OBJECTIVE To investigate the effect of meniscus suture on meniscus healing which included healing time and healing pattern. METHODS Fourty healthy rabbits were adopted in this study. The model of meniscus injury was made by a longitudinal incision at the medial meniscus of the left knee. The rabbits were divided into two groups, the experimental group was treated by meniscus suture and the control group was unsutured. After operation, the meniscus samples were collected periodically and observed by gross, light and electronic microscope to analysis the meniscus healing. RESULTS The injured meniscus was healed gradually and completely at the sixth week in the experimental groups. More fibroblasts and less fibrocartilage cells could be observed in the healed meniscus. Oppositely, there was no meniscus healing in the control group and the edge of injured meniscus was sealed by epithelioid cells. CONCLUSION The meniscus suture can accelerate the healing process of meniscus injury. Besides, early suture make the injured meniscus correctly positioned to ensure the normal healing process.
【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.
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 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.
ObjectiveTo investigate the effects of meniscectomy and transplantation repair of the knee on the stress area and average pressure of the tibiofemoral articular surface so as to provide a reference for the relevant basic and clinical researches. MethodsSeven qualified right knee joints from adult men cadavers were selected. Required structure was retained after careful dissection. The pressure-sensitive paper was clipped to the proper size in accordance with the measured size of the tibial platform to reserve. The experiment was divided into 4 groups: normal knee group (group A), knee meniscus injury group (group B), knee meniscectomy group (group C), and knee meniscus transplantation group (group D). A horizontal incision above the meniscus was made in the position of knee joint capsule, and the pressure-sensitive paper was placed into the medial and lateral space of the knee joint, then the proximal tibia and distal femur were fixed stably and finally a universal mechanical machine was used for testing in appropriate environmental conditions (the knee joints were given longitudinal 700 N pressure at 0° extension and 30, 60, 90, and 120° flexion for continuous 120 seconds) until the full color reaction. The knee models were prepared, and then the universal mechanical machine was used to perform a test according to the method stated above respectively. The pressure-sensitive paper was removed, and the color negative films were separated and marked. Colorful image analysis system was used to calculate and analyze the stress area and average pressure after the scanner being used to collect image information. ResultsThe stress area was gradually reduced and the average pressure was gradually increased with increasing flexion angle of the knee. There was significant difference in the stress area and the average pressure between various flexion angles in 4 groups (P<0.05). Group C had significantly lower stress area and significantly higher average pressure than the other 3 groups (P<0.05), but no significant difference was found among groups A, B, and D (P>0.05). ConclusionThe stress of the tibiofemoral articular surface significantly increases after knee meniscus injury or resection, and the average pressure significantly increases. The stress of the tibiofemoral articular surface can be restored to almost normal after meniscus transplantation. Therefore, the injured meniscus should also be retained or repaired in the static state.
Objective To elucidate the latest research progress and application of tissue engineered meniscus. Methods The literature concerning the advance in tissue engineered meniscus was extensively reviewed, then closely-related issues including seed cells, scaffolds, and bioreactors were analyzed. Results With more and more attention being paid to meniscus tissue engineering, different approaches and strategies for seed cells, scaffolds, and bioreactors have contributed to the generation of meniscal constructs, which are capable of restoring meniscal lesions to some extent, but translating successes in basic science research to clinical application is still limited. Conclusion More research for the optimal combination of the appropriate cell source, the scaffold type, and the proper physical and chemical factors for the stimulation of cells differentiation into tissue with optimal phenotypes in tissue engineered meniscus is still in needed, but the overall future looks promising.
ObjectiveTo investigate the medium-term effectiveness of both side stereo suture for meniscus bucket handle tear under arthroscopy. MethodsBetween January 2009 and December 2012, 38 patients with combined injury of meniscus bucket handle tear underwent arthroscope surgery by the method of both side stereo suture. There were 26 males and 12 females with an average age of 32 years (range, 19-42 years). The injury causes included sports injury in 21 cases, traffic accident injury in 11 cases, and other trauma in 6 cases. The left knee was involved in 15 cases and the right knee in 23 cases. The interval between injury and operation was 2 days to 6 months (mean, 2.5 months). MRI examination showed meniscus injury at grade Ⅲ, including 22 cases of internal injury and 16 cases of lateral injury. The Barrett standard, Lysholm score of knee joint, and joint mobility were used to assess the function recovery of the knee joint. ResultsAll incisions healed primarily with no complication. All cases were followed up 24.5 months on average (range, 18-36 months). Based on the Barrett standard, meniscus bucket handle tear was successfully repaired in all cases. The Lysholm scores and range of motion of the knee at 6 months, 12 months, and last follow-up were significantly better than preoperative ones (P<0.05). ConclusionThe both side stereo suture of meniscus bucket handle tear under arthroscopy has an excellent medium-term effectiveness, with the advantages of firm suture and high healing rate.
Objective To investigate the effects of the insulin-like growth factor 1 (IGF-1), the transforming growth factor β1(TGFβ1), and the basic fibroblast growth factor (bFGF) on proliferation and cell phenotype of the human fetal meniscal cells, and to find out the best combination and concentration of the growth factors for the meniscus tissue engineering. Methods The fetus came from the healthy woman accidental abortion and the procedure had got her approval.The human fetal meniscal fibrochondrocytes were cultured in vitro. The cell phenotype was identifiedby the collagen type Ⅱ immunohistochemistry and Aggrecan immunofluorescence. Inthe growth factor groups, the 3rd passage meniscal cells synchronized by the serum starvation method and were mixed with IGF-1 (1, 10, 50, 100 μg/L), TGF-β1 (0.1, 1.0, 5.0, 10.0, 50.0 μg/L), and bFGF (5, 10, 50, 100, 200 μg/L), respectively, and in the combination groups, the combinations of bFGF and TGF-β1, bFGF and IGF-1, TGF-β1 and IGF-1 were established at their optimal effect concentrations. The control group was also established for comparison. The dose-response relationship was studied at 48 h and 72 h bythe MTT colorimetric method. Results The 3rd passage meniscalcells could express collagen type Ⅱ and Aggrecan before and after the addition of the three growth factors. The proliferating effects of the growth factors (IGF-1 50 μg/L，TGF-β1 5 μg/L，bFGF 50 μg/L) on the 3rd passage cells at 48 h and 72 h were significantly better in the growth factor groups than in the control group (Plt;0.05)，and the combination groups of bFGF 50 μg/L and IGF-1 50 μg/L, IGF-1 50 μg/L and TGF-β1 5 μg/L showed a significantly higher proliferatingeffect than that in the single growth factor group (Plt;0.05). bFGF 50 μg/L and TGF-β1 5 μg/L had no synergetic effect (Pgt;0.05). Conclusion IGF-1, TGF-β1 and bFGF can promote the proliferation of the human fetal meniscal cells, respectively, and the combinations of bFGF and IGF-1, IGF-1 and TGF-β1 at their optimal concentrations can have better proliferating effects than the single growth factor. They can be used for the in vitro amplification of the meniscal seed cells.
ObjectiveTo explore the application value and operation skills of arthroscopic automatic reverse guide wire passer (hereinafter referred to as wire passer) in the posterior meniscus root reconstruction. Methods Between August 2015 and December 2020, 36 patients with posterior meniscus root tears were admitted. There were 16 males and 20 females, with an average age of 46 years (range, 26-66 years). There were 15 cases of sports injury and 21 cases of degenerative injury. The disease duration was 3-180 days, with a median of 28 days. The posterior root of the medial meniscus was injured in 29 cases, and the posterior root of the lateral meniscus was injured in 7 cases. The preoperative Lysholm score of the knee joint was 47.6±3.9, and the International Knee Score Committee (IKDC) score was 39.3±3.0. The meniscus was sutured by using wire passer under arthroscopy. During operation, the suture operation was evaluated according to the self-defined evaluation standard. Lysholm score and IKDC score were used to evaluate knee joint function. Results All meniscuses were sutured successfully by using wire passer. The operation time of suture was 5-15 minutes, with an average of 10 minutes. According to the self-defined evaluation standard, the suture operation was scored as 0-10, with an average of 5. After operation, except for 2 cases of incision fat liquefaction, the incisions of the other patients healed by first intention. All patients were followed up 1-3 years, with an average of 1.5 years. The Lysholm score was 88.2±2.1 and the IKDC score was 51.7±2.3 at 1 year after operation, showing significant difference when compared with preoperative ones (P<0.001). Fifteen cases underwent MRI re-examination, the results showed that the continuity and integrity of the posterior root had been restored. Conclusion Under arthroscopy, the wire passer for the posterior meniscus root reconstruction has the advantages of simple operation, reliable suture quality, and shorter operation time.
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.