Rodilla/Knee: Si el menisco se lesiona, se resentirá el cartílago

Quantitative MRI T2 Relaxation Time Evaluation of Knee Cartilage: Comparison of Meniscus-Intact and -Injured Knees After Anterior Cruciate Ligament Reconstruction.
Li H, Chen S, Tao H, Chen S
Am J Sports Med. 2015 Jan 14. pii: 0363546514564151. [Epub ahead of print]


Abstract

BACKGROUND:
Associated meniscal injury is well recognized at anterior cruciate ligament (ACL) reconstruction, and it is a known risk factor for osteoarthritis.

PURPOSE:
To evaluate and characterize the postoperative appearance of articular cartilage after different meniscal treatment in ACL-reconstructed knees using T2 relaxation time evaluation on MRI.

STUDY DESIGN: Cohort study; Level of evidence, 3

METHODS:
A total of 62 consecutive patients who under ACL reconstruction were recruited in this study, including 23 patients undergoing partial meniscectomy (MS group), 21 patients undergoing meniscal repair (MR group), and 18 patients with intact menisci (MI group) at time of surgery. Clinical evaluation, including subjective functional scores and physical examination, was performed on the same day as the MRI examination and at follow-up times ranging from 2 to 4.2 years. The MRI multiecho sagittal images were segmented to determine the T2 relaxation time value of each meniscus and articular cartilage plate. Differences in each measurement were compared among groups.

RESULTS:
No patient had joint-line tenderness or reported pain or clicking on McMurray test or instability. There were also no statistically significant differences in functional scores or medial or lateral meniscus T2 values among the 3 groups (P > .05 for both). There was a significantly higher articular cartilage T2 value in the medial femorotibial articular cartilage for the MS group (P < .01) and the MR group (P < .05) compared with that of the MI group, while there was no significant difference in articular cartilage T2 value between the MS and MR groups (P > .05) in each articular cartilage plate. The medial tibial articular cartilage T2 value had a significant positive correlation with medial meniscus T2 value (r = 0.287; P = .024)

CONCLUSION:
This study demonstrates that knees with meniscectomy or meniscal repair had articular cartilage degeneration at 2 to 4 years postoperatively, with higher articular cartilage T2 relaxation time values compared with the knees with an intact meniscus.

Rodilla/Knee/Knie: No hay que arrojar la toalla ante asas de cubo crónicas

Outcomes After Repair of Chronic Bucket-Handle Tears of Medial Meniscus

Alejandro Espejo Reina, José Miguel Serrano Fernández, Belén Martín Castilla, Francisco Javier Estades Rubio, Karen K. Briggs, Alejandro Espejo Baena

Arthroscopy: The Journal of Arthroscopikc & Related Surgery, Volume 30, Issue 4

Purpose

The purpose of this study was to determine the outcomes after repair of chronic bucket-handle medial meniscal tears by use of magnetic resonance imaging, clinical examination, and patient-reported outcomes.

Methods

A retrospective review of patients with chronic bucket-handle medial meniscal tears that had been repaired with meniscal sutures was undertaken. The following criteria for inclusion were adopted: minimum tear length of 2 cm and chronic medial meniscal tear identified at the time of arthroscopy. The tears were susceptible to dislocation with probing. Data collected included demographic, clinical, radiologic, and surgical data. Postoperative healing was assessed with the clinical criteria of Barrett et al. The International Knee Documentation Committee rating, Lysholm score, and Tegner activity level were determined, and postoperative magnetic resonance imaging was used to evaluate healing in accordance with the criteria of Henning et al.

Results

Twenty-four patients fulfilled the inclusion criteria. The mean time from injury to surgery was 10 months (range, 2 to 60 months). Sixteen patients underwent anterior cruciate ligament reconstruction, 1 patient underwent posterior cruciate ligament reconstruction, and 6 patients underwent meniscus repair only. A median of 5 sutures (range, 3 to 6 sutures) were used for repair. Four cases (all of which had undergone meniscus repair only) required revision. Complete healing was achieved in 83% of cases according to the criteria of Barrett et al. The mean follow-up time was 48 months (range, 24 to 112 months). An International Knee Documentation Committee rating of A or B was achieved in the 20 patients who did not require revision. The median Lysholm score was 95 (range, 92 to 100). The median Tegner activity level before injury was 7, and it remained unchanged after surgery in all cases.

Conclusions

This study showed that repair of chronic bucket-handle meniscal tears can lead to good clinical outcomes and a relatively low (17%) failure rate. In addition, repairs of isolated meniscal tears had a significantly higher risk of failure than repairs performed in conjunction with anterior cruciate ligament reconstruction.

Level of Evidence

Level IV, therapeutic case series.