The effects of previous meniscus and anterior cruciate ligament injuries in patients with total knee arthroplasty.

BACKGROUND: Patients undergoing total knee replacements constitute a suitable population to study the natural history of traumatic joint injuries. MATERIAL AND METHODS: We studied all the patients who received a TKA (Total knee arthroplasty) over the course of one year, in five different centers. The study included 474 patients who had undergone primary TKA for knee OA over a one-year period. In each patient, we analyzed age, sex, side of operation, weight, height and body mass index (BMI, kg/m2). BMI were stratified into four groups according to the WHO classification: normal (25 and 30 and 40). RESULTS: In the TKA group, 74% of the patients were women, while in the THA group the percentage of men and women was similar. No differences were found in the sides operated on. Differences between both groups were found in knee alignment. Women were operated on more frequently for TKA, as there was a higher incidence of OA of the knee joints in women aged over 65. CONCLUSIONS: Patients who required a total knee arthroplasty are likely to have previously undergone surgery or trauma to the knee joints

Surgical treatment for early osteoarthritis. Part II: allografts and concurrent procedures

Young patients with early osteoarthritis (OA) represent a challenging population due to a combination of high functional demands and limited treatment options. Conservative measures such as injection and physical therapy can provide short-term pain relief but are only palliative in nature. Joint replacement, a successful procedure in the older population, is controversial in younger patients, who are less satisfied and experience higher failure rates. Therefore, while traditionally not indicated for the treatment of OA, cartilage repair has become a focus of increased interest due to its potential to provide pain relief and alter the progression of degenerative disease, with the hope of delaying or obviating the need for joint replacement. The field of cartilage repair is seeing the rapid development of new technologies that promise greater ease of application, less demanding rehabilitation and better outcomes. Concurrent procedures such as meniscal transplantation and osteotomy, however, remain of crucial importance to provide a normalized biomechanical environment for these new technologies. Level of evidence: Systematic review, Level I

Capsular fixation limits graft extrusion in lateral meniscal allograft transplantation

Purpose: The main purpose of this investigation was to compare the amount of graft extrusion of lateral meniscal allograft transplantation (MAT) performed with a suture-only technique with or without a capsulodesis. Secondarily, the assessment of functional results was also covered. We hypothesized that capsular fixation reduces the post-operative degree of allograft extrusion and it does not affect the functional outcomes during the short-term follow-up period studied. Methods: Prospective series of 29 lateral MAT. Fifteen were fixed with a suture-only technique (group A). The remaining 14 cases (group B) also included arthroscopic lateral capsular fixation (capsulodesis). Functional results were assessed with Lysholm, Tegner, and VAS for pain. Magnetic resonance imaging (MRI) was performed to determine the degree of meniscal extrusion. Millimeters of extrusion and percentage of extruded meniscal tissue were calculated for both groups. The degree of extrusion was considered minor if it was 3 mm. Results: Group A had 11 cases (73.3%) of major extrusion and group B had 4 cases (28.6%) (p = 0.02). The percentage of extruded meniscal tissue was 35% in group A and 24.6% in group B (p = 0.04). At a mean 3.4 years (range 1-4) post-operatively, the Lysholm score had a mean 89.60 ± 6.93 and 91.43 ± 6.19 points in groups A and B, respectively (p < 0.001). The median follow-up Tegner score improved from 4 (range 3-5) to 7 (range 6-9) in group A (p < 0.001) and from 4 (range 3-5) to 7 (range 6-8) in group B (p < 0.001). VAS dropped 5 and 7.3 points in groups A and B, respectively (p < 0.001). There were no complications in this series. Conclusions: In lateral MAT with the suture-only fixation technique, the described capsulodesis minimized meniscal extrusion. In terms of functional results, there were no differences between the groups at a mean 3.4-year follow-up

Meniscus Reconstruction Using a New Collagen Meniscus Implant

Sports Injuries: Prevention, Diagnosis, Treatment and Rehabilitation covers the whole field of sports injuries and is an up-to-date guide for the diagnosis and treatment of the full range of sports injuries. The work pays detailed attention to biomechanics and injury prevention, examines the emerging treatment role of current strategies and evaluates sports injuries of each part of musculoskeletal system. In addition, pediatric sports injuries, extreme sports injuries, the role of physiotherapy, and future developments are extensively discussed. All those who are involved in the care of patients with sports injuries will find this textbook to be an invaluable, comprehensive, and up-to-date reference