Objective To investigate the clinical application of periosteal autograft in repair of cartilage defect caused by osteoarthritis of knee. Methods From 1996 to 1999, 36 knees of cartilage defect of knee joint in 28 cases were treated. In the operation, the cracked degenerative cartilage was removed before free periosteum from tibia was transplanted to repair the defect, and the meniscuses in 8 knees of the 36 knees were reconstructed. After operation, early continuous passive movement was adopted for 4 weeks, and 8 knees with reconstruction ofthe meniscus were immobilized by plaster splint for 7 days after operation and before passive movement. All of the cases were followed up for 1 to 4 years before clinical evaluation in symptoms, signs and radiological findings. Results The general satisfactory rate was 86.1%, in which the function was excellent in 22 knees and good in 9 knees. Conclusion The periosteal autograft is a good choice for repairing cartilage defect due to osteoarthritis, with a satisfactory outcomein the short term.
Objective
To investigate the injury mechanism, clinical characteristics, and treatments of Segond fracture and complications.
Methods
Fifteen patients suffering from Segond fracture were treated between January 2007 and December 2011. There were 10 males and 5 females, aged 16-50 years (mean, 31.8 years). Fracture was caused by traffic accident in 8 cases, by sports in 6 cases, and by bruise in 1 case. Before operation, the knee range of motion (ROM) was (36.60 ± 8.94)°; the Lysholm score was 32.27 ± 3.73; and the International Knee Documentation Committee (IKDC) score was 42.34 ± 4.97. The duration from injury to operation was 1-3 weeks with an average of 1.2 weeks. In 12 patients having associated anterior cruciate ligament (ACL) injury, arthroscopic reconstruction of ACL was performed with allogeneic anterior tibial tendon; in 2 patients having associated avulsion fracture of the intercondylar eminence of the tibia, arthroscopic fracture reduction and fixation with Orthocord wire were performed. In 8 patients having associated meniscus injury, meniscus suture and meniscectomy were performed in 3 and 5 patients, respectively. In 7 patients having associated collateral ligament injury, conservative treatment was given in 5 patients, and medial collateral ligament was repair in 2 patients.
Results
All incisions healed primarily without complications of infection and nerve or blood vessel injury. All the patient were followed up 12-16 months (mean, 14.3 months). At 12 months after operation, the results of anterior drawer test, Lachman test, and lateral stress test were all negative. The knee ROM was (129.27 ± 5.89)°, the IKDC score and Lysholm score were significantly increased to 89.45 ± 3.05 and 87.87 ± 4.12 at 12 months after operation; all showing significant differences when compared with preoperative values (P lt; 0.05).
Conclusion
Segond fracture is often combined with ACL, collateral ligament, and meniscus injuries, and the evidence of Segond fracture can bly suggests the knee injury. Personalized treatment should be chosen according to complications.
【Abstract】 Objective To compare the short-term effects of arthroscopic partial meniscectomy in treating medial versuslateral meniscus injuries. Methods From January 2003 to January 2006, 207 patients with meniscus injury(without intraarticularligament injury) underwent arthroscopic partial meniscectomy. The medial meniscus injury group included 115 cases, 50males and 65 females; aged 14 to 78 years(mean 46.9 years); 66 left knees and 49 right knees. Twenty-six cases had injury histories,the delayed time from injury to surgery ranged from 6 d to 6 months (mean 2.1 months). The lateral meniscus injury group included92 cases, 18 males and 74 females; aged 16 to 62 years (mean 41.1 years); 57 left knees and 35 right knees. Twenty-four caseshad injury histories, the delayed time from injury to surgery ranged from 9 d to 6 months (mean 1.9 months). Lysholm score systemwas applied and the scors of pre- and post-operation and were compared between two groups. Results The period of followupranged from 12 to 45 months (mean 31.5 months). In medial meniscus injury group and lateral meniscus injury roup, theLysholm score increased from 61.3±16.9 and 57.4±17.6 preoperation to 95.0±7.9 and 93.3±7.4 postoperation respectively. Therewas statistically significant difference between preoperation and postoperation (P lt; 0.01), and there was no statistically significantdifference between two groups（P gt; 0.05）. The excellent and good rates for function of knee joint were 97.39% (excellent in 107cases, good in 5 cases and fair in 3 cases) in medial meniscus injury group and 100%(excellent in 80 cases and good in 12 cases)in lateral meniscus injury group. Conclusion Arthroscopic partial meniscectomy is a safe and effective treatment for meniscusinjury, there is no diference in short-term effects in treating medial versus lateral meniscus injuries.
Objective To investigate the result of the arthroscopicrepair of the meniscus tears with the absorbable sutures. Methods From June 1998 to May2003，the meniscus tears in 110 patients (78 males, 32 females; aged 1466 years, averaged 27.5 years) were repaired with absorbable sutures under an arthroscope. In the patients, there were 93 vertical split injuries, 12 transverse split injuries, and 5 hidden split injuries. There were 78 tears in the lateral margin of the meniscus, 23 tears in the anterior angle of the meniscus, and 9 tears in the posterior angle of the meniscus. Ninetyone patients had 2 sutures, 13 patients had 4 sutures, 4 patients had 6 sutures, and 2 patients had 8 sutures. The rehabilitation program was performed in all the patients postoperatively, and the clinical outcome was observed. The Lysholm score was 57±12 preoperatively. Results Thefollow-up for an average of 26 months (range,12-67 months) showed that 3 patients had a light pain on exertion in the surgically-treated knee;1 patientunderwent an operation again for recurrence of the symptoms due to a failure in the healing of the meniscus tear, so a second arthroscopic operation was performed; and the other patients had a satisfactory result with an excellent knee function. The Lysholm score was 92±7 after operation. Conclusion The arthroscopic repair of the meniscustears has advantages of safety and reliability in the suturing and easier to perform. The repaired meniscus can play much better physiological and biomechanical functions, and will not limit the normal movement of the meniscus during the knee flexion after the sutures are absorbed.
Objective?To observe the changes of force bearing area and pressures of the rabbit tibiofemoral contact area and the biomechanical reconstruction level of joint after meniscal allograft.?Methods?A total of 28 Japanese rabbits were involved, weighing 3.0-3.5 kg, male or female. Of 28 rabbits, 7 were selected as meniscus donors, the remaining 21 rabbits were randomized into group A (n=7), group B (n=7), and group C (n=7). Group A underwent single knee opening and suturing, group B underwent medial meniscus excision and suturing, and group C underwent medial meniscus allograft after medial meniscus excision and suturing. The rabbits were sacrified at 12 weeks after operation for biomechanical observation through biomechanical machine and color imaging system. The meniscus tissue specimens were harvested from groups A and C to perform histological and immunohistochemical staining.?Results?After operation, all rabbits in 3 groups survived to the end of experiment. There were significant differences in the force bearing area and pressures at 0-90° flexion between group B and groups A, C (P lt; 0.05) at 12 weeks, showing no significant difference between group A and group C (P gt; 0.05); and there were significant differences in the force bearing area and pressures at 120° flexion among 3 groups (P lt; 0.05). The histological observation showed that the number of cartilage cells and collagen fibers returned to normal in group C, and the immunohistochemical staining showed that transplanted meniscus of group C contained large amounts of collagen fibers consisting of collagen type I and collagen type II. After 12 weeks of operation, the collagen type I contents were 0.612 5 ± 0.059 8 in group A and 0.587 2 ± 0.063 9 in group C, showing no significant difference (t=0.765, P=0.465); the collagen type II contents were 0.772 4 ± 0.081 5 and 0.814 3 ± 0.051 7, respectively, showing no significant difference (t= —0.136, P=0.894).?Conclusion?The allograft of rabbit meniscus can significantly increase the force bearing area of the tibiofemoral contact area and reduce the average pressure. Therefore, biomechanically speaking, the meniscus allograft can protect the articular cartilage and reconstruct the biomechanical balance.
OBJECTIVE To investigate possibility of cartilage cultured in centrifuge tube as graft materials. METHODS: Articular chondrocytes isolated from a 3-week-old rabbit formed cartilage after cultivation for 2 weeks. Articular cartilage of humeral head, growth plate of proximal tibia and meniscus were collected from a 6-week-old rabbit. The ultrastructure of chondrocytes and extracellular matrix in the three kinds of cartilages and cultured cartilage were observed by transmission electronic microscopy. RESULTS: Cartilage cultured in centrifuge tube possessed unique ultrastructure and was similar to articular cartilage and growth plate, but it was markedly different from meniscus. The four kinds of cartilages were characteristic of respectively different chondrocytes and extracellular matrix. Cultured cartilage showed typical apoptosis of chondrocytes and "dark chondrocytes" appeared in growth plate. Condrocyte apoptosis was not seen in articular cartilage and meniscus. CONCLUSION: Cartilage cultured in centrifuge tube has unique ultrastructure and may be used as graft materials for articular cartilage and growth plate.
To design a new suit of instruments for meniscal suture with tondon, and then authenticate their feasibil ity and the therapeutic effect of the new technique. Methods Instruments were developed, including new ones and others which was improved according to the current instruments. From October 2005 to December 2006, 45 patients with meniscal injury were treated by meniscal suture with tendon. There were 29 males and 16 females, aged 17-40 years (mean 28 years). Injury was caused by sports in 33 cases, by traffic accident in 5 cases, by fall ing in 3 case and others in 4 cases. The disease course was 3 days to 6 months (mean 2 months). There were 23 cases accompanying with anterior cruciate l igament injury and 6 cases accompanying with posterior cruciate l igament injury. E-MRI showed 2 cases of degree II and 43 cases of degree III. Arthroscope showed that injury was at medial meniscus in 39 cases and at lateral meniscus in 6 cases. The pre-operationalLysholm score was 53.0 ± 10.3. Autogeneic or xenogenic tendon was made into suture l ine guided by stitch at the two ends. Thetherapeutic effect of the new technique was authenticated by cl inical results, including the change of symptoms and phy sical signs, and by comparing the pre-operational Lysholm score with the post one. Results Nineteen pieces of instruments weredeveloped. All the operation were successful, with no harm to nerves and vessels. The follow-up was 6 months to 24 mo nths (mean15 months). At the last follow-up, all the symptoms disappeared, including pain, swell ing and locking, etc. The Lysholm sc oreafter 6 months of operation was 87.8 ± 9.2, showing statistically significant difference when compared with per-operati on ( P lt; 0.01). Conclusion It is feasible to suture injured menisci with the new instruments and technique. It is an effective way to repair menisci with tendon according to the short-term results.
Objective To compare biological characteristics between articular chondrocyte and meniscal fibrochondrocyte cultured in vitro andto investigate the possibility of using cultured cartilage as a substitute for meniscus.Methods Chondrocytes isolated from articular cartilage and meniscus of rabbits aged 3 weeks were respectively passaged in monolayer and cultured in centrifuge tube. Cartilages cultured in centrifuge tube and meniscus of rabbit aged 6 weeks were detected by histological examination and transmission electron microscopy. Growth curves of articular chondrocytes and meniscalfibrochondrocytes were compared; meanwhile, cell cycles of articular chondrocytes and meniscal fibrochondrocytes in passage 2and 4 were separately measured by flow cytometry.Results Articular chondrocytes in passage 4 were dedifferentiated. Articular chondrocytes formed cartilage 2 weeks after cultivation in centrifuge tube, but meniscal fibrochondrocytes could not generate cartilage. The differences in ultrastructure and histology obviously existed between cultured cartilage and meniscus; moreover, apoptosis of chondrocytes appeared in cultured cartilage. Proportion of subdiploid cells in articular chondrocytes passage 2 and 4 was markedly higher than that in passage 2 and 4 fibrochondrocytes(Plt;0.05). Conclusion Meniscal fibrochondrocytes can not form cartilage after cultivationin centrifuge tube, while cartilage cultured in centrifuge tube from articular chondrocytes can not be used as graft material for meniscus. Articular cartilage ismarkedly different from meniscus.
Objective To examine the research status and predict trends in ME research findings from 1997-2023 on a global scale. Methods Web of Science Core Collection database was searched for original articles on ME published between 1997 and 2023, and then analyzed using CiteSpace, VOSviewer and the Online Analysis Platform of Literature Metrology to map scientific knowledge. Results A total of 748 articles were eventually included. The number of ME publications increased year by year, with the USA being the most productive country. Osteoarthritis, MRI, medial meniscus posterior root repair, biomechanical evaluation, lateral meniscus allograft transplantation, radiographic joint space narrowing are the high frequency keywords in co-occurrence cluster analysis and cocited reference cluster analysis. Medial meniscus posterior root tear and lateral meniscus allograft transplantation are current and evolving research hotspots in citation burst detection analysis. Conclusions The understanding of ME has been improved significantly during the past decades. Current research focuses on optimizing surgical repair methods and obtaining long-term follow-up outcomes for medial meniscal posterior root repair and developing methods to reduce ME after lateral meniscal allograft, as well as they are the highlights of future research on ME.
ObjectiveTo manufacture a polycaprolactone (PCL)/type Ⅰ collagen (COL Ⅰ) tissue engineered meniscus scaffold (hereinafter referred to as PCL/COL Ⅰ meniscus scaffold) by three-dimensional (3D) printing with low temperature deposition technique and to study its physicochemical properties.MethodsFirst, the 15% PCL/4% COLⅠ composite solution and 15% PCL simple solution were prepared. Then, 15% PCL/4% COL Ⅰmeniscus scaffold and 15% PCL meniscal scaffold were prepared by using 3D printing with low temperature deposition techniques. The morphology and microstructure of the scaffolds were observed by gross observation and scanning electron microscope. The compression modulus and tensile modulus of the scaffolds were measured by biomechanical test. The components of the scaffolds were analyzed by Fourier transform infrared spectroscopy (FTIR). The contact angle of the scaffold surface was measured. The meniscus cells of rabbits were cultured with the two scaffold extracts and scaffolds, respectively. After cultured, the cell proliferations were detected by cell counting kit 8 (CCK-8), and the normal cultured cells were used as controls. Cell adhesion and growth of scaffold-cell complex were observed by scanning electron microscope.ResultsAccording to the gross and scanning electron microscope observations, two scaffolds had orientated 3D microstructures and pores, but the surface of the PCL/COLⅠ meniscus scaffold was rougher than the PCL meniscus scaffold. Biomechanical analysis showed that the tensile modulus and compression modulus of the PCL/COL Ⅰ meniscus scaffold were not significantly different from those of the PCL meniscus scaffold (P>0.05). FTIR analysis results showed that COL Ⅰ and PCL were successful mixed in PCL/ COL Ⅰ meniscus scaffolds. The contact angle of PCL/COLⅠ meniscus scaffold [(83.19±7.49)°] was significantly lower than that of PCL meniscus scaffold [(111.13±5.70)°] (t=6.638, P=0.000). The results of the CCK-8 assay indicated that with time, the number of cells cultured in two scaffold extracts showed an increasing trend, and there was no significant difference when compared with the control group (P>0.05). Scanning electron microscope observation showed that the cells attached on the PCL/ COL Ⅰ meniscus scaffold more than that on the PCL scaffold.ConclusionPCL/COLⅠmeniscus scaffolds are prepared by 3D printing with low temperature deposition technique, which has excellent physicochemical properties without cytotoxicity. PCL/COLⅠmeniscus scaffold is expected to be used as the material for meniscus tissue engineering.
