniscus, but the new tissue had no apparent negative effects.

Follow-up of collagen meniscus implant patients: clinical, radiological, and magnetic resonance imaging results at 5 years.

Introduction: Most current cell-based cartilage repair techniques require some form of scaffolds and 2 separate surgical procedures. We propose a novel, scaffold-less technique of cartilage repair in the human knee that combines arthroscopic microfracture and outpatient intra-articular injections of autologous bone marrow-derived mesenchymal stem cells (MSCs) and hyaluronic acid (HA). Materials and Methods: Seventy matched (age, sex, lesion size) knees with symptomatic cartilage defects underwent cartilage repair with the proposed technique (n = 35) or an open technique (n = 35) in which the MSCs were implanted beneath a sutured periosteal patch over the defect. Prospective evaluation of both groups were performed using the International Cartilage Repair Society (ICRS) Cartilage Injury Evaluation Package, which included questions from the Short-Form (SF-36) Health Survey, International Knee Documentation Committee (IKDC) subjective knee evaluation form, Lysholm knee scale, and Tegner activity level scale. Postoperative magnetic resonance imaging (MRI) evaluation was also performed at 1 year for most patients. Results: There were no clinically signifi cant adverse events reported through the course of our study. At the fi nal follow-up (mean = 24.5 months), there was signifi cant improvement in mean IKDC, Lysholm, SF-36 physical component score and visual analogue pain scores in both treatment groups. Conclusion: In the short term, the results of this novel technique are comparable to the open procedure with the added advantages of being minimally invasive and requiring only a single operation under general anaesthesia. Its safety has been validated and its effi cacy is currently being evaluated in an ongoing randomised controlled trial. Ann Acad Med Singapore 2012;41:511-7

A novel, minimally-invasive technique of cartilage repair in the human knee using arthroscopic microfracture and injections of mesenchymal stem cells and hyaluronic acid--a prospective comparative study on safety and short-term efficacy.

Purpose: To determine the incidence and morphologic characteristics of knee chondral lesions found at arthroscopy and their correlation with magnetic resonance imaging (MRI). Methods: This is a prospective study on 190 consecutive knee arthroscopic procedures performed between March 2003 and February 2004 by the same surgical team. The study group's age average was 34.8 years (14 to 77 years). The indication for surgery included anterior cruciate ligament tears, meniscal tears, and anterior knee pain. Patients without a preoperative MRI study were excluded. MRI reports were performed by qualified radiologists in all the cases. Chondral lesions were classified according to the International Cartilage Repair Society (ICRS) classification and were included in a database along with the MRI reports. The results were analyzed statistically with analysis of variance, Pearson, kappa, and χ-square tests. Results: One hundred fifteen chondral lesions in 82 patients were found during the arthroscopic procedure. Most of them were single lesions (72%) located on the medial femoral condyle (32.2%) or medial patellae (22.6%); 62.6% of the lesions were classified as ICRS type 2 or 3-A, with an average surface of 1.99 cm 2 . We found a significant direct correlation between the patient's age and the size of the lesion ( P = .001). MRI sensitivity was 45% with a specificity of 100%. The sensitivity increased with deeper lesions (direct relation with the ICRS classification). Our results showed a statistical power of 100%. Conclusions: Although unenhanced MRI using a 1.5-Tesla magnet with conventional sequences (proton density-weighted, T1-weighted, and T2-weighted) is most accurate at revealing deeper lesions and defects at the patellae, our study shows that a considerable number of lesions will remain undetected until arthroscopy, which remains the gold standard. Level of Evidence: Level III, diagnostic study of nonconsecutive patients.

Knee Chondral Lesions: Incidence and Correlation Between Arthroscopic and Magnetic Resonance Findings

Summary: After primary Bankart repair, recurrent shoulder instability occurs in up to 20% of the patients. Untreated bone defects, such as Hill Sachs lesions, may play an important role in the etiology of postoperative recurrence, especially when large and engaging defects are present. Remplissage (infraspinatus tenodesis and posterior capsulodesis) is an arthroscopic technique that \"fills\" the Hill Sachs defect, preventing its engagement on the glenoid, and thereby decreasing the possibility of postoperative subluxation or dislocation. Objective: We present an arthroscopic all intraarticular technique for the treatment of Hill Sachs defects in patients with anterior shoulder instability. Conclusion: The all intraarticular Remplissage technique is a reproducible procedure for the treatment of large engaging Hill Sachs defects in patients with anterior shoulder instability. The surgery is followed by a standard Bankart repair rehabilitation protocol. No further decrease in shoulder range of motion has been observed after this procedure.

Remplissage: Infraspinatus Tenodesis and Posterior Capsulodesis for the Treatment of Hill Sachs Lesions: An All Intraarticular Technique

The Latarjet-Bristow procedure has been shown to be a safe and reliable method of treating recurrent anterior instability. We proposed using bioabsorbable screws for fixation of the coracoid graft to avoid the potential complications associated with metallic hardware. The aim of this study was to assess the early radiologic healing of the graft using bioabsorbable screws and comment on our initial experience using this method of fixation for the Latarjet-Bristow procedure. Twelve Latarjet-Bristow procedures were performed for recurrent anterior instability using two 4.5-mm bioabsorbable compression screws composed of L-lactic/co-glycolic acid copolymer (PLGA 85L/15G). All patients had follow-up imaging including plain radiographs and a computed tomography scan performed at 3 months postoperatively to assess bone healing and graft position. In all cases, there was radiologic evidence of bony graft healing in a satisfactory position. There were no intraoperative or postoperative complications observed. This study confirms that satisfactory bone healing in the Latarjet-Bristow procedure can be obtained with the use of bioabsorbable screws. Although the early radiographic results were encouraging, at this stage, we cannot recommend the use of bioabsorbable screws for use with the Latarjet-Bristow procedure until the long-term clinical and radiologic outcomes are assessed. Level of Evidence Case series (IV).

Latarjet-Bristow Procedure Performed With Bioabsorbable Screws: Computed Tomography Evidence of Healing

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Knee Chondral Lesions: Incidence and Correlation Between Arthroscopic and Magnetic Resonance Findings

Remplissage: Infraspinatus Tenodesis and Posterior Capsulodesis for the Treatment of Hill Sachs Lesions: An All Intraarticular Technique

Latarjet-Bristow Procedure Performed With Bioabsorbable Screws: Computed Tomography Evidence of Healing