Sample records for tear meniscus height

  1. Anterior Segment Optical Coherence Tomography for Tear Meniscus Evaluation and its Correlation with other Tear Variables in Healthy Individuals

    PubMed Central

    Dhasmana, Renu; Nagpal, Ramesh Chander

    2016-01-01

    Introduction Dry eye is one of the most common ocular diseases in this cyber era. Despite availability of multiple tests, no single test is accurate for the diagnosis of dry eye. Anterior segment optical coherence tomography is the recent tool which can be added in the armentarium of dry eye tests. Aim To evaluate tear meniscus with anterior segment optical coherence tomography and its correlation with other tear variables in normal healthy individuals. Materials and Methods In this prospective cross-sectional observational study, right eye of 203 consecutive patients were studied. All the patients were divided into three groups Group 1, 2 and 3 according to their age ≤20 years, 21-40 years and >40 years respectively. All patients underwent routine ophthalmologic examinations along with slit-lamp bio-microscopy for tear meniscus height measurement, tear film break up time, Schirmer’s I test (with anaesthesia) and optical coherence tomography imaging of inferior tear meniscus height. After focusing of the instrument with a Cross Line (CL) centered on lower tear meniscus at 6’0 clock of cornea, a 6 mm long scan was obtained. The tear meniscus height (μm) and tear meniscus area (mm2) were measured manually with help of callipers by joining upper corneo-meniscus junction to the lower lid-meniscus junction and tear meniscus height and area within the plotted line respectively and calculated by using the integrated analysis available in the custom software. Results There was significant decrease in the all tear variables with the increase in the age. According to age groups in group 1, the mean Schirmer’s (24.0±4.9)mm, tear film break up time (11.1±1.9) sec, tear meniscus height on slit lamp (600.2±167.3)mm were higher but decreased in group 2 (21.5±5.4,10.8±1.4, 597.5±186.3) and group 3 (19.8 ± 5.1, 10.2 ± 1.6, 485.6 ± 157.7) respectively. Schirmer’s test values and tear film break up time were similar in both sexes (p=0.1 and p= 0.9). Tear meniscus

  2. Ipsilateral Medial and Lateral Discoid Meniscus with Medial Meniscus Tear

    PubMed Central

    Shimozaki, Kengo; Nakase, Junsuke; Ohashi, Yoshinori; Numata, Hitoaki; Oshima, Takeshi; Takata, Yasushi; Tsuchiya, Hiroyuki

    2016-01-01

    Introduction: Discoid meniscus is a well-documented knee pathology, and there are many cases of medial or lateral discoid meniscus reported in the literature. However, ipsilateral concurrent medial and lateral discoid meniscus is very rare, and only a few cases have been reported. Herein, we report a case of concurrent medial and lateral discoid meniscus. Case Report: A 27-year-old Japanese man complained of pain on medial joint space in his right knee that was diagnosed as a complete medial and lateral discoid meniscus. In magnetic resonance imaging, although the lateral discoid meniscus had no tear, the medial discoid meniscus had a horizontal tear. Arthroscopic examination of his right knee similarly revealed that the medial discoid meniscus had a horizontal tear. In addition, the discoid medial meniscus also had an anomalous insertion to the anterior cruciate ligament, and there was also mild fibrillation of the medial tibial cartilage surface. We performed arthroscopic partial meniscectomy for the torn medial discoid meniscus but not for the asymptomatic lateral discoid meniscus. The latest follow-up at 18 months indicated satisfactory results. Conclusion: We report a rare case of ipsilateral medial and lateral discoid meniscus with medial meniscus tear. The medial discoid meniscus with tear was treated with partial meniscectomy, whereas the lateral discoid meniscus without tear was only followed up. PMID:28164045

  3. Radial tears associated with cleavage tears of the medial meniscus in athletes.

    PubMed

    Kidron, Amos; Thein, Rafael

    2002-03-01

    To evaluate the significance of a small radial tear in the root of the posterior horn of the medial meniscus in an otherwise normal-looking meniscus in individuals who play vigorous sports. Retrospective review. Arthroscopy was performed in 1,270 patients; 11 patients (0.86%) had a small radial tear in the root of the medial meniscus. Trimming of the tear revealed a large horizontal cleavage tear of the posterior horn and body of the meniscus. The average age of the affected patients was 29.6 years (range, 21 to 45 years), and all were active in sports. Magnetic resonance imaging was of dubious diagnostic value. Three patients had undergone previous arthroscopy at which time the small radial root tear had been noted but was not thought to warrant treatment. All 11 patients returned to their former levels of activity after adequate surgery. When a radial root tear in the medial meniscus is found in an athletic patient, the edges of the tear should be trimmed, the root of the medial meniscus examined, and any additional torn cartilage resected.

  4. Posterior meniscus root tears: associated pathologies to assist as diagnostic tools.

    PubMed

    Matheny, Lauren M; Ockuly, Andrew C; Steadman, J Richard; LaPrade, Robert F

    2015-10-01

    The purpose of this study was to investigate associated pathologies identified at arthroscopy in patients with meniscus root tears. This study was Institutional Review Board approved. All patients who underwent arthroscopic knee surgery where a complete meniscus root tear was identified were included in this study. Concurrent ligament tears and articular cartilage changes ≥Outerbridge grade 2 were recorded and stored in a data registry. Fifty patients (28 males, 22 females) [mean age = 36.5 years (range 17.1-68.1 years)] who were diagnosed with a medial or lateral meniscus root tear at arthroscopy were included in this study out of 673 arthroscopic surgeries (prevalence 7.4 %). Twenty-three (46 %) patients had a medial meniscus root tear, 26 (52 %) patients had a lateral meniscus root tear and one (2 %) patient had both. Thirty-four per cent of patients (n = 17) underwent partial meniscectomy, while 60 % (n = 31) underwent suture repair. During arthroscopy, 60 % (n = 30) of patients were diagnosed with an anterior cruciate ligament (ACL) tear. Patients with lateral meniscus root tears were 10.3 times (95 % CI 2.6-42.5) more likely to have ACL tears than patients with medial meniscus root tears (p = 0.012). Patients who had medial meniscus root tears were 5.8 times (95 % CI 1.6-20.5) more likely to have chondral defects than patients who had lateral meniscus root tears (p = 0.044). In this study, patients' preoperative functional scores and activity levels were low. Patients with lateral meniscal root tears were more likely to have an ACL tear. Patients with medial meniscal root tears were more likely to have an knee articular cartilage defect with an Outerbridge grade 2 or higher chondral defect. This study confirms the importance of comprehensive assessment of concurrent injuries to properly diagnose meniscus root tears. IV.

  5. Characteristics of radial tears in the posterior horn of the medial meniscus compared to horizontal tears.

    PubMed

    Choi, Chul-Jun; Choi, Yun-Jin; Song, In-Bum; Choi, Chong-Hyuk

    2011-06-01

    The clinical and radiologic features of radial tears of the medial meniscus posterior horn were compared with those of horizontal tears. From January 2007 to December 2008, 387 consecutive cases of medial meniscal tears were treated arthroscopically. Among these, 91 were radial tears in the medial meniscus posterior horn, and 95 were horizontal tears in the posterior segment of the medial meniscus. The patients' data (age, gender, duration of symptom, body mass index, and injury history), radiographic findings (Kellgren and Lawrence score, posterior tibial slope, and femorotibial angle), and chondral lesions were recorded. The patient factors of age, gender, and body mass index were related to radial tears of the medial meniscus posterior horn. Radial tears were significantly correlated with Kellgren and Lawrence score, varus alignment, posterior tibial slope, and severity of the chondral lesion. Radial tears of the medial meniscus posterior horn are a unique clinical entity that are associated with older age, females and obesity, and are strongly associated with an increased incidence and severity of cartilage degeneration compared to horizontal tears.

  6. Comparison of Medial and Lateral Meniscus Root Tears.

    PubMed

    Koo, Ji Hyun; Choi, Sang-Hee; Lee, Seung Ah; Wang, Joon Ho

    2015-01-01

    The meniscus root plays an essential role in maintaining the circumferential hoop tension and preventing meniscal displacement. Studies on meniscus root tears have investigated the relationship of osteoarthritis and an anterior cruciate ligament tear. However, few studies have directly compared the medial and lateral root tears. To assess the prevalence of meniscal extrusion and its relationship with clinical features in medial and lateral meniscus root tears, we performed a retrospective review of the magnetic resonance imaging (MRI) results of 42 knee patients who had meniscus posterior horn root tears and who had undergone arthroscopic operations. The presence of meniscal extrusion was evaluated and the exact extent was measured from the tibial margin. The results were correlated with arthroscopic findings. Clinical features including patients' ages, joint abnormalities, and previous trauma histories were evaluated. Twenty-two patients had medial meniscus root tears (MMRTs) and twenty patients had lateral meniscus root tears (LMRTs). Meniscal extrusion was present in 18 MMRT patients and one LMRT patient. The mean extent of extrusion was 4.2mm (range, 0.6 to 7.8) in the MMRT group and 0.9mm (range, -1.9 to 3.4) in the LMRT group. Five patients with MMRT had a history of trauma, while 19 patients with LMRT had a history of trauma. Three patients with MMRT had anterior cruciate ligament (ACL) tears, while 19 patients with LMRT had ACL tears. The mean age of the patients was 52 years (range: 29-71 years) and 30 years (range: 14-62 years) in the MMRT and LMRT group, respectively. There was a significant correlation between a MMRT and meniscal extrusion (p<0.0001), and between an ACL tear and LMRT (p<0.0001). A history of trauma was significantly common in LMRT (p<0.0001). LMRT patients were significantly younger than MMRT patients (p<0.0001). Kellgren-Lawrence (K-L) grade differed significantly between MMRT and LMRT group (p<0.0001). Meniscal extrusion is common in

  7. Comparison of Medial and Lateral Meniscus Root Tears

    PubMed Central

    Koo, Ji Hyun; Choi, Sang-Hee; Lee, Seung Ah; Wang, Joon Ho

    2015-01-01

    The meniscus root plays an essential role in maintaining the circumferential hoop tension and preventing meniscal displacement. Studies on meniscus root tears have investigated the relationship of osteoarthritis and an anterior cruciate ligament tear. However, few studies have directly compared the medial and lateral root tears. To assess the prevalence of meniscal extrusion and its relationship with clinical features in medial and lateral meniscus root tears, we performed a retrospective review of the magnetic resonance imaging (MRI) results of 42 knee patients who had meniscus posterior horn root tears and who had undergone arthroscopic operations. The presence of meniscal extrusion was evaluated and the exact extent was measured from the tibial margin. The results were correlated with arthroscopic findings. Clinical features including patients’ ages, joint abnormalities, and previous trauma histories were evaluated. Twenty-two patients had medial meniscus root tears (MMRTs) and twenty patients had lateral meniscus root tears (LMRTs). Meniscal extrusion was present in 18 MMRT patients and one LMRT patient. The mean extent of extrusion was 4.2mm (range, 0.6 to 7.8) in the MMRT group and 0.9mm (range, -1.9 to 3.4) in the LMRT group. Five patients with MMRT had a history of trauma, while 19 patients with LMRT had a history of trauma. Three patients with MMRT had anterior cruciate ligament (ACL) tears, while 19 patients with LMRT had ACL tears. The mean age of the patients was 52 years (range: 29–71 years) and 30 years (range: 14–62 years) in the MMRT and LMRT group, respectively. There was a significant correlation between a MMRT and meniscal extrusion (p<0.0001), and between an ACL tear and LMRT (p<0.0001). A history of trauma was significantly common in LMRT (p<0.0001). LMRT patients were significantly younger than MMRT patients (p<0.0001). Kellgren-Lawrence (K-L) grade differed significantly between MMRT and LMRT group (p<0.0001). Meniscal extrusion is

  8. Evaluation of meniscus tears of the knee by radionuclide imaging

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Marymont, J.V.; Lynch, M.A.; Henning, C.E.

    We compare the accuracy of radionuclide imaging of the knee with Tc99m-pyrophosphate with arthrography for the evaluation of meniscus tears in young athletes with clinically suspected knee injury. All patients had arthroscopy which was used as the standard against which the other two diagnostic procedures were compared. Radionuclide scintigraphy and arthrography were comparable in their ability to detect tears of the medial meniscus. Scintigraphy was superior for the detection of tears of the lateral meniscus and of both menisci.

  9. Posterior root tear of the medial and lateral meniscus.

    PubMed

    Petersen, Wolf; Forkel, Philipp; Feucht, Matthias J; Zantop, Thore; Imhoff, Andreas B; Brucker, Peter U

    2014-02-01

    An avulsion of the tibial insertion of the meniscus or a radial tear close to the meniscal insertion is defined as a root tear. In clinical practice, the incidence of these lesions is often underestimated. However, several biomechanical studies have shown that the effect of a root tear is comparable to a total meniscectomy. Clinical studies documented progredient arthritic changes following root tears, thereby supporting basic science studies. The clinical diagnosis is limited by unspecific symptoms. In addition to the diagnostic arthroscopy, MRI is considered to be the gold standard of diagnosis of a meniscal root tear. Three different direct MRI signs for the diagnosis of a meniscus root tear have been described: Radial linear defect in the axial plane, vertical linear defect (truncation sign) in the coronal plane, and the so-called ghost meniscus sign in the sagittal plane. Meniscal extrusion is also considered to be an indirect sign of a root tear, but is less common in lateral root tears. During arthroscopy, the function of the meniscus root must be assessed by probing. However, visualization of the meniscal insertions is challenging. Refixation of the meniscal root can be performed using a transtibial pull-out suture, suture anchors, or side-to-side repair. Several short-term studies reported good clinical results after medial or lateral root repair. Nevertheless, MRI and second-look arthroscopy revealed high rates of incomplete or absent healing, especially for medial root tears. To date, most studies are case series with short-term follow-up and level IV evidence. Outerbridge grade 3 or 4 chondral lesions and varus malalignment of >5° were found to predict an inferior clinical outcome after medial meniscus root repair. Further research is needed to evaluate long-term results and to define evident criteria for meniscal root repair.

  10. Meniscus tear surgery and meniscus replacement

    PubMed Central

    Vaquero, Javier; Forriol, Francisco

    2016-01-01

    Summary Objective the menisci are easily injured and difficult to repair. The aim of this study was to analyze the current state of meniscal surgery aimed at preserving morphology and conserving the biomechanics of the knee to prevent joint degeneration. Methodology a search of the electronic medical literature database Medline was conducted, from http://www.ncbi.nlm.nih.gov/pubmed. The search was not limited by language. Candidate articles were identified by searching for those that included the keywords meniscus, surgery, suture, implant, allograft. The limits were included for clinical research and clinical trials. Basic research was not included. The studies selected were evaluated and classified in three different categories: basic science, reconstruction (suture and meniscectomy) and implants (scaffolds and allograft). Results the consequences of meniscectomy performed at a young age can lead to a joint cartilage degeneration twenty years later. There are few surgical options for the repair of meniscal injuries in order both to preserve the meniscus and to ensure the long term survival of the knee joint, meniscectomy, repair, suturing the tear, or reconstruction, when a meniscal allograft or synthetic substitute is used to replace the meniscus, but the biomechanical properties of the native meniscus are not reproduced entirely by the scaffolds that exist today. Conclusion therapies that successfully repair or replace the meniscus are therefore likely to prevent or delay osteoarthritis progression. PMID:27331034

  11. [Diagnostic value of MRI for posterior root tear of medial and lateral meniscus].

    PubMed

    Qian, Yue-Nan; Liu, Fang; Dong, Yi-Long; Cai, Chun-Yuan

    2018-03-25

    To explore diagnostic value of MRI on posterior root tear of medial and lateral meniscus. From January 2012 to January 2016, clinical data of 43 patients with meniscal posterior root tear confirmed by arthroscopy were retrospective analyzed, including 25 males and 18 females, aged from 27 to 69 years old with an average age of(42.5±8.3)years old;27 cases on the right side and 16 cases on the left side. MRI examinations of 43 patients with tear of posterior meniscus root confirmed by knee arthroscopies were retrospectively reviewed. MRI images were double-blinded, independently, retrospectively scored by two imaging physicians. Sensitivity, specificity and accuracy of MRI diagnosis of lateral and medial meniscus posterior root tear were calculated, and knee ligament injury and meniscal dislocation were calculated. Forty-three of 143 patients were diagnosed with meniscus posterior root tears by arthroscopy, including 19 patients with lateral tears and 24 patients with medial tears. The sensitivity, specificity and accuracy in diagnosis of posterior medial meniscus root tears for doctor A were 91.67%, 86.6% and 83.9% respectively, and for doctor B were 87.5%, 87.4% and 87.4%, 19 patients with medial meniscal protrusion and 2 patients with anterior cruciate ligament tear. The sensitivity, specificity and accuracy in diagnosis of posterior lateral meniscus root tears for doctor A were 73.7%, 79.9% and 79% respectively, and for doctor B were 78.9%, 82.3% and 82.5%, 4 patients with lateral meniscus herniation and 16 patients with cruciate ligament tear. Kappa statistics for posterior medial meniscus root tears and posterior lateral meniscus root tears were 0.84 and 0.72. MRI could effectively demonstrate imaging features of medial and lateral meniscal root tear and its accompanying signs. It could provide the basis for preoperative diagnosis of clinicians, and be worthy to be popularized. Copyright© 2018 by the China Journal of Orthopaedics and Traumatology Press.

  12. The Degeneration of Meniscus Roots Is Accompanied by Fibrocartilage Formation, Which May Precede Meniscus Root Tears in Osteoarthritic Knees.

    PubMed

    Park, Do Young; Min, Byoung-Hyun; Choi, Byung Hyune; Kim, Young Jick; Kim, Mijin; Suh-Kim, Haeyoung; Kim, Joon Ho

    2015-12-01

    Fibrocartilage metaplasia in tendons and ligaments is an adaptation to compression as well as a pathological feature during degeneration. Medial meniscus posterior roots are unique ligaments that resist multidirectional forces, including compression. To characterize the degeneration of medial meniscus posterior root tears in osteoarthritic knees, with an emphasis on fibrocartilage and calcification. Cross-sectional study; Level of evidence, 3. Samples of medial meniscus posterior roots were harvested from cadaveric specimens and patients during knee replacement surgery and grouped as follows: normal reference, no tear, partial tear, and complete tear. Degeneration was analyzed with histology, immunohistochemistry, and real-time polymerase chain reaction. Uniaxial tensile tests were performed on specimens with and without fibrocartilage. Quantifiable data were statistically analyzed by the Kruskal-Wallis test with the Dunn comparison test. Thirty, 28, and 42 samples harvested from 99 patients were allocated into the no tear, partial tear, and complete tear groups, respectively. Mean modified Bonar tendinopathy scores for each group were 3.97, 9.31, and 14.15, respectively, showing a higher degree of degeneration associated with the extent of the tear (P < .05 for all groups). The characterization of root matrices revealed an increase in fibrocartilage according to the extent of the tear. Tear margins revealed fibrocartilage in 59.3% of partial tear samples and 76.2% of complete tear samples, with a distinctive cleavage-like shape. Root tears with a similar shape were induced within fibrocartilaginous areas during uniaxial tensile testing. Even in the no tear group, 56.7% of samples showed fibrocartilage in the anterior margin of the root, adjacent to the meniscus. An increased stained area of calcification and expression of the ectonucleotide pyrophosphatase/phosphodiesterase 1 gene were observed in the complete tear group compared with the no tear group (P < .0001

  13. [The correlations between corneal sensation, tear meniscus volume, and tear film osmolarity after femtosecond laser-assisted LASIK].

    PubMed

    Zhang, Luyan; Sun, Xiyu; Yu, Ye; Xiong, Yan; Cui, Yuxin; Wang, Qinmei; Hu, Liang

    2016-01-01

    To investigate the correlations between corneal sensation, tear meniscus volume, and tear film osmolarity after femtosecond laser-assisted LASIK (FS-LASIK) surgery. In this prospective clinical study, 31 patients undergoing FS-LASIK for myopia were recruited. The upper and lower tear meniscus volumes (UTMV and LTMV) were measured by customized anterior segment optical coherence tomography, tear film osmolarity was measured by a TearLab Osmolarity test device, central corneal sensation was measured by a Cochet-Bonner esthesiometer preoperatively, at 1 week, 1 and 3 months postoperatively. Repeated measures analysis of variance was used to evaluate whether the tear film osmolarity, tear meniscus volume, and corneal sensation were changed after surgery. The correlations between these variables were analyzed by the Pearson correlation analysis. The tear film osmolarity was (310.03 ± 16.48) mOsms/L preoperatively, (323.51 ± 15.92) mOsms/L at 1 week, (319.93 ± 14.27) mOsms/L at 1 month, and (314.97±12.91) mOsms/L at 3 months. The UTMV was (0.42±0.15), (0.25± 0.09), (0.30±0.11), and (0.35±0.09) μL, respectively; the LTMV was (0.60±0.21),(0.37±0.08), (0.44± 0.14), and (0.52±0.17) μL, respectively. The tear film osmolarity was significantly higher at 1 week and 1 month postoperatively compared with the baseline (P=0.001, 0.004), and reduced to the preoperative level at 3 months (P=0.573). The UTMV, LTMV, and corneal sensation values presented significant decreases at all postoperative time points (all P<0.05). The Pearson correlation analysis showed the postoperative UTMV had a weak relationship with corneal sensation at 1 week after surgery (r=0.356,P=0.005). There were significant correlations between the preoperative LTMV and corneal sensation at 1 week, 1 and 3 months (respectively, r=0.422, 0.366, 0.352;P=0.001, 0.004, 0.006). No significant correlations were found between the tear film osmolarity, tear meniscus volume, and corneal sensation after surgery

  14. The efficacy, sensitivity, and specificity of strip meniscometry in conjunction with tear function tests in the assessment of tear meniscus.

    PubMed

    Ibrahim, Osama M A; Dogru, Murat; Ward, Samantha K; Matsumoto, Yukihiro; Wakamatsu, Tais Hitomi; Ishida, Katsushi; Tsuyama, Atsushi; Kojima, Takashi; Shimazaki, Jun; Tsubota, Kazuo

    2011-04-06

    To evaluate the specificity and sensitivity of strip meniscometry (SM) testing in conjunction with tear function tests in the diagnosis of dry eye (DE) disease and to investigate the effect of SM on reflex tearing. One hundred seven left eyes of 107 patients with definite DE disease according to the Japanese DE diagnostic criteria and 68 left eyes of 68 age- and sex-matched control subjects were studied. Tear meniscus height (TMH) measurements, fluorescein tear film break-up time (FTBUT), fluorescein (F) and rose bengal (RB) staining, and Schirmer's test-1 (ST) were also performed. The assessment of reflex tearing before and after SM application was assessed with a graticule scale at the slit lamp and by optical coherence tomography. The sensitivity and specificity of SM alone and in combination with tear function tests were also sought. The SM scores, TMH measurements, FTBUTs, and STs were significantly lower in dry eye patients than in the controls (P < 0.001). The RB and F staining scores were significantly higher in the dry eye group than in the control group (P < 0.001). The meniscometry strips did not induce significant changes in relation to reflex tearing. SM had an acceptable sensitivity and specificity. SM is a swift, noninvasive, promising method of assessing tear meniscus volume. The combined SM and FTBUT examination appears to be a sensitive approach to the assessment of dry eye disease.

  15. Different patterns of lateral meniscus root tears in ACL injuries: application of a differentiated classification system.

    PubMed

    Forkel, Philipp; Reuter, Sven; Sprenker, Frederike; Achtnich, Andrea; Herbst, Elmar; Imhoff, Andreas; Petersen, Wolf

    2015-01-01

    Posterior lateral meniscus root tears (PLMRTs) affect the intra-articular pressure distribution in the lateral compartment of the knee. The biomechanical consequences of these injuries are significantly influenced by the integrity of the meniscofemoral ligaments (MFLs). A newly introduced arthroscopic classification system for PLMRTs that takes MFL integrity into account has not yet been clinically applied but may be useful in selecting the optimal method of PLMRT repair. Prospective ACL reconstruction data were collected. Concomitant injuries of the lateral meniscus posterior horn were classified according to their shape and MFL status. The classifications were: type 1, avulsion of the root; type 2, radial tear of the lateral meniscus posterior horn close to the root with an intact MFL; and type 3, complete detachment of the posterior meniscus horn. Between January 2011 and May 2012, 228 consecutive ACL reconstructions were included. Lateral and medial meniscus tears were identified in 38.2% (n = 87) and 44.7% (n = 102), respectively. Of the 87 lateral meniscus tears, 32 cases had PLMRTs; the overall prevalence of PLMRTs was 14% (n = 32). Two medial meniscus root tears were detected. All PLMRTs were classified according to the classification system described above, and the fixation procedure was adapted to the type of meniscus tear. The PLMRT tear is a common injury among patients undergoing ACL repair and can be arthroscopically classified into three different types. Medial meniscus root tears are rare in association with ACL tears. The PLMRT classification presented here may help to estimate the injury's impact on the lateral compartment and to identify the optimal treatment. These tears should not be overlooked, and the treatment strategy should be chosen with respect to the type of root tear. IV.

  16. Augmentation of the Pullout Repair of a Medial Meniscus Posterior Root Tear by Arthroscopic Centralization.

    PubMed

    Koga, Hideyuki; Watanabe, Toshifumi; Horie, Masafumi; Katagiri, Hiroki; Otabe, Koji; Ohara, Toshiyuki; Katakura, Mai; Sekiya, Ichiro; Muneta, Takeshi

    2017-08-01

    The meniscus roots are critical for meniscus function in preserving correct knee kinematics and avoiding meniscus extrusion and, consequently, in the progression of osteoarthritis. Several techniques exist for medial meniscus posterior root tear repair; however, current surgical techniques have been proved to fail to reduce meniscus extrusion, which has been shown to be associated with development of osteoarthritis, although significant improvements in the postoperative clinical findings have been achieved. This Technical Note describes an arthroscopic technique for the medial meniscus posterior root tear in which a pullout repair is augmented by a centralization technique to restore and maintain the medial meniscus function by efficiently reducing meniscus extrusion.

  17. Posterior root tear of the medial meniscus in multiple knee ligament injuries.

    PubMed

    Kim, Young Jae; Kim, Jin Goo; Chang, Seok Hwan; Shim, Jae Chan; Kim, Sang Bum; Lee, Mi Young

    2010-10-01

    The purposes of the present study were to examine the frequency and characteristics of root tears of the medial meniscus associated with ligament injuries of the knee and to evaluate the effectiveness of pull-out repair for restoring meniscus function. We retrospectively analyzed the 9 patients (10 knees) with posterior root tears of the medial meniscus and ligament injuries of the knee treated between August 2004 and February 2007. All the patients were male, with average age of 29.8 years, and the mean follow-up period was 29.7 months. The pull-out suture technique was used to repair the root tears. Clinical outcomes were evaluated using the Lysholm, IKDC, and Tegner scores, as well as the McMurray and Apley tests. The mean follow-up period was 41.1 months (range, 30 to 63 months). The incidence of root tears of the medial meniscus with ligament injuries was 2.74% (10 cases in 365 ligament surgeries). All clinical results showed significant improvement. At the final follow-up, McMurray test showed one positive and nine negative cases, and the Apley test revealed two positive and eight negative cases. There were no positive findings in anterior drawer test, posterior drawer test, valgus and varus stress test, and posterolateral instability test. Healing of the root tear was confirmed by arthroscopy in five patients and by MR in four patients. Root tears of the medial meniscus may occur in multiple knee ligament injuries. It is important not to miss them. Our results indicate that pull-out repair provides satisfactory results and evidence of healing. Copyright 2009 Elsevier B.V. All rights reserved.

  18. The effect of complete radial lateral meniscus posterior root tear on the knee contact mechanics: a finite element analysis.

    PubMed

    Bao, H R C; Zhu, D; Gong, H; Gu, G S

    2013-03-01

    In recent years, with technological advances in arthroscopy and magnetic resonance imaging and improved biomechanical studies of the meniscus, there has been some progress in the diagnosis and treatment of injuries to the roots of the meniscus. However, the biomechanical effect of posterior lateral meniscus root tears on the knee has not yet become clear. The purpose of this study was to determine the effect of a complete radial posterior lateral meniscus root tear on the knee contact mechanics and the function of the posterior meniscofemoral ligament on the knee with tear in the posterior root of lateral meniscus. A finite element model of the knee was developed to simulate different cases for intact knee, a complete radial posterior lateral meniscus root tear, a complete radial posterior lateral meniscus root tear with posterior meniscofemoral ligament deficiency, and total meniscectomy of the lateral meniscus. A compressive load of 1000 N was applied in all cases to calculate contact areas, contact pressure, and meniscal displacements. The complete radial posterior lateral meniscus root tear decreased the contact area and increased the contact pressure on the lateral compartment under compressive load. We also found a decreased contact area and increased contact pressure in the medial compartment, but it was not obvious compared to the lateral compartment. The lateral meniscus was radially displaced by compressive load after a complete radial posterior lateral meniscus root tear, and the displacement took place mainly in the body and posterior horn of lateral meniscus. There were further decrease in contact area and increases in contact pressure and raidial displacement of the lateral meniscus in the case of the complete posterior lateral meniscus root tear in combination with posterior meniscofemoral ligament deficiency. Complete radial posterior lateral meniscus root tear is not functionally equivalent to total meniscectomy. The posterior root torn lateral

  19. Correlations among ocular surface temperature difference value, the tear meniscus height, Schirmer's test and fluorescein tear film break up time.

    PubMed

    Su, Tai Yuan; Ho, Wei Ting; Lu, Chien Yi; Chang, Shu Wen; Chiang, Huihua Kenny

    2015-04-01

    To report the use of a thermographer for measuring ocular surface temperature, and to evaluate the correlation among the obtained temperature difference values (TDVs) and dry eye parameters (tear meniscus height (TMH); Schirmer's test results; fluorescent tear breakup time (FTBUT)). Forty-three participants (age 40.2±14.7 years; range 21-67 years) from Far Eastern Memorial Hospital, Taiwan were recruited for the study. The surface temperature was measured at the centre of the ocular surface for 4 s after blinking. TDV was defined as the change in corneal surface temperature relative to that of the preceding eye opening, where TDV01, TDV02, TDV03, and TDV04 represent the values obtained 1, 2, 3, and 4 s after blinking, respectively. Anterior segment optical coherence tomography (AS-OCT) was employed to measure the lower TMH. Schirmer's test with topical anaesthetic was conducted to measure the basal tear secretion. The FTBUT was recorded using a digital camera. TDV measurement exhibited high reliability (intraclass correlation coefficient=0.91). TDV03 exhibited the highest significance and strongest positive correlation with the TMH (r=0.52, p=0.0003) and Schirmer's test value (r=0.39, p=0.008), whereas the TDV03-FTBUT correlation was non-significant. Age correlated negatively and significantly with the TDV (r= -0.35, p=0.021), TMH (r= -0.33, p=0.031), and Schirmer's test value (r= -0.31, p=0.044). TDV03 remained significantly correlated with the TMH and Schirmer's test value after adjustment for age. The thermographer was effective in capturing temperature changes in the ocular surface. The temperature difference 3 s after blinking appears to be correlated with lower TMH and Schirmer test values. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  20. UTE-T2* mapping detects sub-clinical meniscus injury after anterior cruciate ligament tear

    PubMed Central

    Williams, A.; Qian, Y.; Golla, S.; Chu, C.R.

    2018-01-01

    SUMMARY Objective Meniscus tear is a known risk factor for osteoarthritis (OA). Quantitative assessment of meniscus degeneration, prior to surface break-down, is important to identification of early disease potentially amenable to therapeutic interventions. This work examines the diagnostic potential of ultrashort echo time-enhanced T2* (UTE-T2*) mapping to detect human meniscus degeneration in vitro and in vivo in subjects at risk of developing OA. Design UTE-T2* maps of 16 human cadaver menisci were compared to histological evaluations of meniscal structural integrity and clinical magnetic resonance imaging (MRI) assessment by a musculoskeletal radiologist. In vivo UTE-T2* maps were compared in 10 asymptomatic subjects and 25 ACL-injured patients with and without concomitant meniscal tear. Results In vitro, UTE-T2* values tended to be lower in histologically and clinically normal meniscus tissue and higher in torn or degenerate tissue. UTE-T2* map heterogeneity reflected collagen disorganization. In vivo, asymptomatic meniscus UTE-T2* values were repeatable within 9% (root-mean-square average coefficient of variation). Posteromedial meniscus UTE-T2* values in ACL-injured subjects with clinically diagnosed medial meniscus tear (n = 10) were 87% higher than asymptomatics (n = 10, P < 0.001). Posteromedial menisci UTE-T2* values of ACL-injured subjects without concomitant medial meniscal tear (n = 15) were 33% higher than asymptomatics (P = 0.001). Posterolateral menisci UTE-T2* values also varied significantly with degree of joint pathology (P = 0.001). Conclusion Significant elevations of UTE-T2* values in the menisci of ACL-injured subjects without clinical evidence of subsurface meniscal abnormality suggest that UTE-T2* mapping is sensitive to subclinical meniscus degeneration. Further study is needed to determine whether elevated subsurface meniscus UTE-T2* values predict progression of meniscal degeneration and development of OA. PMID:22306000

  1. Effect of radial meniscal tear on in situ forces of meniscus and tibiofemoral relationship.

    PubMed

    Tachibana, Yuta; Mae, Tatsuo; Fujie, Hiromichi; Shino, Konsei; Ohori, Tomoki; Yoshikawa, Hideki; Nakata, Ken

    2017-02-01

    To clarify the effect of the radial tear of the lateral meniscus on the in situ meniscus force and the tibiofemoral relationship under axial loads and valgus torques. Ten intact porcine knees were settled to a 6-degree of freedom robotic system, while the force and 3-dimensional path of the knees were recorded via Universal Force Sensor (UFS) during 3 cycles of 250-N axial load and 5-Nm valgus torque at 15°, 30°, 45°, and 60° of knee flexion. The same examination was performed on the following 3 meniscal states sequentially; 33, 66, and 100% width of radial tears at the middle segment of the lateral meniscus, while recording the force and path of the knees via UFS. Finally, all paths were reproduced after total lateral meniscectomy and the in situ force of the lateral meniscus were calculated with the principle of superposition. The radial tear of 100% width significantly decreased the in situ force of the lateral meniscus and caused tibial medial shift and valgus rotation at 30°-60° of knee flexion in both testing protocols. Under a 250-N axial load at 60° of knee flexion, the in situ force decreased to 36 ± 29 N with 100% width of radial tear, which was 122 ± 38 N in the intact state. Additionally, the tibia shifted medially by 2.1 ± 0.9 mm and valgusrotated by 2.5 ± 1.9° with the complete radial tear. However, the radial tear of 33 or 66% width had little effect on either the in situ force or the tibial position. A radial tear of 100% width involving the rim significantly decreased the in situ force of the lateral meniscus and caused medial shift and valgus rotation of the tibia, whereas a radial tear of up to 66% width produced only little change. The clinical relevance is that loss of meniscal functions due to complete radial tear can lead to abnormal stress concentration in a focal area of cartilage and can increase the risk of osteoarthritis in the future.

  2. Biomechanical consequences of a posterior root tear of the lateral meniscus: stabilizing effect of the meniscofemoral ligament.

    PubMed

    Forkel, Philipp; Herbort, Mirco; Schulze, Martin; Rosenbaum, Dieter; Kirstein, Lars; Raschke, Michael; Petersen, Wolf

    2013-05-01

    The purpose of this study was to evaluate the effects of different types of lateral meniscus root tears in terms of tibiofemoral contact stress. Ten porcine knees each underwent five different testing conditions with the menisci intact, a simulated lateral posterior root tear with and without cutting the meniscofemoral ligament and with an artificial tear of the posterior root of the medial meniscus. Biomechanical testing was performed at 30° of flexion with an axial load of 100 N. A pressure sensor (st Sensor Type S2042, Novel, Munich) was used to measure the tibiofemoral contact area and the tibiofemoral contact pressure. Data were analyzed to assess the differences in contact area and tibiofemoral peak contact pressure among the five meniscal conditions. There was no significant difference in mean contact pressure between the state with the menisci intact and an isolated posterior root tear of the lateral meniscus. In case of a root tear and a tear of the meniscofemoral ligament, the contact area decreased in comparison with the intact state of the menisci. After additional cutting of the meniscofemoral ligament, the tibiofemoral contact pressure was significantly higher in comparison with the intact state and the avulsion injury. In the medial compartment, joint compression forces were significantly increased in comparison with the intact state after cutting the posterior root of the medial meniscus (P < 0.05). The consequence of a medial meniscus root tear is well known and was verified by this analysis. The results of the present study show that the biomechanical consequences of a lateral meniscus root tear depend on the state of the meniscofemoral ligament. An increase in tibiofemoral contact pressure is only to be expected in combined injuries of the meniscus root and the meniscofemoral ligaments. Posterior lateral meniscus root tear might have a better prognosis in terms of the development of osteoarthritis when the meniscofemoral ligament is intact.

  3. Magnetic resonance imaging evidence of meniscal extrusion in medial meniscus posterior root tear.

    PubMed

    Choi, Chul-Jun; Choi, Yun-Jin; Lee, Jae-Jeong; Choi, Chong-Hyuk

    2010-12-01

    The purpose of this study was to evaluate the relation between meniscal extrusion on magnetic resonance imaging (MRI) and tearing of the posterior root of the medial meniscus, as well as to understand the relation between meniscal extrusion and chondral lesions. From January 2007 to December 2008, 387 consecutive cases of medial meniscal tears were treated arthroscopically. Of these cases, 248 (64.1%) with MRI were reviewed. Arthroscopic findings were reviewed for the type of tear and medial compartment cartilage lesion. Root tear was defined as a radial tear in the posterior horn of the medial meniscus near the tibial spine (i.e., within 5 mm of the root attachment). An MRI scan of the knee was used to evaluate the presence and extent of meniscal extrusion. Meniscal extrusion of 3 mm or greater was considered pathologic. Arthroscopic findings were compared with respect to the extent of meniscal extrusion. There were 98 male patients and 150 female patients. The mean age was 53.5 years (range, 15 to 81 years). The results showed 127 cases (51.2%) in which the medial meniscus had meniscal extrusion of 3 mm or greater. Posterior root tears were found in 66 (26.6%) of the 248 knees. The mean meniscal extrusion in patients with root tear was 3.8 ± 1.4 mm, whereas the mean extrusion of those who had no root tear was 2.7 ± 1.3 mm. We found an association between pathologic meniscal extrusion and root tear (P < .001). Meniscal extrusion showed a low positive predictive value (39%) and specificity (58%) with regard to the meniscal root tear. Meniscal extrusion was also significantly correlated with severity of chondral lesions (P < .001). Considerable extrusion (≥3 mm) can be associated with tearing of the medial meniscus root and chondral lesion of the medial femoral condyle. Level IV, therapeutic case series. Copyright © 2010 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  4. Complex Medial Meniscus Tears Are Associated With a Biconcave Medial Tibial Plateau.

    PubMed

    Barber, F Alan; Getelman, Mark H; Berry, Kathy L

    2017-04-01

    To determine whether an association exists between a biconcave medial tibial plateau and complex medial meniscus tears. A consecutive series of stable knees undergoing arthroscopy were evaluated retrospectively with the use of preoperative magnetic resonance imaging (MRI), radiographs, and arthroscopy documented by intraoperative videos. Investigators independently performed blinded reviews of the MRI or videos. Based on the arthroscopy findings, medial tibial plateaus were classified as either biconcave or not biconcave. A transverse coronal plane ridge, separating the front of the tibial plateau from the back near the inner margin of the posterior body of the medial meniscus, was defined as biconcave. The medial plateau slope was calculated with MRI sagittal views. General demographic information, body mass index, and arthroscopically confirmed knee pathology were recorded. A total of 179 consecutive knees were studied from July 2014 through August 2015; 49 (27.2%) biconcave medial tibial plateaus and 130 (72.8%) controls were identified at arthroscopy. Complex medial meniscus tears were found in 103. Patients with a biconcave medial tibial plateau were found to have more complex medial meniscus tears (69.4%) than those without a biconcavity (53.1%) (P = .049) despite having lower body mass index (P = .020). No difference in medial tibial plateau slope was observed for biconcavities involving both cartilage and bone, bone only, or an indeterminate group (P = .47). Biconcave medial tibial plateaus were present in 27.4% of a consecutive series of patients undergoing knee arthroscopy. A biconcave medial tibial plateau was more frequently associated with a complex medial meniscus tear. Level III, case-control study. Copyright © 2016 Arthroscopy Association of North America. All rights reserved.

  5. Arthroscopic partial meniscectomy of a medial meniscus bucket-handle tear using the posteromedial portal.

    PubMed

    Ahn, Jin Hwan; Oh, Irvin

    2004-09-01

    Arthroscopic resection of irreparable bucket-handle tears of the medial meniscus is a commonly performed procedure. Adequate visualization of the posterior horn of the medial meniscus can be a challenging task with the conventional use of the anterior portal. An attempt to resect the posterior horn in a blind fashion may result in iatrogenic damage of the articular cartilage in the posterior compartment, over-resection of a remnant meniscus, or an insufficient resection of the torn fragment. We describe the use of the posteromedial portal for an accurate visualization and resection of the posterior attachment of a bucket-handle tear for arthroscopic partial meniscectomy, as well as detection of other injuries that may be involved in the posteromedial compartment, while avoiding injury to other intra-articular structures during the arthroscopic procedure. We found that the use of the posteromedial portal is a safe and efficient method in removing a bucket-handle tear of the medial meniscus in one piece.

  6. Effect of Leukocyte-Rich and Platelet-Rich Plasma on Healing of a Horizontal Medial Meniscus Tear in a Rabbit Model

    PubMed Central

    Shin, Kyun Ho; Lee, Haseok; Kang, Seonghyun; Ko, You-Jin; Lee, Seung-Yup; Park, Jung-Ho; Bae, Ji-Hoon

    2015-01-01

    There are limited reports on the effect of platelet-rich plasma (PRP) on meniscus healing. The purpose of this study was to investigate the effect of leukocyte-rich PRP (L-PRP) on potential healing of the horizontal medial meniscus tears in a rabbit model. A horizontal medial meniscus tear was created in both knees of nine skeletally mature adult rabbits. Left or right knees were randomly assigned to a L-PRP group, or a control group. 0.5 mL of L-PRP from 10 mL of each rabbit's whole blood was prepared and injected into the horizontal tears in a L-PRP group. None was applied to the horizontal tears in a control group. The histological assessment of meniscus healing was performed at two, four, and six weeks after surgery. We found that there were no significant differences of quantitative histologic scoring between two groups at 2, 4, and 6 weeks after surgery (p > 0.05). This study failed to show the positive effect of single injection of L-PRP on enhancing healing of the horizontal medial meniscus tears in a rabbit model. Single injection of L-PRP into horizontal meniscus tears may not effectively enhance healing of horizontal medial meniscus tears. PMID:26180783

  7. Second-look arthroscopic findings after repairs of posterior root tears of the medial meniscus.

    PubMed

    Seo, Hee-Soo; Lee, Su-Chan; Jung, Kwang-Am

    2011-01-01

    A posterior root tear of the medial meniscus disrupts hoop tension and causes extrusion of the meniscus, which results in progressive cartilage degeneration. To identify the structural integrity of healing after arthroscopic repair of a posterior root tear of the medial meniscus by second-look arthroscopy and to determine the clinical relevance of the findings. Case series; Level of evidence, 4. From December 2006 to August 2008, 21 consecutive patients underwent arthroscopic pullout suture repair for a posterior root tear of the medial meniscus. Eleven were available for second-look arthroscopy evaluation (mean, 13.4 months; range, 10 to 22 months). The healing status of the repaired meniscus was classified as complete healing, lax healing, scar tissue healing, and failed healing. Chondral lesions were reviewed using arthroscopic photographs, and clinical evaluation was based on the Lysholm knee scores and the Hospital for Special Surgery scores. There was no case with complete healing. Five knees had lax healing (symptomatic in 2 and asymptomatic in 3); 4, scar tissue healing (asymptomatic in all 4); and 2, failed healing (symptomatic in 1 and asymptomatic in 1). Progression of the chondral lesion was found in 1 case. Mean Lysholm scores improved from 56.1 preoperatively (range, 41 to 71) to 83.0 at follow-up (range, 69 to 91; P = .003); mean Hospital for Special Surgery score also significantly increased, from 64.1 (range, 50 to 76) to 87.4 (range, 77 to 95; P = .003). Complete healing was not observed in this retrospective case series of posterior horn meniscus repairs performed by 2 surgeons using a single technique. Further research is needed to clarify why all patients showed clinical improvement despite findings of incomplete or failed healing on second-look arthroscopy. Treatment modalities for managing posterior root tears of the medial meniscus require further investigation to determine their efficacy.

  8. Traumatic posterior root tear of the medial meniscus in patients with severe medial instability of the knee.

    PubMed

    Ra, Ho Jong; Ha, Jeong Ku; Jang, Ho Su; Kim, Jin Goo

    2015-10-01

    To examine the incidence and diagnostic rate of traumatic medial meniscus posterior root tear associated with severe medial instability and to evaluate the effectiveness of pullout repair. From 2007 to 2011, 51 patients who underwent operation due to multiple ligament injuries including medial collateral ligament rupture were reviewed retrospectively. The International Knee Documentation Committee (IKDC) subjective and Lysholm score were evaluated pre- and postoperatively. Postoperative magnetic resonance imaging (MRI) was performed, and if indicated, a second-look arthroscopic examination was conducted. Fourteen out of 51 patients were associated with severe medial instability. Seven patients were diagnosed with traumatic medial meniscus posterior root tear and underwent arthroscopic pullout repair. Five of them were missed at initial diagnosis using MRI. In seven patients, the mean Lysholm and IKDC subjective scores improved from 74.6 ± 10.3 and 47.6 ± 7.3 to 93.0 ± 3.7 and 91.6 ± 2.6, respectively. All showed complete healing of meniscus root on follow-up MRI and second-look arthroscopy. Medial meniscus posterior root tear may occur in severe medial instability from trauma. It is a common mistake that surgeons may not notice on the diagnosis of those injuries using MRI. Therefore, a high index of suspicion is required for the diagnosis of medial meniscus posterior root tear in this type of injuries. The traumatic medial meniscus posterior root tear could be healed successfully using arthroscopic pullout repair technique. The possibility of the medial meniscus posterior root tear should be considered in severe medial instability and arthroscopic pullout repair can be an effective option for treatment. Case series with no comparison group, Level IV.

  9. Lateral meniscus posterior root tear contributes to anterolateral rotational instability and meniscus extrusion in anterior cruciate ligament-injured patients.

    PubMed

    Minami, Takao; Muneta, Takeshi; Sekiya, Ichiro; Watanabe, Toshifumi; Mochizuki, Tomoyuki; Horie, Masafumi; Katagiri, Hiroki; Otabe, Koji; Ohara, Toshiyuki; Katakura, Mai; Koga, Hideyuki

    2018-04-01

    The purposes of this study were to investigate (1) meniscus status and clinical findings in anterior cruciate ligament (ACL)-injured patients to clarify associations between the meniscus posterior root tear (PRT) and knee instability, and (2) magnetic resonance imaging (MRI) findings of the PRT to clarify sensitivity and specificity of MRI and prevalence of meniscus extrusion. Three hundred and seventeen patients with primary ACL reconstruction were included. PRTs for both medial and lateral sides were confirmed by reviewing surgical records. Preoperative MRI was reviewed to evaluate sensitivity and specificity of the PRT and meniscus extrusion width (MEW). Clinical information regarding the number of giving-way episodes, preoperative KT-1000 measurements and preoperative pivot shift was also assessed. Thirty-nine patients had a lateral meniscus (LM) PRT, whereas only four patients had a medial meniscus PRT. One hundred and seventeen patients had no meniscus tear (control). Twenty-eight patients (71.8%) showed positive signs of the LMPRT based on at least one view of MR images, with the coronal view showing the highest sensitivity. MEW in the LMPRT group was significantly larger than that in the control group. The preoperative pivot shift test grade in the LMPRT group was significantly greater than that in the control group. There were no significant differences in other parameters. In ACL-injured patients, the LMPRT was associated with ALRI as well as with meniscus extrusion. The coronal view of MRI was useful in identifying the LMPRT, although its sensitivity was not high. Therefore, surgeons should prepare to repair PRTs at the time of ACL reconstruction regardless of MRI findings, and they should make every effort to repair the LMPRT. III.

  10. Changes in Contact Area in Meniscus Horizontal Cleavage Tears Subjected to Repair and Resection.

    PubMed

    Beamer, Brandon S; Walley, Kempland C; Okajima, Stephen; Manoukian, Ohan S; Perez-Viloria, Miguel; DeAngelis, Joseph P; Ramappa, Arun J; Nazarian, Ara

    2017-03-01

    To assess the changes in tibiofemoral contact pressure and contact area in human knees with a horizontal cleavage tear before and after treatment. Ten human cadaveric knees were tested. Pressure sensors were placed under the medial meniscus and the knees were loaded at twice the body weight for 20 cycles at 0°, 10°, and 20° of flexion. Contact area and pressure were recorded for the intact meniscus, the meniscus with a horizontal cleavage tear, after meniscal repair, after partial meniscectomy (single leaflet), and after subtotal meniscectomy (double leaflet). The presence of a horizontal cleavage tear significantly increased average peak contact pressure and reduced effective average tibiofemoral contact area at all flexion angles tested compared with the intact state (P < .03). There was approximately a 70% increase in contact pressure after creation of the horizontal cleavage tear. Repairing the horizontal cleavage tear restored peak contact pressures and areas to within 15% of baseline, statistically similar to the intact state at all angles tested (P < .05). Partial meniscectomy and subtotal meniscectomy significantly increased average peak contact pressure and reduced average contact area at all degrees of flexion compared with the intact state (P < .05). The presence of a horizontal cleavage tear in the medial meniscus causes a significant reduction in contact area and a significant elevation in contact pressure. These changes may accelerate joint degeneration. A suture-based repair of these horizontal cleavage tears returns the contact area and contact pressure to nearly normal, whereas both partial and subtotal meniscectomy lead to significant reductions in contact area and significant elevations in contact pressure within the knee. Repairing horizontal cleavage tears may lead to improved clinical outcomes by preserving meniscal tissue and the meniscal function. Understanding contact area and peak contact pressure resulting from differing strategies

  11. The knee meniscus: management of traumatic tears and degenerative lesions

    PubMed Central

    Beaufils, Philippe; Becker, Roland; Kopf, Sebastian; Matthieu, Ollivier; Pujol, Nicolas

    2017-01-01

    Meniscectomy is one of the most popular orthopaedic procedures, but long-term results are not entirely satisfactory and the concept of meniscal preservation has therefore progressed over the years. However, the meniscectomy rate remains too high even though robust scientific publications indicate the value of meniscal repair or non-removal in traumatic tears and non-operative treatment rather than meniscectomy in degenerative meniscal lesions In traumatic tears, the first-line choice is repair or non-removal. Longitudinal vertical tears are a proper indication for repair, especially in the red-white or red-red zones. Success rate is high and cartilage preservation has been proven. Non-removal can be discussed for stable asymptomatic lateral meniscal tears in conjunction with anterior cruciate ligament (ACL) reconstruction. Extended indications are now recommended for some specific conditions: horizontal cleavage tears in young athletes, hidden posterior capsulo-meniscal tears in ACL injuries, radial tears and root tears. Degenerative meniscal lesions are very common findings which can be considered as an early stage of osteoarthritis in middle-aged patients. Recent randomised studies found that arthroscopic partial meniscectomy (APM) has no superiority over non-operative treatment. Thus, non-operative treatment should be the first-line choice and APM should be considered in case of failure: three months has been accepted as a threshold in the ESSKA Meniscus Consensus Project presented in 2016. Earlier indications may be proposed in cases with considerable mechanical symptoms. The main message remains: save the meniscus! Cite this article: EFORT Open Rev 2017;2. DOI: 10.1302/2058-5241.2.160056. Originally published online at www.efortopenreviews.org PMID:28698804

  12. Medial Meniscus Posterior Root Tear: A Comprehensive Review

    PubMed Central

    Lee, Dhong Won; Ha, Jeong Ku

    2014-01-01

    Damage to the medial meniscus root, for example by a complete radial tear, destroys the ability of the knee to withstand hoop strain, resulting in contact pressure increases and kinematic alterations. For these reasons, several techniques have been developed to repair the medial meniscus posterior root tear (MMPRT), many of which have shown complete healing of the repaired MMPRT. However, efforts to standardize or optimize the treatment for MMPRT are much needed. When planning a surgical intervention for an MMPRT, strict surgical indications regarding the effect of pullout strength on the refixed root, bony degenerative changes, mechanical alignment, and the Kellgren-Lawrence grade should be considered. Although there are several treatment options and controversies, the current trend is to repair the MMPRT using various techniques including suture anchors and pullout sutures if the patient meets the indications. However, there are still debates on the restoration of hoop tension and prevention of arthritis after repair and further biomechanical and clinical studies should be conducted in the future. The aim of this article was to review and summarize the recent literature regarding various diagnosis and treatment strategies of MMPRT, especially focusing on conflict issues including whether repair techniques can restore the main function of normal meniscus and which is the best suture technique to repair the MMPRT. The authors attempted to provide a comprehensive review of previous studies ranging from basic science to current surgical techniques. PMID:25229041

  13. Medial meniscus posterior root tear: a comprehensive review.

    PubMed

    Lee, Dhong Won; Ha, Jeong Ku; Kim, Jin Goo

    2014-09-01

    Damage to the medial meniscus root, for example by a complete radial tear, destroys the ability of the knee to withstand hoop strain, resulting in contact pressure increases and kinematic alterations. For these reasons, several techniques have been developed to repair the medial meniscus posterior root tear (MMPRT), many of which have shown complete healing of the repaired MMPRT. However, efforts to standardize or optimize the treatment for MMPRT are much needed. When planning a surgical intervention for an MMPRT, strict surgical indications regarding the effect of pullout strength on the refixed root, bony degenerative changes, mechanical alignment, and the Kellgren-Lawrence grade should be considered. Although there are several treatment options and controversies, the current trend is to repair the MMPRT using various techniques including suture anchors and pullout sutures if the patient meets the indications. However, there are still debates on the restoration of hoop tension and prevention of arthritis after repair and further biomechanical and clinical studies should be conducted in the future. The aim of this article was to review and summarize the recent literature regarding various diagnosis and treatment strategies of MMPRT, especially focusing on conflict issues including whether repair techniques can restore the main function of normal meniscus and which is the best suture technique to repair the MMPRT. The authors attempted to provide a comprehensive review of previous studies ranging from basic science to current surgical techniques.

  14. The potential effect of anatomic relationship between the femur and the tibia on medial meniscus tears.

    PubMed

    Bozkurt, Murat; Unlu, Serhan; Cay, Nurdan; Apaydin, Nihal; Dogan, Metin

    2014-10-01

    The anatomic and the kinematical relationships between the femur and the tibia have been previously examined in both normal and diseased knees. However, less attention has been directed to the effect of these relationships on the meniscal diseases. Therefore, we aimed to investigate the impact of femorotibial incongruence on both lateral and medial meniscal tears. A total of 100 images obtained from MRI of 100 patients (39 males and 61 females) were included in the study. Diameters of the medial and the lateral femoral condyles, thicknesses of the menisci, and diameters of the medial and the lateral tibial articular surfaces were measured. The medial meniscus tear was detected in 40 (40 %) patients. However, no lateral meniscus tear was found. Significant relationships were found between the diameters of the posterior medial femoral condyle and the medial tibial superior articular surface and between the diameters of the posterior lateral femoral condyle and the lateral tibial superior articular surface. The mean values for the diameter of the medial condyle of the femur, the lateral condyle of the femur, the medial superior articular surface of the tibia, and the lateral superior articular surface of the tibia were found to be significantly higher in cases with meniscus tear compared to cases without meniscus tear. However, no significant difference was present regarding the thicknesses of the medial and the lateral menisci. A positive relationship between the diameter of the posterior medial femoral condyle and the tibial medial superior articular surface was found in cases with (n = 40) (r (2) = 0.208, p = 0.003) and without tear (n = 60) (r (2) = 0.182, p = 0.001). In addition, a significant positive relationship was found between the diameter of the posterior medial femoral condyle and the medial tibial superior articular surface in cases with and without tear. The impact of femorotibial incongruence on the medial meniscus tear is important for

  15. Biomechanical consequences of a tear of the posterior root of the medial meniscus. Surgical technique.

    PubMed

    Harner, Christopher D; Mauro, Craig S; Lesniak, Bryson P; Romanowski, James R

    2009-10-01

    Tears of the posterior root of the medial meniscus are becoming increasingly recognized. They can cause rapidly progressive arthritis, yet their biomechanical effects are not understood. The goal of this study was to determine the effects of posterior root tears of the medial meniscus and their repairs on tibiofemoral joint contact pressure and kinematics. Nine fresh-frozen cadaver knees were used. An axial load of 1000 N was applied with a custom testing jig at each of four knee-flexion angles: 0 degrees , 30 degrees , 60 degrees , and 90 degrees . The knees were otherwise unconstrained. Four conditions were tested: (1) intact, (2) a posterior root tear of the medial meniscus, (3) a repaired posterior root tear, and (4) a total medial meniscectomy. Fuji pressure-sensitive film was used to record the contact pressure and area for each testing condition. Kinematic data were obtained by using a robotic arm to record the position of the knees for each loading condition. Three-dimensional knee kinematics were analyzed with custom programs with use of previously described transformations. The measured variables were axial rotation, varus angulation, lateral translation, and anterior translation. In the medial compartment, a posterior root tear of the medial meniscus caused a 25% increase in peak contact pressure compared with that found in the intact condition (p < 0.001). Repair restored the peak contact pressure to normal. No difference was detected between the peak contact pressure after the total medial meniscectomy and that associated with the root tear. The peak contact pressure in the lateral compartment after the total medial meniscectomy was up to 13% greater than that for all other conditions (p = 0.026). Significant increases in external rotation and lateral tibial translation, compared with the values in the intact knee, were observed in association with the posterior root tear (2.98 degrees and 0.84 mm, respectively) and the meniscectomy (4.45 degrees and 0

  16. Pullout failure strength of the posterior horn of the medial meniscus with root ligament tear.

    PubMed

    Kim, Young-Mo; Joo, Yong-Bum

    2013-07-01

    To evaluate the reparability of the posterior horn of the medial meniscus with root ligament tear by measuring the actual pullout failure strength of a simple vertical suture of an arthroscopic subtotal meniscectomized posterior horn of the medial meniscus. From November 2009 to May 2010, nine posterior horns of the medial meniscus specimens were collected from arthroscopic subtotal meniscectomy performed as a treatment for root ligament rupture of the posterior horn of the medial meniscus. Simple vertical sutures were performed on the specimens, and pullout failure load was tested with a biaxial servohydraulic testing machine (Model 8874; Instron Corp., Norwood, MA, USA). The degree of degeneration, extrusion, and medial displacement of the medial meniscus were evaluated with magnetic resonance imaging (MRI). The Kellgren-Lawrence classification was used in standing plain radiography, and mechanical alignment was measured using orthoroentgenography. Tear morphology was classified into ligament proper type or meniscoligamentous junctional type according to the site of the torn root ligament of the posterior horn of the medial meniscus during arthroscopy. The mean pullout failure strength of the posterior horn of the medial meniscus was 71.6 ± 23.2 N (range, 41.4-107.7 N). The degree of degeneration of the posterior horn of the medial meniscus on MRI showed statistically significant correlation with pullout failure strength and Kellgren-Lawrence classification. Pullout failure strength showed correlation with mechanical alignment and Kellgren-Lawrence classification (P < 0.05). The measurement of pullout failure strength of the posterior horn of the medial meniscus with root ligament tear showed a degree of repairability. The degree of degeneration of the posterior horn of the medial meniscus on MRI showed a significant correlation with the pullout failure strength. The pullout failure strength was also not only correlated with the degree of degeneration of the

  17. Medial Meniscus Posterior Root Tear Repair Using a 2-Simple-Suture Pullout Technique.

    PubMed

    Samy, Tarek Mohamed; Nassar, Wael A M; Zakaria, Zeiad Mohamed; Farrag Abdelaziz, Ahmed Khaled

    2017-06-01

    Medial meniscus posterior root tear is one of the underestimated knee injuries in terms of incidence. Despite its grave sequelae, using simple but effective technique can maintain the native knee joint longevity. In the current note, a 2-simple-suture pullout technique was used to effectively reduce the meniscus posterior root to its anatomic position. The success of the technique depended on proper tool selection as well as tibial tunnel direction that allowed easier root suturing and better suture tensioning, without inducing any iatrogenic articular cartilage injury or meniscal tissue loss. Using anterior knee arthroscopy portals, anterolateral as a viewing portal and anteromedial as a working portal, a 7-mm tibial tunnel starting at Gerdy tubercle and ending at the medial meniscus posterior root bed was created. The 2 simple sutures were retrieved through the tunnel and tensioned and secured over a 12-mm-diameter washer at the tibial tunnel outer orifice. Anatomic reduction of the medial meniscus posterior root tear was confirmed arthroscopically intraoperatively and radiologically by postoperative magnetic resonance imaging.

  18. Usability and reproducibility of tear meniscus values generated via swept-source optical coherence tomography and the slit lamp with a graticule method.

    PubMed

    Imamura, Hitoshi; Tabuchi, Hitoshi; Nakakura, Shunsuke; Nagasato, Daisuke; Baba, Hiroaki; Kiuchi, Yoshiaki

    2018-04-01

    To investigate the usability and the reproducibility of the tear meniscus values via swept-source optical coherence tomography (SS-OCT) and the conventional slit lamp microscope method with a graticule. The right eye was examined in 90 healthy adult subjects who were grouped according to age (group 1: 20-39 years; group 2: 40-59 years; group 3: ≥60 years). The tear meniscus height (TMH) and tear meniscus area were measured using SS-OCT and TMH by the slit lamp microscope method. The reproducibility of each method was calculated using intraclass correlation coefficients (ICCs) in additionally enrolled 30 healthy young subjects. We also evaluated TMH at 3 mm from the corneal center in both temporal and nasal directions using SS-OCT. The mean of the TMH values measured by SS-OCT was significantly higher than those measured by the slit lamp method (328 vs. 212 μm, P < 0.001, respectively). High reproducibility was observed for each method (ICC > 0.75 for both). No statistically significant differences were found in TMH among the age groups using both SS-OCT and slit lamp methods (P = 0.985, 0.380, respectively). TMH values at both sides of the corneal center were significantly smaller than those at the corneal center (P < 0.0001). TMH values obtained by the slit lamp method were lower than those obtained by SS-OCT. However, both methods yielded highly reproducible TMH measurements, suggesting that they are clinically useful. Tear meniscus values did not vary by age but by measurement points in our cohort.

  19. Clinical Evaluation of the Root Tear of the Posterior Horn of the Medial Meniscus in Total Knee Arthroplasty for Osteoarthritis.

    PubMed

    Choi, Eui-Sung; Park, Sang-Jun

    2015-06-01

    To investigate the incidence of root tears of the posterior horn of the medial meniscus in total knee replacement arthroplasty for knee osteoarthritis and retrospectively analyze clinical results and factors associated with root tears. There were 197 knees of 140 enrolled patients who had undergone total knee replacement arthroplasty between September 2010 and May 2014. The presence of a root tear of the posterior horn of the medial meniscus was confirmed in all patients. Statistical analysis was performed to investigate the correlation between root tears and the possible factors of meniscal tears including gender, age, severity of symptoms (visual analogue scale [VAS] score and medial joint line tenderness), grade of osteoarthritis (Kellgren-Lawrence grading scale), body mass index (BMI), varus deformity, and mechanical axis deviation. Meniscal tears were observed in 154 knees (78.17%). The root tear had correlation with the severity of osteoarthritis (p<0.05), varus deformity (p<0.05), mechanical axis deviation (p<0.05), and BMI (p<0.05). Factors considered to represent the severity of osteoarthritis were found to be associated with root tears of the medial meniscus posterior horn. Increased BMI seemed to be associated with the increased incidence of root tears of the medial meniscus posterior horn.

  20. Clinical Evaluation of the Root Tear of the Posterior Horn of the Medial Meniscus in Total Knee Arthroplasty for Osteoarthritis

    PubMed Central

    Park, Sang-Jun

    2015-01-01

    Purpose To investigate the incidence of root tears of the posterior horn of the medial meniscus in total knee replacement arthroplasty for knee osteoarthritis and retrospectively analyze clinical results and factors associated with root tears. Materials and Methods There were 197 knees of 140 enrolled patients who had undergone total knee replacement arthroplasty between September 2010 and May 2014. The presence of a root tear of the posterior horn of the medial meniscus was confirmed in all patients. Statistical analysis was performed to investigate the correlation between root tears and the possible factors of meniscal tears including gender, age, severity of symptoms (visual analogue scale [VAS] score and medial joint line tenderness), grade of osteoarthritis (Kellgren-Lawrence grading scale), body mass index (BMI), varus deformity, and mechanical axis deviation. Results Meniscal tears were observed in 154 knees (78.17%). The root tear had correlation with the severity of osteoarthritis (p<0.05), varus deformity (p<0.05), mechanical axis deviation (p<0.05), and BMI (p<0.05). Conclusions Factors considered to represent the severity of osteoarthritis were found to be associated with root tears of the medial meniscus posterior horn. Increased BMI seemed to be associated with the increased incidence of root tears of the medial meniscus posterior horn. PMID:26060607

  1. Predictive value of painful popping for a posterior root tear of the medial meniscus in middle-aged to older Asian patients.

    PubMed

    Bae, Ji-Hoon; Paik, Nak Hwan; Park, Gyu-Won; Yoon, Jung-Ro; Chae, Dong-Ju; Kwon, Jae Ho; Kim, Jong In; Nha, Kyung-Wook

    2013-03-01

    The purpose of this study was to determine the accuracy, sensitivity, specificity, and predictive values of a single event of painful popping in the presence of a posterior root tear of the medial meniscus in middle-aged to older Asian patients. We conducted a retrospective review of medical records of 936 patients who underwent arthroscopic surgeries for an isolated medial meniscus tear between January 2000 and December 2010. There were 332 men and 604 women with a mean age of 41 years (range, 25 to 66 years). The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of a painful popping sensation for a posterior root tear of the medial meniscus were calculated. Arthroscopy confirmed the presence of posterior root tears of the medial menisci in 237 of 936 patients (25.3%). A single event of a painful popping sensation was present in 86 of these 936 patients (9.1%). Of these 86 patients with a painful popping sensation, 83 (96.5%) were categorized as having an isolated posterior root tear of the medial meniscus. The positive predictive value of a painful popping sensation in identifying a posterior root tear of the medial meniscus was 96.5%, the negative predictive value was 81.8%, the sensitivity was 35.0%, the specificity was 99.5%, and the diagnostic accuracy was 77.9%. A single event of painful popping can be a highly predictive clinical sign of a posterior root tear of the medial meniscus in the middle-aged to older Asian population. However, it has low sensitivity for the detection of a posterior root tear of the medial meniscus. Level IV, therapeutic case series. Copyright © 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  2. The Fate of Meniscus Tears Left in situ at the time of Anterior Cruciate Ligament Reconstruction: A 6-year Follow-up Study from the MOON Cohort

    PubMed Central

    Duchman, Kyle R.; Westermann, Robert W.; Spindler, Kurt P.; Reinke, Emily K.; Huston, Laura J.; Amendola, Annunziato; Wolf, Brian R.

    2016-01-01

    Background The management of meniscus tears identified at the time of primary ACL reconstruction is highly variable and includes repair, meniscectomy, and non-treatment. Hypothesis/Purpose The purpose of this study is to determine the reoperation rate for meniscus tears left untreated at the time of ACL reconstruction with minimum follow-up of 6 years. We hypothesize that small, peripheral tears identified at the time of ACL reconstruction managed with “no treatment” will have successful clinical outcomes. Study Design Retrospective study of a prospective cohort; Level of Evidence, 3 Methods Patients with meniscus tears left untreated at the time of primary ACL reconstruction were identified from a multicenter study group with minimum 6-year follow-up. Patient, tear, and reoperation data were obtained for analysis. Need for reoperation was used as the primary endpoint, with analysis performed to determine patient and tear characteristics associated with reoperation. Results There were 194 patients with 208 meniscus tears (71 medial; 137 lateral) left in situ without treatment with complete follow-up for analysis. Of these, 97.8% of lateral and 94.4% of medial untreated tears required no reoperation. Sixteen tears (7.7%) left in situ without treatment underwent subsequent reoperation: 9 tears (4.3%) underwent reoperation in the setting of revision ACL reconstruction and 7 tears (3.4%) underwent reoperation for isolated meniscus pathology. Patient age was significantly lower in patients requiring reoperation, while tears measuring ≥ 10 mm more frequently required reoperation. Conclusions Lateral and medial meniscus tears left in situ at the time of ACL reconstruction did not require reoperation at minimum 6-year follow-up for 97.8% and 94.4% of tears, respectively. These findings reemphasize the low reoperation rate following non-treatment of small, peripheral lateral meniscus tears while noting less predictable results for medial meniscus tears left without

  3. The Fate of Meniscus Tears Left In Situ at the Time of Anterior Cruciate Ligament Reconstruction: A 6-Year Follow-up Study From the MOON Cohort.

    PubMed

    Duchman, Kyle R; Westermann, Robert W; Spindler, Kurt P; Reinke, Emily K; Huston, Laura J; Amendola, Annunziato; Wolf, Brian R

    2015-11-01

    The management of meniscus tears identified at the time of primary anterior cruciate ligament (ACL) reconstruction is highly variable and includes repair, meniscectomy, and nontreatment. The purpose of this study was to determine the reoperation rate for meniscus tears left untreated at the time of ACL reconstruction with a minimum follow-up of 6 years. The hypothesis was that small peripheral tears identified at the time of ACL reconstruction managed with "no treatment" would have successful clinical outcomes. Cohort study; Level of evidence, 3. Patients with meniscus tears left untreated at the time of primary ACL reconstruction were identified from a multicenter study group with a minimum 6-year follow-up. Patient, tear, and reoperation data were obtained for analysis. The need for reoperation was used as the primary endpoint, with analysis performed to determine patient and tear characteristics associated with reoperation. There were 194 patients with 208 meniscus tears (71 medial, 137 lateral) left in situ without treatment with a complete follow-up for analysis. Of these, 97.8% of lateral and 94.4% of medial untreated tears required no reoperation. Sixteen tears (7.7%) left in situ without treatment underwent subsequent reoperation: 9 tears (4.3%) underwent reoperation in the setting of revision ACL reconstruction, and 7 tears (3.4%) underwent reoperation for an isolated meniscus injury. The patient age was significantly lower in patients requiring reoperation, while tears measuring ≥10 mm more frequently required reoperation. Lateral and medial meniscus tears left in situ at the time of ACL reconstruction did not require reoperation at a minimum 6-year follow-up for 97.8% and 94.4% of tears, respectively. These findings re-emphasize the low reoperation rate after the nontreatment of small, peripheral lateral meniscus tears while noting less predictable results for medial meniscus tears left without treatment. © 2015 The Author(s).

  4. Temporal Characteristics of Sodium Fluorescein in the Tear Meniscus.

    PubMed

    Markoulli, Maria; Isa, Nur Amalina M D; Papas, Eric B

    2017-02-01

    To observe the emission intensity profile of sodium fluorescein in the human tear film as a function of time and concentration. Twenty-two participants with no dry eye signs or symptoms were randomly allocated to receive 1 μL of either a 2 or 10% concentration of fluorescein to one eye. Images of the inferior tear meniscus were captured at regular intervals over 30 minutes and the process repeated for the other eye with the alternate concentration. Fluorescence intensity was quantified on the basis of the grayscale pixel values in the tear meniscus images. The fluorescein-decay profile over time and between concentrations was determined. Peak fluorescence intensity was reached in 3.9 ± 3.0 and 8.7 ± 4.4 minutes after instillation for the 2 and 10% concentrations, respectively. The 10% concentration of fluorescein maintained its peak fluorescence intensity longer than the 2% concentration (about 9 and 2 minutes, respectively). The peak fluorescence intensity was not significantly different between the higher and lower concentrations (44 ± 37 vs. 38 ± 32 units, P = .22). For both concentrations, the observed intensity did not return to baseline levels by the end of the 30-minute observation time. The fluorescence intensity of fluorescein in a clinical setting varies with time such that both the onset and duration of maximum brightness are concentration dependent. At low concentration (2%), maximum brightness occurs almost immediately after instillation and lasts about 2 minutes. With a higher concentration (10%), the effective working window is delayed for about 7 to 8 minutes. Irrespective of initial concentration, observable fluorescence remains in the tear film beyond 30 minutes post-instillation.

  5. Anatomical significance of a posterior horn of medial meniscus: the relationship between its radial tear and cartilage degradation of joint surface.

    PubMed

    Kan, Akinori; Oshida, Midori; Oshida, Shigemi; Imada, Masato; Nakagawa, Takumi; Okinaga, Shuji

    2010-01-12

    Traumatic injury and surgical meniscectomy of a medial meniscus are known to cause subsequent knee osteoarthritis. However, the difference in the prevalence of osteoarthritis caused by the individual type of the medial meniscal tear has not been elucidated. The aim of this study was to investigate what type of tear is predominantly responsible for the degradation of articular cartilage in the medial compartment of knee joints. Five hundred and forty eight cadaveric knees (290 male and 258 female) were registered in this study. The average age of cadavers at death was 78.8 years old (range: 52-103 years). The knees were macroscopically examined and their medial menisci were classified into four groups according to types of tears: "no tear", "radial tear of posterior horn", "other types of tear" and "worn-out meniscus" groups. The severity of cartilage degradation in their medial compartment of knee joints was evaluated using the international cartilage repair society (ICRS) grading system. We statistically compared the ICRS grades among the groups using Mann-Whitney U test. The knees were assigned into the four groups: 416 "no tear" knees, 51 "radial tear of posterior horn" knees, 71 "other types of tear" knees, and 10 "worn-out meniscus" knees. The knees with substantial meniscal tears showed the severer ICRS grades of cartilage degradation than those without meniscal tears. In addition, the ICRS grades were significantly severer in the "radial tear of posterior horn" group than in the "other types of tear" group, suggesting that the radial tear of posterior horn in the medial meniscus is one of the risk factors for cartilage degradation of joint surface. We have clarified the relationship between the radial tear of posterior horn in the medial meniscus and the severer grade of cartilage degradation. This study indicates that the efforts should be made to restore the anatomical role of the posterior horn in keeping the hoop strain, when patients' physical activity

  6. Double PCL sign does not always indicate a bucket-handle tear of medial meniscus.

    PubMed

    Liu, Chen; Zheng, Hua Yong; Huang, Yan; Li, Hai Peng; Wu, Han; Sun, Tian Sheng; Yao, Jian Hua

    2016-09-01

    The discoid medial meniscus is an extremely rare anomaly. Bilateral discoid medial menisci are much more rare but intermittently reported. We report the first case of bilateral discoid medial menisci with positive double PCL sign, which typically indicates a bucket-handle tear of medial meniscus. A literature review was also conducted on bilateral discoid medial menisci.

  7. Evaluating tear clearance rate with optical coherence tomography.

    PubMed

    Garaszczuk, Izabela K; Mousavi, Maryam; Cervino Exposito, Alejandro; Bartuzel, Maciej M; Montes-Micó, Robert; Iskander, D Robert

    2018-02-01

    To assess the early-phase of tear clearance rate (TCR) with anterior segment optical coherence tomography (OCT) and to determine the association between TCR and other clinical measures of the tear film in a group of young subjects with different levels of tear film quality. TCR was classified as the percentage decrease of subject's inferior tear meniscus height 30s after instillation of 5μl 0.9% saline solution. Fifty subjects (32F and 18M) aged (mean±standard deviation) 25.5±4.3 years volunteered for the study. It consisted of a review of medical history, Ocular Surface Disease Index (OSDI) questionnaire, tear film osmolarity measurements, slit lamp examination and TCR estimation based on dynamic measurements of the lower tear meniscus with OCT. Estimates of TCR were contrasted against subject age and tear film measures commonly used for dry eye diagnosis, which includes OSDI score, fluorescein tear film break-up time (FBUT), tear meniscus height (TMH), blinking frequency, tear film osmolarity and corneal staining. The group mean TCR was 29±13% and 36±19% respectively after 30 and 60s margin after saline solution instillation. Statistically significant correlations were found between TCR and FBUT (r 2 =0.319, p<0.001), blinking frequency (r 2 =0.138, p<0.01), tear film osmolarity (r 2 =0.133, p<0.01) and subject's age (r 2 =0.095, p<0.05). Anterior segment optical coherence tomography allows following changes of tear meniscus morphology post saline solution instillation and evaluating the TCR. OCT based TCR might be used as additional measure of the lacrimal functional unit. Copyright © 2017 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.

  8. Biomechanical consequences of a tear of the posterior root of the medial meniscus. Similar to total meniscectomy.

    PubMed

    Allaire, Robert; Muriuki, Muturi; Gilbertson, Lars; Harner, Christopher D

    2008-09-01

    Tears of the posterior root of the medial meniscus are becoming increasingly recognized. They can cause rapidly progressive arthritis, yet their biomechanical effects are not understood. The goal of this study was to determine the effects of posterior root tears of the medial meniscus and their repairs on tibiofemoral joint contact pressure and kinematics. Nine fresh-frozen cadaver knees were used. An axial load of 1000 N was applied with a custom testing jig at each of four knee-flexion angles: 0 degrees, 30 degrees, 60 degrees, and 90 degrees. The knees were otherwise unconstrained. Four conditions were tested: (1) intact, (2) a posterior root tear of the medial meniscus, (3) a repaired posterior root tear, and (4) a total medial meniscectomy. Fuji pressure-sensitive film was used to record the contact pressure and area for each testing condition. Kinematic data were obtained by using a robotic arm to record the position of the knees for each loading condition. Three-dimensional knee kinematics were analyzed with custom programs with use of previously described transformations. The measured variables were axial rotation, varus angulation, lateral translation, and anterior translation. In the medial compartment, a posterior root tear of the medial meniscus caused a 25% increase in peak contact pressure compared with that found in the intact condition (p < 0.001). Repair restored the peak contact pressure to normal. No difference was detected between the peak contact pressure after the total medial meniscectomy and that associated with the root tear. The peak contact pressure in the lateral compartment after the total medial meniscectomy was up to 13% greater than that for all other conditions (p = 0.026). Significant increases in external rotation and lateral tibial translation, compared with the values in the intact knee, were observed in association with the posterior root tear (2.98 degrees and 0.84 mm, respectively) and the meniscectomy (4.45 degrees and 0

  9. Simultaneous measurement of tear film dynamics using wavefront sensor and optical coherence tomography.

    PubMed

    Koh, Shizuka; Tung, Cynthia; Aquavella, James; Yadav, Rahul; Zavislan, James; Yoon, Geunyoung

    2010-07-01

    PURPOSE. To investigate tear film dynamics using simultaneous measurements of ocular aberrations and lower tear meniscus. METHODS. Simultaneous measurements of wavefront aberration and lower tear meniscus were performed for 11 normal eyes and 7 eyes with short tear film break-up time (SBUT) dry eye, with a tear film break-up time shorter than 5 seconds, using a wavefront sensor and an anterior segment optical coherence tomography (OCT). During the measurement, the subjects were instructed to blink every 6 seconds for a total of 30 seconds. From the measured aberration, root mean square (RMS) wavefront error and volume modulation transfer function (vMTF) induced by changes in tear film dynamics were calculated for a 5-mm pupil. Lower tear meniscus height (TMH) and area (TMA) were estimated from the cross-sectional OCT images of lower tear meniscus. RESULTS. There was a positive correlation between RMS and tear meniscus dimensions and a negative correlation between vMTF and tear meniscus in both groups. There were moderate negative correlations between the postblink initial RMS change and baseline TMH (R = -0.61) and TMA (R = -0.54) in SBUT dry eyes that were stronger than in normal eyes (R = -0.37, R = -0.38). CONCLUSIONS. Tear meniscus dimensions increase with RMS over time, and tear quantity before blink has a significant role in maintaining initial optical integrity, especially in SBUT dry eye. Simultaneous measurement of optical quality and tear meniscus has the potential to improve understanding of tear stability in normal eyes and dry eyes.

  10. Altered tibiofemoral contact mechanics due to lateral meniscus posterior horn root avulsions and radial tears can be restored with in situ pull-out suture repairs.

    PubMed

    LaPrade, Christopher M; Jansson, Kyle S; Dornan, Grant; Smith, Sean D; Wijdicks, Coen A; LaPrade, Robert F

    2014-03-19

    An avulsion of the posterior root attachment of the lateral meniscus or a radial tear close to the root attachment can lead to degenerative knee arthritis. Although the biomechanical effects of comparable injuries involving the medial meniscus have been studied, we are aware of no such study involving the lateral meniscus. We hypothesized that in situ pull-out suture repair of lateral meniscus root avulsions and of complete radial tears 3 and 6 mm from the root attachment would increase the contact area and decrease mean and peak tibiofemoral contact pressures, at all knee flexion angles, relative to the corresponding avulsion or tear condition. Eight human cadaveric knees underwent biomechanical testing. Eight lateral meniscus conditions (intact, footprint tear, root avulsion, root avulsion repair, radial tears at 3 and 6 mm from the posterior root, and repairs of the 3 and 6-mm tears) were tested at five different flexion angles (0°, 30°, 45°, 60°, and 90°) under a compressive 1000-N load. Avulsion of the posterior root of the lateral meniscus or an adjacent radial tear resulted in significantly decreased contact area and increased mean and peak contact pressures in the lateral compartment, relative to the intact condition, in all cases except the root avulsion condition at 0° of flexion. In situ pull-out suture repair of the root avulsion or radial tear significantly reduced mean contact pressures, relative to the corresponding avulsion or tear condition, when the results for each condition were pooled across all flexion angles. Posterior horn root avulsions and radial tears adjacent to the root attachment of the lateral meniscus significantly increased contact pressures in the lateral compartment. In situ pull-out suture repairs of these tears significantly improved lateral compartment joint contact pressures. In situ repair may be an effective treatment to improve tibiofemoral contact profiles after an avulsion of the posterior root of the lateral

  11. A lateral meniscus tear incarcerated behind the popliteus tendon: a case report.

    PubMed

    Eskander, Mark S; Drew, Jacob M; Osuch, Daniel B; Metzmaker, Jeff

    2010-10-01

    A 51-year-old male, sustained an injury to his left knee after being pinned between his motorcycle and a road barrier. In the ER, the patient complained of medial knee pain, and had a significant joint effusion. MRI demonstrated an ACL injury, medial meniscal tear, bone bruising and impaction at the lateral femoral condyle and tibial plateau, and a tear of the posterior horn of the lateral meniscus that was displaced behind the popliteus. Unfortunately, the patient also presented with a deep vein thrombosis and thus could not proceed to the operating room for two months. During this time, scar tissue developed around the lateral meniscus. The purpose of this report is to present an unusual variant of a common injury pattern previously unreported where the posterior horn of the lateral meniscus became incarcerated behind the popliteus tendon and was left in place. It is likely that our patient will develop osteoarthritis in the future, but considering the circumstances he received a favorable early clinical outcome. Early recognition and a mobile fragment are essential restoring a patient's original anatomical features and achieving an optimal clinical outcome. Copyright 2009 Elsevier B.V. All rights reserved.

  12. Surgical Treatment of Combined Posterior Root Tears of the Lateral Meniscus and ACL Tears

    PubMed Central

    Pan, Fengyu; Hua, Shan; Ma, Zhuang

    2015-01-01

    Background The treatment of anterior cruciate ligament (ACL) rupture complicated with posterior lateral meniscus root (PLMR) tears remains controversial. The goal of this study was to evaluate clinical outcomes of PLMR tear refixation versus left untreated at the time of reconstruction. Material/Methods From August 2001 to January 2012, 31 patients who undergone repair of PLMR tears were evaluated and compared with a matched control group with untreated PLMR tears. Clinical evaluation consisted of the Lysholm scale, subjective International Knee Documentation Committee (IKDC) questionnaires, and radiographic evaluation with MRI. Results Regarding to the Lysholm score and the subjective questionnaire score, there were no statistical difference between the 2 groups. However, patients after operative treatment reach higher functional scores and lower rates of osteoarthritis (normal: group A, 80%, and group B, 48%, respectively) with statistical significance (P<0.05) compared to the matched control group. Conclusions Surgical and conservative treatment of the PLMR can both effectively improve knee function. However, a tendency towards higher functional scores and lower rates of osteoarthritis for patients with operative treatment was observed. PMID:25959903

  13. Arthroscopic Direct Repair for a Complete Radial Tear of the Posterior Root of the Medial Meniscus

    PubMed Central

    Wang, Kook Hyun; Hwang, Dae Hee; Cho, Jin Ho; Changale, Sachin D.; Woo, Sung Jong

    2011-01-01

    We report here on a new arthroscopic direct repair technique for a radial tear of the posterior root of the medial meniscus (PRMM) using a posterior trans-septal portal. Radial tears of the PRMM are commonly observed in the elderly population of Korea and Japan, and the life style of these people requires squatting and kneeling down in daily life. A radial tear of the PRMM results in the loss of hoop tension and this accelerates degenerative changes in the knee joint and causes early osteoarthritis. Several reports in the medical literature have focused on various repair techniques for these tears by using pull out sutures. These techniques result in nonanatomic fixation of the meniscus, which may lead to disturbed meniscal excursion and failure to restore hoop tension. Arthroscopic direct repair may contribute to restoring hoop tension and preventing accelerated degenerative changes in the knee joint of these patients. PMID:22162797

  14. Arthroscopic direct repair for a complete radial tear of the posterior root of the medial meniscus.

    PubMed

    Wang, Kook Hyun; Hwang, Dae Hee; Cho, Jin Ho; Changale, Sachin D; Woo, Sung Jong; Nha, Kyung Wook

    2011-12-01

    We report here on a new arthroscopic direct repair technique for a radial tear of the posterior root of the medial meniscus (PRMM) using a posterior trans-septal portal. Radial tears of the PRMM are commonly observed in the elderly population of Korea and Japan, and the life style of these people requires squatting and kneeling down in daily life. A radial tear of the PRMM results in the loss of hoop tension and this accelerates degenerative changes in the knee joint and causes early osteoarthritis. Several reports in the medical literature have focused on various repair techniques for these tears by using pull out sutures. These techniques result in nonanatomic fixation of the meniscus, which may lead to disturbed meniscal excursion and failure to restore hoop tension. Arthroscopic direct repair may contribute to restoring hoop tension and preventing accelerated degenerative changes in the knee joint of these patients.

  15. Meniscus root repair.

    PubMed

    Vyas, Dharmesh; Harner, Christopher D

    2012-06-01

    Root tears are a subset of meniscal injuries that result in significant knee joint pathology. Occurring on either the medial or lateral side, root tears are defined as radial tears or avulsions of the posterior horn attachment to bone. After a root tear, there is a significant increase in tibio-femoral contact pressure concomitant with altered knee joint kinematics. Previous cadaver studies from our institution have shown that root repair of the medial meniscus is successful in restoring joint biomechanics to within normal limits. Indications for operative management of meniscal root tears include (1) a symptomatic medial meniscus root tear with minimal arthritis and having failed non-operative treatment, and (2) a lateral root tear in associated with an ACL tear. In this review, we describe diagnosis, imaging, patient selection, and arthroscopic surgical technique of medial and lateral meniscus root injuries. In addition we highlight the pearls of repair technique, associated complications, post-operative rehabilitation regimen, and expected outcomes.

  16. Complex Meniscus Tears Treated with Collagen Matrix Wrapping and Bone Marrow Blood Injection

    PubMed Central

    Piontek, Tomasz; Ciemniewska-Gorzela, Kinga; Naczk, Jakub; Jakob, Roland; Szulc, Andrzej; Grygorowicz, Monika; Slomczykowski, Michal

    2015-01-01

    Objective To collect and analyze the 2-year follow-up clinical and MRI results of patients treated with an arthroscopic technique of collagen membrane-based meniscus repair. Design 53 consecutive patients with combined (horizontal and radial or longitudinal component) and complex meniscal tears (tear extended through avascular zones or/and composed with two or more morphological tear pattern) were treated with an “all-inside” arthroscopic suture of meniscus and wrapping with a collagen membrane (Chondro-Gide) technique with bone marrow blood injection. The IKDC 2000 subjective score, IKDC 2000 clinical evaluation score, Lysholm score and Barret clinical criteria of meniscal healing were recorded. All patients were examinated by MRI 2 years postoperatively, using modified WORMS criteria for meniscal integrity. Results The 2 year follow-up was achieved in 50 cases. Of these, 2 patients were excluded from the evaluation due to incomplete data and 2 patients underwent partial meniscectomy and were classified as failures. In 46 patients (86.8% of the intended to treat cases), a statistically significant improvement in IKDC 2000 subjective, Lysholm scores and IKDC 2000 clinical assessment between preoperative and the 2-year follow-up time points were obsereved. Barret criteria demonstrated an improved clinical outcome between pre- and post-operative values. MRI revealed a non-homogeneous signal without meniscal tear (WORMS grade 1) in 76% of the operated menisci (13% WORMS grade 2). Conclusions The 2-year follow-up data demonstrate that this technique is safe and can offer an additional tool to save the meniscus in the patients otherwise scheduled for meniscal removal. Level of evidence IV PMID:27047635

  17. Medial extrusion of the posterior segment of medial meniscus is a sensitive sign for posterior horn tears.

    PubMed

    Ohishi, Tsuyoshi; Suzuki, Daisuke; Yamamoto, Kazufumi; Banno, Tomohiro; Shimizu, Yuta; Matsuyama, Yukihiro

    2014-01-01

    To evaluate medial extrusion of the posterior segment of the medial meniscus in posterior horn tears. This study enrolled 72 patients without medial meniscal tears (group N), 72 patients with medial meniscal tears without posterior horn tears (group PH-), 44 patients with posterior horn tears of the medial meniscus (group PH+). All meniscal tears were confirmed by arthroscopy. Medial extrusion of the middle segment and the posterior segment was measured on coronal MRIs. Extrusions of both middle and posterior segments in groups PH- and PH+ (middle segment; 2.94±1.51 mm for group PH- and 3.75±1.69 mm for group PH+, posterior segment; 1.85±1.82 mm for group PH- and 4.59±2.74 mm for group PH+) were significantly larger than those in group N (middle segment; 2.04±1.20, posterior segment; 1.21±1.86). Both indicators of extrusion in group PH+ were larger than those in group PH-. In the early OA category, neither middle nor posterior segment in group PH- extruded more than in group N. However, only the posterior segment in group PH+ extruded significantly more than in group N. Multiple lineal regression analyses revealed that posterior segment extrusion was strongly correlated with the posterior horn tears (p<0.001) among groups PH- and PH+. The newly presented indicator for extrusion of the posterior segment of the medial meniscus is associated with posterior horn tears in comparison with the extrusion of the middle segment, especially in the early stages of osteoarthritis. Level II--Diagnostic Study. Copyright © 2013 Elsevier B.V. All rights reserved.

  18. Efficacy of therapeutic ultrasound treatment of a meniscus tear in a severely disabled patient: a case report.

    PubMed

    Muché, Julie A

    2003-10-01

    This report focuses on diagnosis and management of a meniscus tear of unknown etiology in a functionally impaired patient. The patient was a 21-year-old man diagnosed with viral meningoencephalitis and postvaccinal central pontine myelinolysis, who experienced respiratory failure and required prolonged mechanical ventilation. He was in a comatose state for approximately 1.5 months. He presented to our facility 3 weeks after coma complaining of left knee pain and limited range of motion (ROM). Diagnostic workup, including magnetic resonance imaging, showed a grade II posterior horn medial meniscus tear and lateral tibial stress injury of the left knee. Management of the meniscus tear included the RICE protocol (rest, ice, compression, elevation), therapeutic ultrasound, and physical therapy. The patient responded extremely well to initial ultrasound therapy, with decreased pain and increased ROM of the left knee, which allowed him to make significant functional gains and to make overall progress in our comprehensive acute rehabilitation program. To date, nonoperative care of acute meniscal injury is commonly considered to be unsatisfactory; however, in this patient it led to rapid functional gains. Thus, therapeutic ultrasound may be a beneficial modality to decrease pain and increase ROM of the knee in an acutely torn meniscus, which, in turn, would likely promote good functional progress in any rehabilitation program.

  19. Large meniscus extrusion ratio is a poor prognostic factor of conservative treatment for medial meniscus posterior root tear.

    PubMed

    Kwak, Yoon-Ho; Lee, Sahnghoon; Lee, Myung Chul; Han, Hyuk-Soo

    2018-03-01

    The purpose of this study was to find a prognostic factor of medial meniscus posterior root tear (MMPRT) for surgical decision making. Eighty-eight patients who were diagnosed as acute or subacute MMPRT without severe degeneration of the meniscus were treated conservatively for 3 months. Fifty-seven patients with MMPRT showed good response to conservative treatment (group 1), while the remaining 31 patients who failed to conservative treatment (group 2) received arthroscopic meniscus repair. Their demographic characteristics and radiographic features including hip-knee-ankle angle, joint line convergence angle, Kellgren-Lawrence grade in plain radiographs, meniscus extrusion (ME) ratio (ME-medial femoral condyle ratio, ME-medial tibial plateau ratio, ME-meniscus width ratio), the location of bony edema, and cartilage lesions in MRI were compared. Receiver operating characteristic (ROC) curve analysis was also performed to determine the cut-off values of risk factors. The degree of ME-medial femoral condyle and medial tibia plateau ratio of group 2 was significantly higher than group 1 (0.08 and 0.07 vs. 0.1 and 0.09, respectively, both p < 0.001). No significant (n.s.) difference in other variables was found between the two groups. On ROC curve analysis, ME-medial femoral condyle ratio was confirmed as the most reliable prognostic factor of conservative treatment for MMPRT (area under ROC = 0.8). The large meniscus extrusion ratio was the most reliable poor prognostic factor of conservative treatment for MMPRT. Therefore, for MMPRT patients with large meniscus extrusion, early surgical repair could be considered as the primary treatment option. III.

  20. Modified Pull-out Suture in Posterior Root Tear of the Medial Meniscus: Using a Posteromedial Portal.

    PubMed

    Cho, Jin Ho

    2012-06-01

    In cases with root tear of the medial meniscus posterior horn, the meniscus usually can be repaired by a pull out suture technique. However, there is difficulty in manipulating a suture hook via the anteromedial portal and looking through the arthroscopic camera via anterolateral portal in the narrow medial joint space at the same time. This article describes a modified simple pull out suture technique for root tear of the medial meniscus posterior horn using a posteromedial portal that provides a safe and easy handling of the suture hook. Our indications of this technique used in patients with Outerbridge 1-2 arthritic change and minimal varus axis change. Benefits of this technique are simple, less invasive, and reduced operation time by simultaneous suture with a hook via posteromedial portal and pulling of a string with grasper. It may reduce the possibility of an additional chondral or meniscal injury.

  1. High Rate of Missed Lateral Meniscus Posterior Root Tears on Preoperative Magnetic Resonance Imaging

    PubMed Central

    Krych, Aaron J.; Wu, Isabella T.; Desai, Vishal S.; Murthy, Naveen S.; Collins, Mark S.; Saris, Daniel B.F.; Levy, Bruce A.; Stuart, Michael J.

    2018-01-01

    Background: Lateral meniscus posterior root tears (LMPRTs), if left untreated, can cause devastating effects to the knee, with rapid articular cartilage degeneration and loss of the meniscus as a secondary stabilizer. Detection and surgical repair of these defects have been linked to favorable outcomes, but preoperative identification of LMPRTs continues to be challenging. Purpose: To determine the rate of LMPRTs diagnosed preoperatively on magnetic resonance imaging (MRI) in a consecutive series of arthroscopically confirmed LMPRTs. Study Design: Case series; Level of evidence, 4. Methods: A retrospective cohort of 45 consecutive patients with arthroscopically confirmed LMPRTs between 2010 and 2017 were included in this study. The preoperative MRI report for each patient was evaluated and compared with intraoperative findings. Each preoperative MRI study was then reviewed by 2 fellowship-trained musculoskeletal radiologists who worked in consensus. Results: A total of 45 patients (32 males, 13 females) with arthroscopically confirmed LMPRTs and a mean age of 27 years (range, 14-54 years) were included in the study. Only 15 of 45 LMPRTs (33%) were initially diagnosed on preoperative MRI. Past or concurrent anterior cruciate ligament (ACL) reconstruction was present in 37 of 45 cases (82%). Upon retrospective review, 15 of the 30 missed LMPRTs were “clearly evident,” 12 “subtly evident,” and 3 “occult” (unavoidably missed). There were no significant differences in the rate of LMPRT diagnosis based on history of prior knee surgery, meniscus extrusion, or tearing of the meniscofemoral ligament. Conclusion: Despite improved identification of other meniscus tear patterns on MRI, a high percentage of LMPRTs were still missed. In the setting of previous ACL reconstruction, if the root cannot be confidently identified, the MRI interpretation should indicate that “the root is poorly visualized” to alert the surgeon to thoroughly evaluate this structure. The

  2. Meniscal tears missed on MR imaging: relationship to meniscal tear patterns and anterior cruciate ligament tears.

    PubMed

    De Smet, A A; Graf, B K

    1994-04-01

    MR imaging of the knee is a valuable technique for diagnosing meniscal tears, but some tears found at arthroscopy are not shown on MR imaging. The purpose of this study was to determine whether or not tears were more frequently missed in the presence of an anterior cruciate ligament tear or when tears had certain locations or configurations. We reviewed the original MR reports and surgical records of 400 patients who had both an MR examination and arthroscopy of the knee. Using chi 2 analysis, we examined how the sensitivity for detecting meniscal tears varied with the presence of a tear of the anterior cruciate ligament, with the location of the tear within the meniscus, and among six configurations of meniscal tears. We also studied whether sensitivity decreased with an increasing delay between MR examination and arthroscopy. In the presence of a tear of the anterior cruciate ligament, the sensitivity decreased from 0.97 to 0.88 (p = .016) for medial meniscal tears and from 0.94 to 0.69 (p = .0005) for lateral tears. The overall sensitivity for lateral meniscal tears was significantly less for posterior (p = .001) and peripheral (p = .005) tears than for other tear locations or configurations. The sensitivities did not significantly differ between tear locations and configurations in the medial meniscus or with an increasing delay until arthroscopy. Patients with a torn anterior cruciate ligament were more likely to have peripheral tears of the medial meniscus (p = .00004) and posterior (p = .0004) and peripheral (p = .04) tears of the lateral meniscus. Because of their location and configuration, meniscal tears associated with an anterior cruciate ligament injury are more difficult to detect on MR images than are tears in knees with an intact ligament. If a tear of the anterior cruciate ligament is detected, special attention should be given to the subtle peripheral tears that may be present in either meniscus, but most commonly in the posterior horn of the

  3. Outcomes after repair of chronic bucket-handle tears of medial meniscus.

    PubMed

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

    2014-04-01

    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. 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. 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. This study showed that repair of chronic bucket-handle meniscal tears can lead to good clinical outcomes and a relatively low (17

  4. Biomechanical consequences of a complete radial tear adjacent to the medial meniscus posterior root attachment site: in situ pull-out repair restores derangement of joint mechanics.

    PubMed

    Padalecki, Jeffrey R; Jansson, Kyle S; Smith, Sean D; Dornan, Grant J; Pierce, Casey M; Wijdicks, Coen A; Laprade, Robert F

    2014-03-01

    Complete radial tears near the medial meniscus posterior root attachment site disrupt the circumferential integrity of the meniscus (similar to a posterior root avulsion). These tears can compromise the circumferential integrity, and they have been reported in biomechanical studies to be comparable with the meniscectomized state. To quantify the tibiofemoral contact pressure and contact area changes that occur in cadaveric knees from complete posterior horn radial tears and subsequent repairs of the medial meniscus adjacent to the posterior root attachment site. Controlled laboratory study. Six nonpaired fresh-frozen human cadaveric knees each underwent 45 different testing conditions: 9 medial meniscus conditions (intact, root avulsion, root repair, serial radial tear at 3, 6, and 9 mm from the root attachment site, and in situ repair at the same 3 distances from the root attachment site) at 5 flexion angles (0°, 30°, 45°, 60°, and 90°), under a 1000-N axial load. Tekscan sensors were used to measure contact area and pressure in the medial and lateral compartments. The medial meniscus root avulsion and all radial tear conditions resulted in significantly decreased contact area and increased mean contact pressure compared with the intact state for knee flexion angles beyond 0° (P < .05). The root repair and in situ repairs restored contact area and pressure to levels statistically indistinguishable from those of the intact meniscus and increased contact area and decreased contact pressure compared with the corresponding tear conditions. Posterior horn radial tears adjacent to the medial meniscus root that extend to the meniscocapsular junction can lead to derangement of the loading profiles of the medial compartment that are similar to a root avulsion. Repair of these radial tears with an in situ pull-out technique restored joint mechanics to the intact state. Complete radial tears of the posterior horn of the medial meniscus, which occur relatively

  5. Long-term evaluation of posterior lateral meniscus root tears left in situ at the time of anterior cruciate ligament reconstruction.

    PubMed

    Shelbourne, K Donald; Roberson, Troy A; Gray, Tinker

    2011-07-01

    The long-term radiographic and subjective results of patients with posterior lateral meniscus root tears left in situ at the time of anterior cruciate ligament reconstruction has not been reported. The authors hypothesized that patients who had posterior lateral meniscus root tears left in situ would have statistically significantly lower subjective scores and greater joint-space narrowing as compared with a control group. Cohort study; Level of evidence, 3. Thirty-three patients who had isolated posterior lateral meniscus root tear and >5 years objective and subjective follow-up were evaluated and compared with a matched control group without meniscal tears based on sex, chronicity of tear, age, and follow-up time. Patients were evaluated subjectively and objectively using the International Knee Documentation Committee criteria. The mean objective follow-up time was 10.6 ± 4.5 years. The mean subjective total score was 84.6 ± 14 in the study group versus 90.5 ± 13 in the control group (P = .09). Radiographs showed lateral joint-space narrowing rated as normal in 19, mild in 10, moderate in 3, and severe in 1 versus the control group, which was normal in 28 and mild in 5 patients. The measured amount of lateral joint-space narrowing compared with the other knee was 1.0 ± 1.6 mm in the study group versus 0 ± 1.1 mm in the controls on 45° flexed posteroanterior radiographs (P < .006). At a mean of 10 years' follow-up of posterior lateral meniscus root tears left in situ, mild lateral joint-space narrowing was measured without significant differences in subjective or objective scores compared with controls. This study provides a baseline that can be used to compare the results of procedures used to treat these tears in other manners.

  6. Arthroscopic Treatment of Discoid Lateral Meniscus Tears in Children With Achondroplasia.

    PubMed

    Atanda, Alfred; Wallace, Maegen; Bober, Michael B; Mackenzie, William

    2016-01-01

    Achondroplasia is the most common form of skeletal dysplasia that presents to the pediatric orthopaedist. More than half of achondroplasia patients are affected with knee pain. It is thought that the majority of this pain may be due to spinal stenosis, hip pathology, or knee malalignment. Discoid menisci can be a source of lateral knee joint pain in skeletally immature patients in general. We present the first case series of patients with achondroplasia who had symptomatic discoid lateral menisci treated with arthroscopic knee surgery. The charts of 6 patients (8 knees) with achondroplasia who underwent arthroscopic knee surgery for symptomatic discoid lateral menisci were collected. History and physical examination data, magnetic resonance imaging findings, and operative reports were reviewed. Meniscal tear configuration and treatment type (meniscectomy vs. repair) were noted. Each patient was found to have a tear of the discoid meniscus. All menisci were treated with saucerization. In addition, meniscal repair was performed in 2 cases, partial meniscectomy in 3 cases, and subtotal meniscectomy in 3 cases. Two patients had bilateral discoid meniscal tears which were treated. Average follow-up was 2.4 years (range, 1 to 4.5 y) and the average pediatric International Knee Documentation Committee (pedi-IKDC) score was 85.3% (range, 75% to 95.4%). At final follow-up, all patients were pain free and able to return to full activities. Discoid meniscus tears may be a source of lateral joint line pain in patients with achondroplasia. These injuries can be successfully treated with arthroscopic surgery in this patient population. Future studies need to be done to determine the exact incidence of discoid menisci in achondroplasia patients and also to determine whether there is a genetic relationship between the 2 conditions. Level IV-case series.

  7. Pullout Fixation of Posterior Medial Meniscus Root Tears: Correlation Between Meniscus Extrusion and Midterm Clinical Results

    PubMed

    Chung, Kyu Sung; Ha, Jeong Ku; Ra, Ho Jong; Nam, Gun Woo; Kim, Jin Goo

    2017-01-01

    Medial meniscus posterior root tears (MMPRTs) lead to extrusion of the meniscus during weightbearing as well as loss of the ability of the meniscus to generate hoop stress. This loss of load-sharing ability leads to progressive arthritic changes. However, there have been no studies that correlate the correction of meniscus extrusion with clinical outcomes. Decreased meniscus extrusion is associated with better clinical and radiographic outcomes compared with increased meniscus extrusion after MMPRT pullout fixation. Case-control study; Level of evidence, 3. A total of 39 patients who underwent MMPRT pullout fixation and had been observed for more than 5 years were recruited for this study. The mean follow-up period was 69.8 months. Participants were categorized into 2 groups according to the direction of meniscus extrusion: group A (increased extrusion; 23 patients) and group B (decreased extrusion; 16 patients). Meniscus extrusion was assessed in the coronal plane on magnetic resonance imaging preoperatively and at 1 year postoperatively. The postoperative clinical outcomes (Lysholm and International Knee Documentation Committee [IKDC] scores) and radiographic results (Kellgren-Lawrence [K-L] grade and medial joint space) were compared between groups. Meniscus extrusion in group A increased significantly from a mean (±SD) of 3.5 ± 0.9 mm preoperatively to 5.1 ± 1.4 mm at 1 year postoperatively ( P < .001), whereas in group B, it decreased significantly from 4.1 ± 1.3 mm preoperatively to 3.5 ± 1.4 mm at 1 year postoperatively ( P < .001). The K-L arthritis grade (0/1/2/3/4) significantly progressed in group A (from 2/12/9/0/0 preoperatively to 0/1/14/8/0 postoperatively, respectively; P = .009) but not in group B (from 1/11/4/0/0 preoperatively to 0/6/8/2/0 postoperatively, respectively; P = .274). The mean final Lysholm and IKDC scores in group B (88.1 ± 12.1 and 79.0 ± 11.4, respectively) were significantly better than those in group A (81.0 ± 9.0 and 71

  8. Clinical, radiological, and morphological evaluations of posterior horn tears of the lateral meniscus left in situ during anterior cruciate ligament reconstruction.

    PubMed

    Lee, Dhong Won; Jang, Hyoung Won; Lee, Sung Rak; Park, Jung Ho; Ha, Jeong Ku; Kim, Jin Goo

    2014-02-01

    Recent studies have shown that lateral menisci have a higher healing potential and that they can be treated successfully without symptoms by being left in situ during anterior cruciate ligament (ACL) reconstruction. However, few studies have reported morphological results. Stable posterior horn tears of the lateral meniscus left in situ during ACL reconstruction could be healed spontaneously and would result in not only successful clinical outcomes but also morphological restoration. Cohort study; Level of evidence, 3. Among 367 patients who underwent primary ACL reconstruction between 2008 and 2010, 53 patients who had lateral meniscus tears that were left in situ were analyzed. These patients were evaluated subjectively and radiologically and compared with a matched control group that underwent ACL reconstruction without any other structural disorders. Of the 53 patients with stable posterior horn tears of the lateral meniscus left in situ, 28 patients were assessed by second-look arthroscopic surgery and magnetic resonance imaging (MRI). The mean follow-up of the study group and the control group was 36.47 and 37.26 months, respectively. There were no statistical differences in postoperative clinical outcomes between the 2 groups. Clinical results of both groups including the Lysholm score, Tegner activity score, and International Knee Documentation Committee (IKDC) score significantly improved. In the subgroup composed of 28 patients, follow-up MRI showed 25 (89%) and 24 (86%) healed menisci in sagittal and coronal views, respectively. Twenty-one (75%) were considered to be completely healed, and 5 (18%) were incompletely healed on second-look arthroscopic surgery. Stable posterior horn tears of the lateral meniscus left in situ at the time of ACL reconstruction revealed successful clinical outcomes compared with isolated ACL injuries and showed considerable healing and functional restoration of tears with repeat MRI and second-look arthroscopic surgery

  9. Posterior root tear fixation of the lateral meniscus combined with arthroscopic ACL double-bundle reconstruction: technical note of a transosseous fixation using the tibial PL tunnel.

    PubMed

    Forkel, Philipp; Petersen, Wolf

    2012-03-01

    According to our observation in ACL reconstruction, we find root tears of the posterior horn of the lateral meniscus as a common concomitant injury in ACL-deficient knees. This might be a consequence of initial trauma or of the increased anterior-posterior translation of the tibia and an overload impact on the posterior meniscus root in ACL-deficient knees. A tear of the posterior horn of the medial meniscus causes a 25% increase in peak pressure in the medial compartment compared with that found in the intact condition. The repair restores the peak contact pressure to normal (Allaire et al. in J Bone Joint Surg Am 90(9):1922-1931, [2008]). A tear of the posterior horn of the lateral meniscus might have similar consequences. We hypothesize the surgical anatomical reattachment of the root at the tibia helping to restore knee joint kinematics and helping to advance ACL-graft function. This article presents an arthroscopical technique to reattach the posterior meniscus root in combination with ACL double-bundle reconstruction. The procedure uses the tibial PL tunnel to fix the meniscus suture.

  10. Repair of Avascular Meniscus Tears with Electrospun Collagen Scaffolds Seeded with Human Cells

    PubMed Central

    Baek, Jihye; Sovani, Sujata; Glembotski, Nicholas E.; Du, Jiang; Jin, Sungho; Grogan, Shawn P.

    2016-01-01

    The self-healing capacity of an injured meniscus is limited to the vascularized regions and is especially challenging in the inner avascular regions. As such, we investigated the use of human meniscus cell-seeded electrospun (ES) collagen type I scaffolds to produce meniscal tissue and explored whether these cell-seeded scaffolds can be implanted to repair defects created in meniscal avascular tissue explants. Human meniscal cells (derived from vascular and avascular meniscal tissue) were seeded on ES scaffolds and cultured. Constructs were evaluated for cell viability, gene expression, and mechanical properties. To determine potential for repair of meniscal defects, human meniscus avascular cells were seeded and cultured on aligned ES collagen scaffolds for 4 weeks before implantation. Surgical defects resembling “longitudinal tears” were created in the avascular zone of bovine meniscus and implanted with cell-seeded collagen scaffolds and cultured for 3 weeks. Tissue regeneration and integration were evaluated by histology, immunohistochemistry, mechanical testing, and magentic resonance imaging. Ex vivo implantation with cell-seeded collagen scaffolds resulted in neotissue that was significantly better integrated with the native tissue than acellular collagen scaffolds or untreated defects. Human meniscal cell-seeded ES collagen scaffolds may therefore be useful in facilitating meniscal repair of avascular meniscus tears. PMID:26842062

  11. Arthroscopic pullout repair of posterior root tear of the medial meniscus: the anterior approach using medial collateral ligament pie-crusting release.

    PubMed

    Park, Young-Sik; Moon, Hong-Kyo; Koh, Yong-Gon; Kim, Yong-Chan; Sim, Dong-Sik; Jo, Seung-Bae; Kwon, Se-Kwang

    2011-08-01

    Posterior root tears of the medial meniscus are frequently encountered and should be repaired if possible to prevent osteoarthritis of the medial compartment. Various surgical techniques have been proposed to repair posterior root tears. The anterior arthroscopic approach can cause an iatrogenic chondral injury due to the narrow medial joint space. The posterior approaches might be technically unfamiliar to many surgeons because they require the establishment of a posteromedial or trans-septal portal. This paper describes the medial collateral ligament pie-crusting release technique for arthroscopic double transosseous pullout repair of posterior root tears of the medial meniscus through the anterior approach to provide the good visualization of the footprint and sufficient working space.

  12. Arthroscopic pullout repair of a complete radial tear of the tibial attachment site of the medial meniscus posterior horn.

    PubMed

    Kim, Young-Mo; Rhee, Kwang-Jin; Lee, June-Kyu; Hwang, Deuk-Soo; Yang, Jun-Young; Kim, Sung-Jae

    2006-07-01

    We developed an effective arthroscopic pullout technique for repairing complete radial tears of the tibial attachment site of the medial meniscus posterior horn (MMPH). In our technique, the torn meniscus is reattached to the tibial plateau immediately medial or anteromedial to the posterior cruciate ligament (PCL) using two No. 2 Ethibond sutures (Ethicon, Somerville, NJ). After a complete radial tear of the tibial attachment site of the MMPH and its reparability were confirmed, using a Caspari suture loaded with a suture shuttle, one No. 2 Ethibond suture is placed through the meniscus, through the red-red zone, 3 to 5 mm medial to the torn edge of the MMPH, and the other is passed through the meniscocapsular junction 3 to 5 mm medial to the torn edge of the meniscus. Then, a tibial tunnel, 5-mm in diameter, is made from the anteromedial aspect of the proximal tibia to the previously prepared tibial plateau, immediately medial or anteromedial to the PCL, and the two No. 2 Ethibond sutures are pulled out through the tibial tunnel and then fixed to the proximal tibia using a 3.5-mm cortical screw and washer. Firm reattachment of the torn meniscus was confirmed arthroscopically.

  13. Validation of a semi-automatic protocol for the assessment of the tear meniscus central area based on open-source software

    NASA Astrophysics Data System (ADS)

    Pena-Verdeal, Hugo; Garcia-Resua, Carlos; Yebra-Pimentel, Eva; Giraldez, Maria J.

    2017-08-01

    Purpose: Different lower tear meniscus parameters can be clinical assessed on dry eye diagnosis. The aim of this study was to propose and analyse the variability of a semi-automatic method for measuring lower tear meniscus central area (TMCA) by using open source software. Material and methods: On a group of 105 subjects, one video of the lower tear meniscus after fluorescein instillation was generated by a digital camera attached to a slit-lamp. A short light beam (3x5 mm) with moderate illumination in the central portion of the meniscus (6 o'clock) was used. Images were extracted from each video by a masked observer. By using an open source software based on Java (NIH ImageJ), a further observer measured in a masked and randomized order the TMCA in the short light beam illuminated area by two methods: (1) manual method, where TMCA images was "manually" measured; (2) semi-automatic method, where TMCA images were transformed in an 8-bit-binary image, then holes inside this shape were filled and on the isolated shape, the area size was obtained. Finally, both measurements, manual and semi-automatic, were compared. Results: Paired t-test showed no statistical difference between both techniques results (p = 0.102). Pearson correlation between techniques show a significant positive near to perfect correlation (r = 0.99; p < 0.001). Conclusions: This study showed a useful tool to objectively measure the frontal central area of the meniscus in photography by free open source software.

  14. Posterior medial meniscus detachment: a unique type of medial meniscal tear.

    PubMed

    Rubinstein, Richard A; DeHaan, Alex; Baldwin, James L

    2009-10-01

    Patients with posterior medial meniscal detachment, as determined at knee arthroscopy, were evaluated retrospectively. Mean follow-up was 5.3 years for 8 men and 20 women (30 knees; mean age, 57 years). Most patients had acute onset of pain with a minor specific incident. Seventeen patients were obese, 9 were overweight, and 2 were normal. Eleven of 22 magnetic resonance imaging evaluations detected a tear at the site of the posterior medial meniscus root. Nine of 16 bone scan evaluations showed moderate uptake medially. Arthroscopic treatment included partial medial meniscectomy or meniscal repair. Twelve knees (40%) showed significant progression of arthritis. Of the 7 patients with severe arthritic knees, 5 have subsequently undergone total knee arthroplasty, 1 is considering total knee arthroplasty, and the other has minimal symptoms. Patients should be counseled about the clinical course of posterior medial meniscus detachment and its potential for progressive arthritis in the joint.

  15. Resection of Grade III cranial horn tears of the equine medial meniscus alter the contact forces on medial tibial condyle at full extension: an in-vitro cadaveric study.

    PubMed

    Fowlie, Jennifer; Arnoczky, Steven; Lavagnino, Michael; Maerz, Tristan; Stick, John

    2011-12-01

    To evaluate the magnitude and distribution of joint contact pressure on the medial tibial condyle after grade III cranial horn tears of the medial meniscus. Experimental study. Cadaveric equine stifles (n = 6). Cadaveric stifles were mounted in a materials testing system and electronic pressure sensors were placed between the medial tibial condyle and medial meniscus. Specimens were loaded parallel to the longitudinal axis of the tibia to 1800 N at 130°, 140°, 150°, and 160° stifle angle. Peak pressure and contact area were recorded from the contact maps. Testing was repeated after surgical creation of a grade III cranial horn tear of the medial meniscus, and after resection of the simulated tear. In the intact specimens, a significantly smaller contact area was observed at 160° compared with the other angles (P < .05). Creation of a grade III cranial horn tear in the medial meniscus did not significantly alter the pressure or contact area measurements at any stifle angle compared with intact specimens (P > .05). Resection of the tear resulted in significantly higher peak pressures in the central region of the medial tibial condyle at a stifle angle of 160° relative to the intact (P = .026) and torn (P = .012) specimens. Resection of grade III cranial horn tears in the medial meniscus resulted in a central focal region of increased pressure on the medial tibial condyle at 160° stifle angle. © Copyright 2011 by The American College of Veterinary Surgeons.

  16. Risk factors for medial meniscus posterior root tear.

    PubMed

    Hwang, Byoung-Yoon; Kim, Sung-Jae; Lee, Sang-Won; Lee, Ha-Eun; Lee, Choon-Key; Hunter, David J; Jung, Kwang-Am

    2012-07-01

    Medial meniscus posterior root tears (MMPRT) have a different clinical effect from other types of meniscal tears. These tears are very common among Asian people and may be related to the frequent use of postures such as the lotus position or squatting. The present study was designed to identify the risk factors for MMPRT among an Asian sample. Cohort study; Level of evidence, 3. An observational study was performed of 476 consecutive patients undergoing an arthroscopic procedure on their medial meniscus from January 2010 to December 2010. One hundred four patients had MMPRT (group 1), and the other patients had other types of medial meniscal tears (group 2). Demographic characteristics (age, sex, body mass index [BMI]), radiographic features (mechanical axis angle, tibia vara angle, tibial slope angle, Kellgren-Lawrence grade [KLG]), and environmental factors (occupation, trauma history, sports activity level, table use or not, bed use or not-variables that are representative of the oriental lifestyle of lotus position and squatting) were surveyed. We assessed the relation of these risk factors to the type of meniscal tear (group 1 or 2). In group 1, there were 7 male and 97 female patients, with an average age of 58.2 years (range, 39-78 years) and BMI of 26.7 ± 3.4 kg/m2. In group 2, there were 136 male and 236 female patients (P < .01 compared with group 1), with an average age of 54.3 years (range, 17-77 years; P < .01) and a BMI of 24.9 ± 3.1 kg/m2 (P < .01). With regard to radiographic features, the mechanical axis angle demonstrated a significantly increased varus alignment in group 1 (4.5° ± 3.4°) compared with group 2 (2.4° ± 2.7°; P < .01), and the KLG was 1.4 ± 0.8 in group 1 and 0.9 ± 0.6 in group 2 (P < .01). Environmental factors showed no differences in occupation, table use or not, and bed use or not, except sports activity level. There were 41 patients (42.7%) in group 1 and 77 patients (20.6%) in group 2 who did not participate in any

  17. Meniscal Extrusion Progresses Shortly after the Medial Meniscus Posterior Root Tear.

    PubMed

    Furumatsu, Takayuki; Kodama, Yuya; Kamatsuki, Yusuke; Hino, Tomohito; Okazaki, Yoshiki; Ozaki, Toshifumi

    2017-12-01

    Medial meniscus posterior root tears (MMPRT) induce medial meniscus extrusion (MME). However, the time-dependent extent of MME in patients suffering from the MMPRT remains unclear. This study evaluated the extent of MME after painful popping events that occurred at the onset of the MMPRT. Thirty-five patients who had an episode of posteromedial painful popping were investigated. All the patients were diagnosed as having an MMPRT by magnetic resonance imaging (MRI) within 12 months after painful popping. Medial meniscus body width (MMBW), absolute MME, and relative MME (100×absolute MME/MMBW) were assessed among three groups divided according to the time after painful popping events: early period (〈1 month), subacute period (1-3 months), and chronic period (4-12 months). In the early period, absolute and relative MMEs were 3.0 mm and 32.7%, respectively. Absolute MME increased up to 4.2 mm and 5.8 mm during the subacute and chronic periods, respectively. Relative MME also progressed to 49.2% and 60.3% in the subacute and chronic periods, respectively. This study demonstrated that absolute and relative MMEs increased progressively within the short period after the onset of symptomatic MMPRT. Our results suggest that early diagnosis of an MMPRT may be important to prevent progression of MME following the MMPRT.

  18. Meniscus tears - aftercare

    MedlinePlus

    ... are younger in age, you may need knee arthroscopy (surgery) to repair or trim the meniscus. In ... Saunders; 2015:chap 96. Phillips BB, Mihalko MJ. Arthroscopy of the lower extremity. In: Azar FM, Beaty ...

  19. Effect of Posterior Horn Medial Meniscus Root Tear on In Vivo Knee Kinematics.

    PubMed

    Marsh, Chelsea A; Martin, Daniel E; Harner, Christopher D; Tashman, Scott

    2014-07-01

    Medial meniscus root tear (MMRT) is a recently recognized yet frequently missed meniscal tear pattern that biomechanically creates an environment approaching meniscal deficiency. The purpose of this study was to assess the effect of MMRT on tibiofemoral kinematics and arthrokinematics during daily activities by comparing the injured knees of subjects with isolated MMRT to their uninjured contralateral knees. The hypothesis was that the injured knee will demonstrate significantly more lateral tibial translation and adduction than the uninjured knee, and that the medial compartment will exhibit significantly different arthrokinematics than the lateral compartment in the affected limb. Cross-sectional study; Level of evidence, 3. Seven subjects with isolated MMRT were recruited and volumetric, density-based 3-dimensional models of their distal femurs and proximal tibia were created from computed tomography scans. High-speed, biplane radiographs were obtained of both their affected and unaffected knees. Moving 3-dimensional models of tibiofemoral kinematics were calculated using model-based tracking to assess overall kinematic variables and specific measures of tibiofemoral joint contact. The affected knees of the subjects were then compared to their unaffected contralateral knees. Affected knees demonstrated significantly more lateral tibial translation than the uninjured contralateral limb in all dynamic activities. Additionally, the medial compartment displayed greater amounts of mobility than the lateral compartment in the injured limbs. This study suggests that MMRT causes significant changes in in vivo knee kinematics and arthrokinematics and that the magnitude of these changes is influenced by dynamic task difficulty. Medial meniscus root tears lead to significant changes in joint arthrokinematics, with increased lateral tibial translation and greater medial compartment excursion. With complete root tears, essentially 100% of circumferential fibers are lost

  20. Tibiofemoral contact pressures in radial tears of the meniscus treated with all-inside repair, inside-out repair and partial meniscectomy.

    PubMed

    Zhang, Alan L; Miller, Stephanie L; Coughlin, Dezba G; Lotz, Jeffrey C; Feeley, Brian T

    2015-10-01

    To test contact pressures in the knee after treatment of a radial meniscus tear with an all-inside meniscal repair technique and compare the results with inside-out repair and partial meniscectomy. Six non-paired cadaveric knees were analyzed with intra-compartment pressures measured at loads of 250 N, 500 N and 1000 N at 0°, eight degrees, 15°, and 30° of knee flexion. Compartmental contact pressures were measured for the intact medial meniscus, radial tear in the posterior horn, all-inside repair using the NovoStitch suture passer device (Ceterix Orthopaedics Inc., Menlo Park, CA), inside-out repair method, and partial meniscectomy. One-way ANOVA was used for statistical analysis. The greatest differences in peak pressures between treatments were observed under 1000 N load at 30° flexion (0.8± (SD) 0.1 MPa (intact meniscus), 0.8± (SD) 0.1 MPa (all-inside), 0.9± (SD) 0.1 MPa (inside-out) and 1.6± (SD) 0.2 MPa (partial meniscectomy)). Treatment with partial meniscectomy resulted in the highest peak pressures compared to all other states (p<0.0001 at each angle). Repair of the radial tear using the all-inside technique as well as the inside-out technique resulted in significantly decreased compartment pressures compared to partial meniscectomies (p<0.0001 at each angle). There were no significant differences between peak pressures in the intact state and after repair with the all-inside or inside-out techniques. An all-inside repair technique using the NovoStitch suture passer can decrease contact pressures for a radial meniscus tear similarly to the inside-out repair technique when compared to partial meniscectomy. This novel arthroscopic suture passer warrants further analysis in the clinical setting as it may be a reliable method for repair of radial meniscal tears through an arthroscopic all-inside technique. Copyright © 2015 Elsevier B.V. All rights reserved.

  1. A novel suture technique using the FasT-Fix combined with Ultrabraid for pullout repair of the medial meniscus posterior root tear.

    PubMed

    Fujii, Masataka; Furumatsu, Takayuki; Kodama, Yuya; Miyazawa, Shinichi; Hino, Tomohito; Kamatsuki, Yusuke; Yamada, Kazuki; Ozaki, Toshifumi

    2017-05-01

    Medial meniscus posterior root has an important role in the maintenance of knee articular cartilage. Although pullout repair of the medial meniscus posterior root tear has become a gold standard, it has several difficulties for suturing. We have developed a modified Mason-Allen suture technique using the FasT-Fix all-inside suture device combined with Ultrabraid. The present suture technique allows a strong grasping of the medial meniscus posterior horn for arthroscopic pullout repair.

  2. Changes in Tear Volume after 3% Diquafosol Treatment in Patients with Dry Eye Syndrome: An Anterior Segment Spectral-domain Optical Coherence Tomography Study.

    PubMed

    Lee, Kwan Bok; Koh, Kyung Min; Kwon, Young A; Song, Sang Wroul; Kim, Byoung Yeop; Chung, Jae Lim

    2017-08-01

    To evaluate changes in the tear meniscus area and tear meniscus height over time in patients with dry eye syndrome, using anterior segment spectral-domain optical coherence tomography after the instillation of 3% diquafosol ophthalmic solution. Sixty eyes from 30 patients with mild to moderate dry eye syndrome were included. Tear meniscus images acquired by anterior segment spectral-domain optical coherence tomography were analyzed using National Institutes of Health's image-analysis software (ImageJ 1.44p). Tear meniscus area and tear meniscus height were measured at baseline, 5 minutes, 10 minutes, and 30 minutes after instillation of a drop of diquafosol in one eye and normal saline in the other eye. Changes in ocular surface disease index score, tear film break-up time, corneal staining score by Oxford schema, and meibomian expressibility were also evaluated at baseline, and after 1 week and 1 month of a diquafosol daily regimen. Sixty eyes from 30 subjects (mean age, 29.3 years; 8 men and 22 women) were included. In eyes receiving diquafosol, tear volume was increased at 5 and 10 minutes compared with baseline. It was also higher than saline instilled eyes at 5, 10, and 30 minutes. Changes in tear volume with respect to baseline were not statistically different after the use of diquafosol for 1 month. Ocular surface disease index score, tear film break-up time, and Oxford cornea stain score were significantly improved after 1 week and 1 month of daily diquafosol instillation, but meibomian expressibility did not change. Topical diquafosol ophthalmic solution effectively increased tear volume for up to 30 minutes, compared to normal saline in patients with dry eye syndrome. © 2017 The Korean Ophthalmological Society

  3. Inside-Out Meniscus Repair

    PubMed Central

    Nelson, Clay G.; Bonner, Kevin F.

    2013-01-01

    Meniscus repair over resection, when feasible, should be strongly considered in an effort to preserve meniscus integrity and function, especially in younger patients. Currently, a number of techniques and implants may be used to achieve a successful result. Although all-inside meniscus repair devices have evolved significantly since their introduction and have become the repair technique of choice for many surgeons, the classic inside-out repair technique is still very useful to have in one's armamentarium. Though less popular because of the ease of current-generation fixators, the inside-out technique can still offer advantages for those surgeons who are proficient. With the versatility to address most tear patterns, the ability to deliver sutures with smaller needle diameters, and proven long-term results, it has been considered the gold standard in meniscus repair. We review the inside-out repair technique for both a medial and lateral meniscus tear with some helpful tips when performing the technique, and we present a video demonstration of the lateral meniscus repair technique. PMID:24400199

  4. Novel technique for repairing posterior medial meniscus root tears using porcine knees and biomechanical study.

    PubMed

    Wu, Jia-Lin; Lee, Chian-Her; Yang, Chan-Tsung; Chang, Chia-Ming; Li, Guoan; Cheng, Cheng-Kung; Chen, Chih-Hwa; Huang, Hsu-Shan; Lai, Yu-Shu

    2018-01-01

    Transtibial pullout suture (TPS) repair of posterior medial meniscus root (PMMR) tears was shown to achieve good clinical outcomes. The purpose of this study was to compare biomechanically, a novel technique designed to repair PMMR tears using tendon graft (TG) and conventional TPS repair. Twelve porcine tibiae (n = 6 each) TG group: flexor digitorum profundus tendon was passed through an incision in the root area, created 5 mm postero-medially along the edge of the attachment area. TPS group: a modified Mason-Allen suture was created using no. 2 FiberWire. The tendon grafts and sutures were threaded through the bone tunnel and then fixed to the anterolateral cortex of the tibia. The two groups underwent cyclic loading followed by a load-to-failure test. Displacements of the constructs after 100, 500, and 1000 loading cycles, and the maximum load, stiffness, and elongation at failure were recorded. The TG technique had significantly lower elongation and higher stiffness compared with the TPS. The maximum load of the TG group was significantly lower than that of the TPS group. Failure modes for all specimens were caused by the suture or graft cutting through the meniscus. Lesser elongation and higher stiffness of the constructs in TG technique over those in the standard TPS technique might be beneficial for postoperative biological healing between the meniscus and tibial plateau. However, a slower rehabilitation program might be necessary due to its relatively lower maximum failure load.

  5. Second-look arthroscopic assessment and clinical results of modified pull-out suture for posterior root tear of the medial meniscus.

    PubMed

    Cho, Jin-Ho; Song, Jae-Gwang

    2014-06-01

    To identify the structural integrity of the healing site after arthroscopic repair of a posterior root tear of the medial meniscus by second-look arthroscopy and to determine the clinical relevance of the findings. From January 2005 to December 2010, 20 consecutive patients underwent arthroscopic modified pull-out suture repair for a posterior root tear of the medial meniscus. Thirteen patients were available for second-look arthroscopic evaluation. The healing status of the medial meniscus was classified as complete healing, lax healing, scar tissue healing, and failed healing. We evaluated the correlation between the clinical symptoms and second-look arthroscopic findings. Clinical evaluation was based on the Lysholm knee scores and Hospital for Special Surgery (HSS) scores. There were 4 cases of complete healing, 4 lax healing, 4 scar tissue healing, and 1 failed healing. The healing status of the repaired meniscus appeared to be related to the clinical symptoms. Patients who achieved complete tissue healing had no complaint. The healing status exhibited no relationship with age, mechanical axis, degree of subluxation, and symptom duration. The mean Lysholm score improved from 34.7 preoperatively to 75.6 at follow-up and the mean HSS score also significantly increased from 33.5 to 82.2. We achieved 4 complete and 8 partial healing (lax or scar) of the medial meniscus in this retrospective case series of posterior horn meniscus root repairs performed by 1 surgeon. Further research is needed to clarify why all patients showed clinical improvement despite findings of partial healing on second-look arthroscopy.

  6. Second-Look Arthroscopic Assessment and Clinical Results of Modified Pull-Out Suture for Posterior Root Tear of the Medial Meniscus

    PubMed Central

    Song, Jae-Gwang

    2014-01-01

    Purpose To identify the structural integrity of the healing site after arthroscopic repair of a posterior root tear of the medial meniscus by second-look arthroscopy and to determine the clinical relevance of the findings. Materials and Methods From January 2005 to December 2010, 20 consecutive patients underwent arthroscopic modified pull-out suture repair for a posterior root tear of the medial meniscus. Thirteen patients were available for second-look arthroscopic evaluation. The healing status of the medial meniscus was classified as complete healing, lax healing, scar tissue healing, and failed healing. We evaluated the correlation between the clinical symptoms and second-look arthroscopic findings. Clinical evaluation was based on the Lysholm knee scores and Hospital for Special Surgery (HSS) scores. Results There were 4 cases of complete healing, 4 lax healing, 4 scar tissue healing, and 1 failed healing. The healing status of the repaired meniscus appeared to be related to the clinical symptoms. Patients who achieved complete tissue healing had no complaint. The healing status exhibited no relationship with age, mechanical axis, degree of subluxation, and symptom duration. The mean Lysholm score improved from 34.7 preoperatively to 75.6 at follow-up and the mean HSS score also significantly increased from 33.5 to 82.2. Conclusions We achieved 4 complete and 8 partial healing (lax or scar) of the medial meniscus in this retrospective case series of posterior horn meniscus root repairs performed by 1 surgeon. Further research is needed to clarify why all patients showed clinical improvement despite findings of partial healing on second-look arthroscopy. PMID:24944976

  7. Tibiofemoral contact mechanics following posterior root of medial meniscus tear, repair, meniscectomy, and allograft transplantation.

    PubMed

    Kim, Jin Goo; Lee, Yong Seuk; Bae, Tae Soo; Ha, Jeong Ku; Lee, Dong Hoon; Kim, Young Jae; Ra, Ho Jong

    2013-09-01

    The purposes of this study were to evaluate the effect on tibiofemoral contact mechanics of repair of the posterior root of the medial meniscus and the effect of meniscal allograft transplantation (MAT) with medial collateral ligament (MCL) release at different flexion angles. Ten fresh-frozen human cadaveric knees (five pairs) were used. A digital pressure sensor was inserted by capsulotomy, and experiments were performed serially under the following six conditions, that is, with an intact medial meniscus (normal controls), with a root tear, after root repair, after total meniscectomy, after MAT, and after MAT plus MCL release. During each experiment, knees were positioned at 0°, 30°, 60°, and 90° of flexion, and peak pressure (kPa) and contact area (cm2) were measured. At 0° of flexion, contact pressure did not differ among the six experimental settings. However, at 30° and 60° of flexion, contact pressure differed significantly between root tear and root repair specimens (p = 0.04 and 0.03, respectively), and between total meniscectomy and MAT specimens (p = 0.02 and 0.03, respectively). On the other hand, mean contact pressures were different between normal (476.7 ± 473.1 and 573.3 ± 479.1 kPa) and root repair (575.7 ± 357.8 and 598.6 ± 415.8), and between normal and MAT (635.7 ± 437.4 and 674.3 ± 533.2). At 0°, 30°, 60°, and 90° of flexion, contact areas differed significantly between normal and total meniscectomy specimens (p = 0.02, 0.01, 0.02, and 0.02, respectively), and between MAT and total meniscectomy specimens (p = 0.03, 0.02, 0.02, and 0.03, respectively). Contact areas differed significantly between root tear and root repair specimens at 60° of flexion (p = 0.04), and between normal control and root repair specimens at 60° and 90° of flexion (p = 0.03 and 0.04, respectively). The effects of MAT plus MCL release on contact mechanics were not different from the effects of MAT alone (n.s.). Both meniscal root repair and

  8. A Novel Repair Method for Radial Tears of the Medial Meniscus: Biomechanical Comparison of Transtibial 2-Tunnel and Double Horizontal Mattress Suture Techniques Under Cyclic Loading.

    PubMed

    Bhatia, Sanjeev; Civitarese, David M; Turnbull, Travis Lee; LaPrade, Christopher M; Nitri, Marco; Wijdicks, Coen A; LaPrade, Robert F

    2016-03-01

    Complete radial tears of the medial meniscus have been reported to be functionally similar to a total meniscectomy. At present, there is no consensus on an ideal technique for repair of radial midbody tears of the medial meniscus. Prior attempts at repair with double horizontal mattress suture techniques have led to a reportedly high rate of incomplete healing or healing in a nonanatomic (gapped) position, which compromises the ability of the meniscus to withstand hoop stresses. A newly proposed 2-tunnel radial meniscal repair method will result in decreased gapping and increased ultimate failure loads compared with the double horizontal mattress suture repair technique under cyclic loading. Controlled laboratory study. Ten matched pairs of male human cadaveric knees (average age, 58.6 years; range, 48-66 years) were used. A complete radial medial meniscal tear was made at the junction of the posterior one-third and middle third of the meniscus. One knee underwent a horizontal mattress inside-out repair, while the contralateral knee underwent a radial meniscal repair entailing the same technique with a concurrent novel 2-tunnel repair. Specimens were potted and mounted on a universal testing machine. Each specimen was cyclically loaded 1000 times with loads between 5 and 20 N before experiencing a load to failure. Gap distances at the tear site and failure load were measured. The 2-tunnel repairs exhibited a significantly stronger ultimate failure load (median, 196 N; range, 163-212 N) than did the double horizontal mattress suture repairs (median, 106 N; range, 63-229 N) (P = .004). In addition, the 2-tunnel repairs demonstrated decreased gapping at all testing states (P < .05) with a final measured gapping of 1.7 mm and 4.1 mm after 1000 cycles for the 2-tunnel and double horizontal mattress suture repairs, respectively. The 2-tunnel repairs displayed significantly less gapping distance after cyclic loading and had significantly stronger ultimate failure loads

  9. New meniscus repair technique for peripheral tears near the posterior tibial attachment of the posterior horn of the medial meniscus.

    PubMed

    Park, In-Seop; Kim, Sung-Jae

    2006-08-01

    We introduce a suture technique to repair a peripheral tear near the posterior tibial attachment of the posterior horn. A suture hook was inserted through the posteromedial portal, and the peripheral capsular rim was penetrated from superior to inferior by the sharp hook. Both relay limbs were brought out through the posteromedial portal. The outer limb of the superior peripheral capsular rim was identified with a hemostat. An 18-gauge spinal needle loaded with a No. 0 polydioxanone suture (PDS) was introduced into the joint from the anteromedial portal; it was passed through the joint space until it penetrated the inner torn meniscus. The PDS suture loaded within the needle was pushed into the joint and picked up through the posteromedial portal. The needle was pulled out of the torn meniscus and readvanced over it while the suture was kept loaded. The other limb of the suture from the tip of the spinal needle was retrieved through the posteromedial portal. The initial PDS suture limb was hooked to the shuttle-relay system; it then was passed through the inner torn meniscus and the peripheral capsular rim. The suture limb exiting from the peripheral capsular rim was used as a post and was joined to the other suture limb to form a sliding knot.

  10. Arthroscopic all-inside repair for a tear of posterior root of the medial meniscus: a technical note.

    PubMed

    Choi, Nam-Hong; Son, Kyung-Mo; Victoroff, Brian N

    2008-09-01

    This technical note describes a new arthroscopic technique to repair a tear of posterior root of the medial meniscus. Cartilage at the insertion area of the posterior horn of the medial meniscus (PHMM) was removed using a curved curette inserted through an anteromedial portal. A metal anchor loaded with two FiberWires (Arthrex, Naples, FL) was placed at the insertion area of the PHMM through a high posteromedial portal. A PDS suture was passed the PHMM by curved suture hook through the anteromedial portal. Two limbs of the PDS were then used to pass two limbs of the FiberWire through the meniscus. The same procedure was repeated for the second FiberWire suture. The sutures were tied, achieving secure fixation of the posterior meniscal root at the anatomic insertion.

  11. Arthroscopic partial meniscectomy of a posteriorly flipped superior leaflet in a horizontal medial meniscus tear using a posterior transseptal portal.

    PubMed

    Jang, Ki-Mo; Ahn, Jin Hwan; Wang, Joon Ho

    2012-03-07

    This article describes a case of an arthroscopic partial meniscectomy of a posteriorly flipped superior leaflet in a horizontal medial meniscus tear using the posterior transseptal portal. An arthroscopic partial meniscectomy for bucket handle or flap tears in medial or lateral compartments using ordinary portals is a relatively common procedure in irreparable cases. However, the posterior compartment of the knee is not readily accessible through ordinary arthroscopic portals. Therefore, it has been considered a blind spot. Through the posterior transseptal portal, surgeons can achieve excellent arthroscopic visualization of the posterior compartment and easily perform arthroscopic procedures of the posterior compartment of the knee. A 48-year-old woman presented with a 1-year history of pain in the medial aspect of the right knee joint. Preoperative magnetic resonance imaging revealed a thinning of the medial meniscus posterior horn in coronal images and a sharp-edged triangle arising from the medial meniscus posterior horn between the medial femoral condyle and medial meniscus posterior horn on sagittal images (flipped-over sign). During the arthroscopic procedure, we found that the flipped leaflet was displaced posteriorly and was not mobile between the medial femoral condyle and medial meniscus posterior horn. Partial meniscectomy for a posteriorly displaced fragment can be performed successfully using the posterior transseptal portal. The posterior transseptal portal is useful for an arthroscopic partial meniscectomy of a posteriorly flipped leaflet in the posterior compartment of the knee. Copyright 2012, SLACK Incorporated.

  12. The Changes of Tear Status after Conventional and Wavefront-Guided IntraLASIK

    PubMed Central

    Foo, Say Kiang; Kaur, Sharanjeet; Abd Manan, Faudziah; Low, Aloysius Joseph

    2011-01-01

    Background: IntraLASIK is a LASIK surgery that involved IntraLase femtosecond laser for the corneal flap creating. The objective of this research was to investigate and compare the changes in tear status at 1 and 3 months after undergoing conventional IntraLASIK with Bausch & Lomb PlanoScan (PS) algorithm, Bausch & Lomb Zyoptix Tissue Saving (ZTS) algorithm, and wavefront-guided (WG) IntraLASIK with VISX CustomVue. Methods: Tear status of 36 patients who were divided into 3 groups depending on the type of IntraLASIK they underwent (PS, n = 13; ZTS, n = 9; WG, n = 14) was evaluated. Tear status was determined by classifying the category of the thickness of pre-corneal tear lipid layer, non-invasive tear break-up time, and tear meniscus height. Repeated measures analysis of variance (ANOVA) and one way ANOVA were used for the statistical analyses. Results: The category of the thickness of tear lipid layer, non-invasive tear break up time and tear meniscus height were neither significantly changed after IntraLASIK for all groups nor showed significant difference among groups at 1 and 3 months post-IntraLASIK (P > 0.05). Blinking rate and palpebral aperture also had no significant changed after IntraLASIK. Conclusion: Both conventional (PS and ZTS) and WG IntraLASIK did not affect tear status up to 3 months post-IntraLASIK. WG IntraLASIK did not show superiority in preserving tear status 1 and 3 months post-surgery compared with conventional IntraLASIK. PMID:22135584

  13. Longitudinal tear of the medial meniscus posterior horn in the anterior cruciate ligament-deficient knee significantly influences anterior stability.

    PubMed

    Ahn, Jin Hwan; Bae, Tae Soo; Kang, Ki-Ser; Kang, Soo Yong; Lee, Sang Hak

    2011-10-01

    Longitudinal tears of the medial meniscus posterior horn (MMPH) are commonly associated with a chronic anterior cruciate ligament (ACL) deficiency. Many studies have demonstrated the importance of the medial meniscus in terms of limiting the amount of anterior-posterior tibial translation in response to anterior tibial loads in ACL-deficient knees. An MMPH tear in an ACL-deficient knee increases the anterior-posterior tibial translation and rotatory instability. In addition, MMPH repair will restore the tibial translation to the level before the tear. Controlled laboratory study. Ten human cadaveric knees were tested sequentially using a custom testing system under 5 conditions: intact, ACL deficient, ACL deficient with an MMPH peripheral longitudinal tear, ACL deficient with an MMPH repair, and ACL deficient with a total medial meniscectomy. The knee kinematics were measured at 0°, 15°, 30°, 60°, and 90° of flexion in response to a 134-N anterior and 200-N axial compressive tibial load. The rotatory kinematics were also measured at 15° and 30° of flexion in a combined rotatory load of 5 N·m of internal tibial torque and 10 N·m of valgus torque. Medial meniscus posterior horn longitudinal tears in ACL-deficient knees resulted in a significant increase in anterior-posterior tibial translation at all flexion angles except 90° (P < .05). An MMPH repair in an ACL-deficient knee showed a significant decrease in anterior-posterior tibial translation at all flexion angles except 60° compared with the ACL-deficient/MMPH tear state (P < .05). The total anterior-posterior translation of the ACL-deficient/MMPH repaired knee was not significantly increased compared with the ACL (only)-deficient knee but was increased compared with the ACL-intact knee (P > .05). A total medial meniscectomy in an ACL-deficient knee did not increase the anterior-posterior tibial translation significantly compared with MMPH tears in ACL-deficient knees at all flexion angles (P > .05

  14. Arthroscopic and magnetic resonance imaging evaluation of meniscus lesions in the chronic anterior cruciate ligament-deficient knee.

    PubMed

    Naranje, Sameer; Mittal, Ravi; Nag, Hiralal; Sharma, Raju

    2008-09-01

    We performed this prospective study to evaluate the incidence of meniscus tears arthroscopically and the effectiveness of magnetic resonance imaging (MRI) in detecting these lesions in patients with chronic anterior cruciate ligament (ACL)-deficient knees. We reviewed 50 patients (46 male and 4 female) with a mean age of 27 years (range, 18 to 48 years) who underwent ACL reconstruction for chronic ACL tears. Injuries were classified as chronic because arthroscopy was performed after more than 6 weeks of injury. All 50 patients had clinical and MRI evaluation followed by knee arthroscopy. The MRI and arthroscopic findings were then analyzed by a single independent reviewer. The presence of meniscus tears and their morphologic types and locations were analyzed. The sensitivity, specificity, positive predictive value, and negative predictive value of MRI were calculated. On arthroscopy, a medial meniscus tear was found in 18 patients (36%), a lateral meniscus tear was found in 11 patients (22%), both menisci were torn in 8 patients (16%), and no meniscus lesion was found in 13 patients (26%). The most common morphologic type of tear seen in the medial meniscus was "complex" (n = 11 [42%]), and that in the lateral meniscus was "longitudinal" (n = 10 [53%]). The posterior horn of the meniscus was the most common tear site. The overall sensitivity, specificity, positive predictive value, and negative predictive value for detecting meniscus tears in chronic ACL-deficient knees on MRI were 90%, 89%, 87%, 93%, respectively. We conclude from our study that in chronic ACL-deficient patients, the prevalence of posterior horn medial meniscus tears seems to be high. Anterior horn tears and radial and horizontal patterns of meniscus tears seem to be rare in chronic ACL deficiency. MRI correlates well with arthroscopy and has high negative predictive values. Level I, prognostic prospective study.

  15. [Effects of creating a tunnel through intercondylar fossa under arthroscopy for the treatment of complex tears at the medial meniscus posterior horn].

    PubMed

    Dong, Ling-Dai; Bing, Chang-Jian; Li, Jian-Lin; Cai, Yue

    2017-04-25

    To discuss the advantages of the arthroscopic treatment for complex tears of the medial meniscus posterior horn by creating a tunnel passageway through the intercondylar fossa. All 127 patients including 24 males and 103 females with complex tears at the medial meniscus posterior horn were reviewed. The age of all patients ranged from 45 to 78 years old, with an average of 67 years old. All 127 patients were treated with partial meniscectomy, in which 112 patients were treated with partial meniscectomy smoothly with three incisions (anterior medial incision, anterior lateral incision, high anterior lateral incision), and 15 patients were treated with four incisions (anterior medial incision, anterior lateral incision, high anterior lateral incision, posterior medial incision). Four aspects were estimated:whether the meniscus posterior horns could be observed totally and conveniently, whether tools could be pushed to target area conveniently, the damage of adjacent cartilages, operation time(the operation time of partial meniscectomy). Posterior horns of all patients were totally and conveniently observed, tools were conveniently pushed to the target area in all cases, and all the cases had no iatrogenic injuries at adjacent cartilages. The operation time of partial meniscectomy at posterior horns with three incisions ranged from 5 to 10 minutes, and it ranged from 10 to 30 minutes with four incisions. It is very convenient and fast of the arthroscopy to treat complex tears of the medial meniscus posterior horn by creating a tunnel through the intercondylor fossa. Iatrogenic injuries of the adjacent cartilages were prevented to the greatest extent.

  16. Development of a fast curing tissue adhesive for meniscus tear repair.

    PubMed

    Bochyńska, Agnieszka Izabela; Hannink, Gerjon; Janssen, Dennis; Buma, Pieter; Grijpma, Dirk W

    2017-01-01

    Isocyanate-terminated adhesive amphiphilic block copolymers are attractive materials to treat meniscus tears due to their tuneable mechanical properties and good adhesive characteristics. However, a drawback of this class of materials is their relatively long curing time. In this study, we evaluate the use of an amine cross-linker and addition of catalysts as two strategies to accelerate the curing rates of a recently developed biodegradable reactive isocyanate-terminated hyper-branched adhesive block copolymer prepared from polyethylene glycol (PEG), trimethylene carbonate, citric acid and hexamethylene diisocyanate. The curing kinetics of the hyper-branched adhesive alone and in combination with different concentrations of spermidine solutions, and after addition of 2,2-dimorpholinodiethylether (DMDEE) or 1,4-diazabicyclo [2.2.2] octane (DABCO) were determined using FTIR. Additionally, lap-shear adhesion tests using all compositions at various time points were performed. The two most promising compositions of the fast curing adhesives were evaluated in a meniscus bucket handle lesion model and their performance was compared with that of fibrin glue. The results showed that addition of both spermidine and catalysts to the adhesive copolymer can accelerate the curing rate and that firm adhesion can already be achieved after 2 h. The adhesive strength to meniscus tissue of 3.2-3.7 N was considerably higher for the newly developed compositions than for fibrin glue (0.3 N). The proposed combination of an adhesive component and a cross-linking component or catalyst is a promising way to accelerate curing rates of isocyanate-terminated tissue adhesives.

  17. A giraffe neck sign of the medial meniscus: A characteristic finding of the medial meniscus posterior root tear on magnetic resonance imaging.

    PubMed

    Furumatsu, Takayuki; Fujii, Masataka; Kodama, Yuya; Ozaki, Toshifumi

    2017-07-01

    The posterior root ligament of the medial meniscus (MM) has a critical role in regulating the MM movement. An accurate diagnosis of the MM posterior root tear (MMPRT) using magnetic resonance imaging (MRI) is important for preventing sequential osteoarthritis following the MMPRT. However, diagnosis of the MMPRT is relatively difficult even after using several characteristic MRI findings. The aim of this study was to identify a useful meniscal body sign of the MMPRT for improving diagnostic MRI reading. Eighty-five patients who underwent surgical treatments for the MMPRT (39 knees) and other types of MM tears (49 knees) were included. The presence of characteristic MRI findings such as cleft sign, ghost sign, radial tear sign, medial extrusion sign, and new meniscal body shape-oriented "giraffe neck sign" was evaluated in 120 MRI examinations. Giraffe neck signs were observed in 81.7% of the MMPRTs and in 3.3% of other MM tears. Cleft, ghost, and radial tear signs were highly positive in the MMPRTs compared with other MM tears. Medial extrusion signs were frequently observed in both groups. Coexistence rates of any 2 MRI signs, except for medial extrusion sign, were 91.7% in the MMPRT group and 5% in other MM tears. This study demonstrated that a new characteristic MRI finding "giraffe neck sign" was observed in 81.7% of the MMPRT. Our results suggest that the combination of giraffe neck, cleft, ghost, and radial tear signs may be important for an accurate diagnostic MRI reading of the MMPRT. Copyright © 2017 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

  18. Repair of the posterior root of the medial meniscus.

    PubMed

    Jones, Christopher; Reddy, Sudheer; Ma, C Benjamin

    2010-01-01

    Tears of the posterior root of the medial meniscus are becoming increasingly recognized. Early identification and treatment of these tears help halt the progression of cartilage degeneration and osteoarthritis of the knee. Repair of these tears is essential for recreating the hoop stress of the medial meniscus. In this note, we describe a successful arthroscopic technique to repair this lesion. A posteromedial portal is established by which two 2-0 PDS sutures are placed through the meniscus root and pulled down through a trans-tibial tunnel and fixed using an EndoButton distally along the anterolateral cortex of the tibia. This has been performed successfully in five patients with no complications.

  19. Role of nonoperative treatment in managing degenerative tears of the medial meniscus posterior root.

    PubMed

    Neogi, Devdatta Suhas; Kumar, Ashok; Rijal, Laxman; Yadav, Chandra Shekhar; Jaiman, Ashish; Nag, Hira Lal

    2013-09-01

    Tears of the medial meniscus posterior root can lead to progressive arthritis, and its management has no consensus. The aim of our study was to evaluate the effect of supervised exercise therapy on patients with medial meniscus posterior root tears. Between January 2005 and May 2007, 37 patients with this tear verified by magnetic resonance imaging (MRI) and osteoarthritis grade 1-2 by radiographic examination were treated by a short course of analgesics daily for up to 6 weeks and then as required during follow-up, as well as a 12-week supervised exercise program followed by a home exercise program. Final analysis was performed for 33 patients, average age 55.8 (range 50-62) years and average follow-up of 35 (range 26-49) months. Patients were followed up at 3, 6, and 12 months and yearly thereafter using the Lysholm Knee Scoring Scale, Tegner Activity Scale (TAS), and visual analog scale (VAS). The analysis was performed using one-way analysis of variance (ANOVA) and Pearson's correlation coefficient to determine the relationship between Lysholm score and body mass index (BMI). Patients showed an improvement in Lysholm score, TAS, and VAS, which reached maximum in 6 months and later was accompanied by a decline. However, scores at the final follow-up were significantly better than the pretherapy scores. There was also a progression in arthritis as per Kellgren and Lawrence radiographic classification from median 1 preintervention to median 2 at the final follow-up. A correlation between BMI and Lysholm scores was seen (r = 0.47). Supervised physical therapy with a short course of analgesics followed by a home-based program results in symptomatic and functional improvement over a short-term follow-up; however, osteoarthritis progression continues and is related to BMI.

  20. Patterns of meniscal tears associated with anterior cruciate ligament lesions in athletes.

    PubMed

    Binfield, P M; Maffulli, N; King, J B

    1993-09-01

    In this study, 400 clinically anterior cruciate ligament (ACL) deficient knees were arthroscoped and studied prospectively in the period January 1986 to April 1992. An ACL tear was always confirmed, and 41 per cent of these patients did not have an associated meniscal tear. In 30.25 per cent the lateral meniscus was torn; in 21.25 per cent the ACL tear was associated with a medial meniscus tear, and in the remaining 7 per cent both menisci were torn. The most frequently associated meniscal injury was the bucket handle tear of the medial meniscus (9 per cent), followed by the posterior horn tear of the lateral meniscus, which showed the same frequency as the ragged (or degenerated) tear of the lateral meniscus (6 per cent). The horizontal tear of the posterior part of the lateral meniscus showed a prevalence of 4.3 per cent. This picture is probably dependent on a secondary referral nature of the centre surveyed, in which the average time between injury and arthroscopy was 23.3 months.

  1. Time course of changes in tear meniscus radius and blink rate after instillation of artificial tears.

    PubMed

    Bandlitz, Stefan; Purslow, Christine; Murphy, Paul J; Pult, Heiko

    2014-08-26

    Using a novel digital meniscometer (PDM), alterations in tear meniscus radius (TMR) were measured simultaneously with blink rate (BR) following the instillation of artificial tears. Central TMR and BR of 22 subjects (11 male and 11 female; mean age, 24.3 ± 2.6 SD years) were measured at baseline, and 0, 1, 5, 10, and 30 minutes after instillation of an artificial tear containing hydroxypropyl-guar and glycol (SYS) or saline (SAL). A dose of 35 μL was applied in one eye in a randomized order with a washout period between each drop. For SAL, compared to baseline TMR (0.33 ± 0.08 mm), TMR significantly increased with drop instillation (1.55 ± 0.69 mm) and at 1 minute (0.66 ± 0.36 mm; P < 0.05), but returned to baseline after 5 minutes. For SYS, TMR (0.32 ± 0.07 mm) remained significantly increased after application (1.62 ± 0.81 mm), and at 1 minute (0.81 ± 0.43 mm) and 5 minutes (0.39 ± 0.08 mm; P < 0.05). Compared to baseline BR with SAL (14.8 ± 7.7) and SYS (14.9 ± 9.4), values were significantly increased upon drop instillation (22.5 ± 11.8; 21.3 ± 11.8; P < 0.05), but returned to baseline after 1 minute. Dry eye symptoms were correlated with baseline BR (r = 0.550, P = 0.008). Results indicate that PDM can detect changes in TMR following instillation of artificial tears. Difference in residence time reflects the different viscosity of each drop. An overload with a large drop may result in an initially increased BR. Copyright 2014 The Association for Research in Vision and Ophthalmology, Inc.

  2. Vertical tears of the cranial horn of the meniscus and its cranial ligament in the equine femorotibial joint: 7 cases and their treatment by arthroscopic surgery.

    PubMed

    Walmsley, J P

    1995-01-01

    Five horses with a vertical tear in the cranial horn and cranial ligament of the medial meniscus and 2 horses with a similar injury in the lateral meniscus were diagnosed from a series of 126 horses which were examined arthroscopically for stifle lameness. All the lesions had similar characteristics. The tear was about 1 cm from the axial border of the meniscus and its ligament and, in all but one case in which it was incomplete, much of the torn tissue was loosely attached in the axial part of the joint from where it was removed. The remaining meniscus, abaxial to the tear, was displaced cranially and abaxially and its torn edges were debrided. Radiographically, 6 cases had proliferative new bone on the cranial aspect of the intercondylar eminence of the tibia and 3 had calcified soft tissue densities in the cranial, medial or lateral femorotibial joint. Following surgery and a 6 month period of rest and controlled exercise, 3 horses returned to full competition work, one was usable for hacking, 2 are convalescing and one is lame after one year. It is postulated that this could be a characteristic meniscal injury in horses which can benefit from arthroscopic surgery. Better techniques for accessing the body and caudal pole of the menisci are needed if a more complete diagnosis and treatment of meniscal injuries are to be achieved.

  3. A Controlled Study on the Correlation between Tear Film Volume and Tear Film Stability in Diabetic Patients.

    PubMed

    Eissa, Iman M; Khalil, Noha M; El-Gendy, Heba A

    2016-01-01

    Purpose. To assess the tear film quantity and correlate it with the quality and stability of the tear film in diabetics and compare them to age matched controls. Introduction. Diabetes affects tear film parameters in multiple ways. Poor metabolic control and neuropathy are postulated factors. To further understand how diabetes affects tear film parameters this study was conducted. Subjects and Methods. Tear meniscus height was measured by anterior segment OCT, along with tear thinning time, a subtype of noninvasive tear break-up time, and blinking rate per minute which were all recorded for 22 diabetic patients. Correlations between these tear film parameters were studied and then compared to 16 age matched controls. Results. A statistically significant difference was found in blinking rate between the diabetic and the control group (P = 0.002), with higher blinking rate among diabetics. All tear film parameters were negatively correlated with duration of diabetes. A positive correlation was found between tear film volume and stability. Conclusion. Diabetes affects the tear film in various ways. Diabetics should be examined for dry eye signs even in absence of symptoms which may be masked by associated neuropathy. Duration of diabetes has an impact on tear film status.

  4. Posterior double PCL sign: a case report of unusual MRI finding of bucket-handle tear of medial meniscus.

    PubMed

    Yoo, Jae Ho; Hahn, Sung Ho; Yi, Seung Rim; Kim, Seong Wan

    2007-11-01

    Among the MRI signs of bucket-handle tears of medial meniscus, double posterior cruciate ligament (PCL) sign denotes a low signal band anterior and parallel to the PCL, which looks like another PCL in MR images. If the bucket-handle fragment subsequently tears at the anterior horn, the torn meniscal substance can be displaced to the posterosuperior region of the PCL, and looks like another PCL behind the original PCL. We propose the lesion be called the "posterior double PCL sign" in contrast to the ordinary double PCL sign. We present a case showing the posterior double PCL sign.

  5. Assessment of Corneal and Tear Film Parameters in Rheumatoid Arthritis Patients Using Anterior Segment Spectral Domain Optical Coherence Tomography.

    PubMed

    El-Fayoumi, Dina; Youssef, Maha Mohamed; Khafagy, Mohamed Mahmoud; Badr El Dine, Nashwa; Gaber, Wafaa

    2018-01-01

    To study the corneal changes in rheumatoid arthritis (RA) patients in vivo, using spectral domain anterior segment optical coherence tomography (AS-OCT). A case-control study was done on 43 RA patients and 40 controls. The disease activity score (DAS28-ESR) was calculated and all participants had lower tear meniscus, corneal thickness, and epithelial thickness evaluation using AS-OCT. The lower tear meniscus height (LTMH) and the lower tear meniscus area (LTMA) were significantly lower in the RA patients than in controls (p < 0.001). RA patients also had a significantly thinner central corneal thickness (p = 0.02) and their epithelium was found to be thinner in the superotemporal peripheral sector. The LTMH and LTMA are significantly reduced in RA patients, despite the absence of clinical diagnosis of dry eye. RA patients have thinner corneal thickness and epithelial thickness than controls, which did not correlate with either disease duration or activity.

  6. Medial meniscus extrusion correlates with disease duration of the sudden symptomatic medial meniscus posterior root tear.

    PubMed

    Furumatsu, T; Kamatsuki, Y; Fujii, M; Kodama, Y; Okazaki, Y; Masuda, S; Ozaki, T

    2017-12-01

    Medial meniscus posterior root tear (MMPRT) leads to abnormal biomechanics of the knee by inducing the medial meniscus extrusion (MME). However, a time-dependent increase of the MME is not fully elucidated in patients suffering from the acute MMPRT. The aim of this study was to investigate the relationships among disease duration of the MMPRT and severity of the MME. We hypothesized that MME measurement correlates with disease duration after a sudden onset of the minor traumatic MMPRT during the short-term follow-up period. Forty-six patients who had an accurate episode of the posteromedial painful popping were investigated. All the patients were diagnosed having a symptomatic MMPRT with magnetic resonance imaging (MRI) examinations. Absolute MME was measured using MRI scans within 12 months after painful popping events. A correlation coefficient between duration from injury to MRI examination and absolute MME was evaluated. Mean absolute MME was 4.5±1.6mm (range, 1.1-8.8mm) on MRI measurements. A good correlation was observed between MME measurement and duration from injury to MRI examination (R 2 =0.612). The best-fit equation for predicting each value was: MME=0.014×disease duration+3.288mm. This study demonstrated that absolute MME increases progressively within the short duration after the onset of symptomatic MMPRT. Our results suggest that preoperative MME assessment may be important in determining disease duration and treatment strategy of the MMPRT. Retrospective cohort study level IV. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  7. Biomechanical comparison between suture anchor and transtibial pull-out repair for posterior medial meniscus root tears.

    PubMed

    Feucht, Matthias J; Grande, Eduardo; Brunhuber, Johannes; Rosenstiel, Nikolaus; Burgkart, Rainer; Imhoff, Andreas B; Braun, Sepp

    2014-01-01

    Posterior medial meniscus root (PMMR) tears have a serious effect on knee joint biomechanics. Currently used techniques for refixation of the PMMR include the transtibial pull-out repair (TP) and suture anchor repair (SA). These techniques have not been compared biomechanically. The SA technique provides superior biomechanical properties compared with the TP technique. Controlled laboratory study. A total of 24 fresh-frozen porcine tibiae with attached intact medial menisci were used. The specimens were randomly assigned to 3 groups (8 specimens each). A standardized PMMR tear was created in 16 specimens. Refixation of the PMMR was performed by either the TP or SA technique. The native PMMR was left intact in 8 specimens. All specimens were subjected to cyclic loading followed by load-to-failure testing. Displacement after 100, 500, and 1000 cycles; maximum load to failure; stiffness; and displacement at failure were recorded. Both repair techniques showed a significantly higher displacement during cyclic loading and a significantly lower maximum load and stiffness during load-to-failure testing compared with the native PMMR (P < .05). The SA technique showed a significantly lower displacement after 100, 500, and 1000 cycles (P < .001) and a significantly higher stiffness (P = .016) compared with the TP technique. Maximum load did not differ significantly between the SA and TP techniques (P = .027, Bonferroni adjustment). No significant difference between the 3 groups was observed for displacement at failure (P > .05). The SA technique provided superior biomechanical properties compared with the TP technique. Both repair techniques did not reach the strength of the native PMMR. The favorable biomechanical properties of the SA technique might be beneficial for healing of the repaired PMMR and restoration of meniscus function. Because of inferior time zero stability compared with the native PMMR, slow rehabilitation is recommended after meniscus root repair.

  8. Classification and Surgical Repair of Ramp Lesions of the Medial Meniscus.

    PubMed

    Thaunat, Mathieu; Fayard, Jean Marie; Guimaraes, Tales M; Jan, Nicolas; Murphy, Colin G; Sonnery-Cottet, Bertrand

    2016-08-01

    Ramp lesions of the medial meniscus are commonly associated with anterior cruciate ligament ruptures and consist of longitudinal peripheral tears of the posterior horn of the medial meniscus. Given the frequency of partial-thickness tears, they can be difficult to diagnose arthroscopically from the anterior compartment. We describe a classification of the different types of ramp lesions depending on both tear pattern (partial- or full-thickness tear) and associated meniscotibial ligament disruption. An original technique of arthroscopic suture placement through a single posteromedial portal with a 25° curved suture hook device is described.

  9. Review: Modelling of meniscus of knee joint during soccer kicking

    NASA Astrophysics Data System (ADS)

    Azrul Hisham Mohd Adib, Mohd; Firdaus Jaafar, Mohd

    2013-12-01

    Knee is a part of the body that located between thigh and shank is one of the most complicated and largest joints in the human body. The common injuries that occur are ligaments, meniscus or bone fracture. During soccer games, the knee is the most critical part that will easily injure due to the shock from an external impact. Torn meniscus is one of the effects. This study will investigate the effect towards the meniscus within the knee joint during soccer ball kicking. We conduct a literary review of 14 journals that discuss the general view of meniscus and also soccer kicking. The selected topics for this review paper are meniscal function, meniscal movement, meniscal tears and also instep kick. As a finding, statistics show that most meniscal tears (73%) occurred in athletes who were soccer players, basketball players or skiers. The tear is frequently happening at the medial side rather than lateral side with a percentage of 70%.

  10. Imaging the Postoperative Knee Meniscus: An Evidence-Based Review.

    PubMed

    Baker, Jonathan C; Friedman, Michael V; Rubin, David A

    2018-06-27

    Unenhanced MRI, indirect MR arthrography, direct MR arthrography, and CT arthrography are each currently used to evaluate patients with recurrent knee pain after meniscus surgery. The purpose of this study is to review the evidence for the use of these examinations in patients with suspected recurrent meniscus tear. Direct and indirect MR arthrography are superior to conventional MRI for the assessment of the postoperative meniscus after meniscus repair or partial meniscectomy involving more than 25% of the meniscus.

  11. Direct measurement of hoop strains in the intact and torn human medial meniscus.

    PubMed

    Jones, R Spencer; Keene, G C R; Learmonth, D J A; Bickerstaff, D; Nawana, N S; Costi, J J; Pearcy, M J

    1996-07-01

    OBJECTIVE: To measure the circumferential or hoop strains generated in the medial meniscus during loading of the knee joint and to examine the effect of longitudinal and radial tears in the meniscus on these strain values. DESIGN: An in vitro investigation measuring the circumferential strains in the medial menisci of cadaveric human knees as they were loaded in a materials testing machine. BACKGROUND: The menisci transmit approximately 50% of the load through the knee, the rest being transmitted by direct contact of the articular cartilage. Damage to the menisci will alter the pattern of load transmission as will meniscectomy. This study examined the changes in the mechanics of the meniscus in situ as a result of simulated tears to assess the effect of its load carrying capacity and the implications of surgery to remove part or all of a damaged meniscus. METHODS: Nineteen human cadaveric knees were tested. Windows were made in the joint capsule and strain gauges inserted into the anterior, middle and posterior sections of the medial meniscus. The knees were then loaded to three times body weight at speeds of 50 and 500 mm/min, with the knee joint at 0 degrees and 30 degrees of flexion. The tests were repeated following the creation of a longitudinal or a radial tear in the meniscus. RESULTS: The intact menisci showed significantly less strain in the posterior section compared to the anterior and middle sections (P < 0.003, with strains of 1.54%, 2.86% and 2.65% respectively). With a longitudinal tear this pattern changed with strains decreasing anteriorly and increasing posteriorly. There were also significant differences at different angles of knee joint flexion not seen in the intact meniscus. 50% radial tears reduced the strains anteriorly whilst a complete radial tear completely defunctioned the meniscus. CONCLUSIONS: This study has shown that there are significantly different hoop strains produced in different sections of the medial meniscus under load and

  12. Meniscal pathology associated with acute anterior cruciate ligament tears in patients with open physes.

    PubMed

    Samora, Walter P; Palmer, Ryan; Klingele, Kevin E

    2011-01-01

    The purpose of this study is to characterize meniscal pathology associated with anterior cruciate ligament (ACL) rupture in skeletally immature patients. We also evaluate the accuracy of preoperative magnetic resonance imaging (MRI) in predicting ACL and meniscus pathology. A retrospective chart review was performed on 124 skeletally immature patients who underwent arthroscopically assisted ACL reconstruction within 3 months of injury. Operative reports and arthroscopic images were reviewed to determine patterns of meniscal injury. The accuracy of preoperative MRI in predicting ACL rupture and meniscus pathology was also compared. One hundred twenty-four patients, including 80 males with an average age of 14.3 years, and 44 females with an average age of 14.1 years were included. The lateral meniscus was torn in 51 patients, the medial meniscus in 17 patients, and both menisci in 19. The prevalence of meniscus tear was 69.3%. Location of the tear occurred in the posterior horn in 69 tears (65.0%), the middle and posterior horn in 31 tears (29.2%), the middle horn in 4 tears (3.7%), and the anterior horn and posterior horn in 2 tears (1.8%). MRI showed 95.6% sensitivity in detecting complete ACL rupture. Further, MRI had a sensitivity of 58.6% and a specificity of 91.3% in characterizing meniscus tears. There are many studies that evaluate ACL rupture in the skeletally immature population, but few studies focus on the meniscus pathology that is associated with these injuries. We reinforce the fact that meniscal injury is commonly associated with ACL rupture in patients with open physes (prevalence of 69.3%). We were able to conclude that lateral meniscus tears are more common than medial meniscus tears, which were equally as common as combined tears in our patient population. The posterior horn is injured in most of patients, and is usually in a repairable configuration and vascular zone. These findings will help to guide surgeons in their clinical evaluation and

  13. Diagnostic accuracy of 3.0 T magnetic resonance imaging for the detection of meniscus posterior root pathology.

    PubMed

    LaPrade, Robert F; Ho, Charles P; James, Evan; Crespo, Bernardo; LaPrade, Christopher M; Matheny, Lauren M

    2015-01-01

    The purpose of this study was to determine the diagnostic accuracy of 3 T MRI, including sensitivity, specificity, negative and positive predictive values, for detection of posterior medial and lateral meniscus root tears and avulsions. All patients who had a 3 T MRI of the knee, followed by arthroscopic surgery, were included in this study. Arthroscopy was considered the gold standard. Meniscus root tears diagnosed at arthroscopy and on MRI were defined as a complete meniscus root detachment within 9 mm of the root. All surgical data were collected prospectively and stored in a data registry. MRI exams were reported prospectively by a musculoskeletal radiologist and reviewed retrospectively. There were 287 consecutive patients (156 males, 131 females; mean age 41.7 years) in this study. Prevalence of meniscus posterior root tears identified at arthroscopy was 9.1, 5.9% for medial and 3.5% for lateral root tears (one patient had both). Sensitivity was 0.770 (95% CI 0.570, 0.901), specificity was 0.729 (95% CI 0.708, 0.741), positive predictive value was 0.220 (95% CI 0.163, 0.257) and negative predictive value was 0.970 (95% CI 0.943, 0.987). For medial root tears, sensitivity was 0.824 (95% CI 0.569, 0.953), specificity was 0.800 (95% CI 0.784, 0.808), positive predictive value was 0.206 (95% CI 0.142, 0.238) and negative predictive value was 0.986 (95% CI 0.967, 0.996). For lateral meniscus posterior root tears, sensitivity was 0.600 (95% CI 0.281, 0.860), specificity was 0.903 (95% CI 0.891, 0.912), positive predictive value was 0.181 (95% CI 0.085, 0.261) and negative predictive value was 0.984 (95% CI 0.972, 0.994). This study demonstrated moderate sensitivity and specificity of 3 T MRI to detect posterior meniscus root tears. The negative predictive value of 3 T MRI to detect posterior meniscus root tears was high; however, the positive predictive value was low. Sensitivity was higher for medial root tears, indicating a higher risk of missing lateral root

  14. Repair of a complete radial tear in the midbody of the medial meniscus using a novel crisscross suture transtibial tunnel surgical technique: a case report.

    PubMed

    James, Evan W; LaPrade, Christopher M; Feagin, John A; LaPrade, Robert F

    2015-09-01

    Complete radial meniscus tears have been reported to result in deleterious effects in the knee joint if left unrepaired. An emphasis on meniscal preservation is important in order to restore native meniscal function. In this case report, a complete radial tear of the medial meniscus midbody was repaired using a novel crisscross suture transtibial technique. This technique secured the anterior and posterior meniscal horns, which were released from their extruded and scarred position along the capsule, using crisscrossing sutures passed through two transtibial tunnels and secured over a bone bridge on the anterolateral tibia. In addition, the repair was supplemented with the injection of platelet-rich plasma and bone marrow aspirate concentrate to promote the healing of the meniscal tissue. Complete healing on second-look arthroscopy is presented, including in the previously unreported white-white meniscal zone.

  15. Arthroscopic pullout suture repair of posterior root tear of the medial meniscus: radiographic and clinical results with a 2-year follow-up.

    PubMed

    Lee, Ju Hong; Lim, Young Jin; Kim, Ki Bum; Kim, Kyu Hyung; Song, Ji Hun

    2009-09-01

    This study was undertaken to document the short-term clinical efficacy of arthroscopic pullout suture repair in treating posterior root tears of the medial meniscus. From March 2004 to August 2006, 26 patients (27 knees) with posterior root tears of the medial meniscus were treated with arthroscopic pullout suture repair surgery by the senior author. Of these, 20 consecutive patients (21 knees) with a minimum of 2 years' follow-up treated by arthroscopic pullout suture repair were analyzed. Clinical results by use of the Lysholm knee and Hospital for Special Surgery scores and radiographic grade were evaluated, both preoperatively and at final follow-up. In addition, the second-look arthroscopic findings for 10 knees were analyzed. A radiographic evaluation using the criteria of Kellgren and Lawrence at final follow-up showed an increase in radiographic grade by 1 grade in only 1 knee. On the second-look arthroscopies performed in 10 knees (47.6%), all repaired menisci had healed completely without additional chondral lesions in the knee. The mean Hospital for Special Surgery scores improved from 61.1 preoperatively to 93.8 at final follow-up (P < .0001), and the mean preoperative Lysholm knee scores improved from 57.0 to 93.1 at final follow-up (P < .0001). Retear was found in 1 knee at the 6-month follow-up, and reoperation was performed with the same procedure used for the index surgery. Arthroscopic pullout suture repair is an effective treatment for alleviating meniscal symptoms in patients with a symptomatic posterior root tear of the medial meniscus with degenerated articular cartilage of less than grade III. In addition, no discernable degenerative arthritic changes were found in terms of radiographic features with our limited short-term follow-up. Level IV, therapeutic case series.

  16. Posterior medial meniscus root ligament lesions: MRI classification and associated findings.

    PubMed

    Choi, Ja-Young; Chang, Eric Y; Cunha, Guilherme M; Tafur, Monica; Statum, Sheronda; Chung, Christine B

    2014-12-01

    The purposes of this study were to determine the prevalence of altered MRI appearances of "posterior medial meniscus root ligament (PMMRL)" lesions, introduce a classification of lesion types, and report associated findings. We retrospectively reviewed 419 knee MRI studies to identify the presence of PMMRL lesions. Classification was established on the basis of lesions encountered. The medial compartment was assessed for medial meniscal tears in the meniscus proper, medial meniscal extrusion, insertional PMMRL osseous changes, regional synovitis, osteoarthritis, insufficiency fracture, and cruciate ligament abnormality. PMMRL abnormalities occurred in 28.6% (120/419) of the studies: degeneration, 14.3% (60/419) and tear, 14.3% (60/419). Our classification system included degeneration and tearing. Tearing was categorized as partial or complete with delineation of the point of failure as entheseal, midsubstance, or junction to meniscus. Of all tears, 93.3% (56/60) occurred at the meniscal junction. Univariate analysis revealed significant differences between the knees with and without PMMRL lesions in age, medial meniscal tear, medial meniscal extrusion, insertional PMMRL osseous change, regional synovitis, osteoarthritis, insufficiency fracture (p=0.017), and cruciate ligament degeneration (p<0.001). PMMRL lesions are commonly detected in symptomatic patients. We have introduced an MRI classification system. PMMRL lesions are significantly associated with age, medial meniscal tears, medial meniscal extrusion, insertional PMMRL osseous change, regional synovitis, osteoarthritis, insufficiency fracture, and cruciate ligament degeneration.

  17. Arthroscopic Medial Meniscus Posterior Root Fixation Using a Modified Mason-Allen Stitch.

    PubMed

    Chung, Kyu Sung; Ha, Jeong Ku; Ra, Ho Jong; Kim, Jin Goo

    2016-02-01

    A complete radial tear of the meniscus posterior root, which can effectively cause a state of total meniscectomy via loss of hoop tension, requires that the torn root be repaired. Several methods have been used to repair medial meniscus posterior root tears, most of which are based on a simple stitch technique that is known to have stitch-holding strength. We applied a modified version of the Mason-Allen stitch technique, which is recognized as a method for rotator cuff repair surgery because its locking effect overcomes the potential weakness of simple stitches. This article introduces the medial meniscus posterior root tears repair procedure based on a modified Mason-Allen stitch technique in which 2 strands (i.e., 1 simple horizontal and 1 simple vertical stitch) are used.

  18. Prognostic factors of arthroscopic pull-out repair for a posterior root tear of the medial meniscus.

    PubMed

    Moon, Hong-Kyo; Koh, Yong-Gon; Kim, Yong-Chan; Park, Young-Sik; Jo, Seung-Bae; Kwon, Sae-Kwang

    2012-05-01

    Repair of a posterior root tear of the medial meniscus (MRT) decreases peak contact pressure by restoring hoop tension and is expected to prevent progression to osteoarthritis. The purposes of this study were (1) to report the clinical and magnetic resonance imaging (MRI) results of arthroscopic pull-out repair of the MRT and (2) to identify prognostic factors of poor outcome. Case series; Level of evidence, 4. Fifty-one patients (47 women, 4 men) who underwent arthroscopic pull-out repair of the MRT by a single surgeon were enrolled. Mean follow-up after surgery was 33 months (range, 24-44 months). To identify factors affecting final outcome, patient-specific factors, such as gender, age, body mass index, meniscus extrusion, extrusion increase, subchondral edema, degree of varus alignment (<5° or >5°), and cartilage status in the medial compartment (Outerbridge grade 1 or 2 lesion vs grade 3 or 4 lesion), were investigated. Final clinical outcomes were determined using a visual analog scale (VAS) for pain and patient satisfaction scores, American Knee Society (AKS) scores, and Lysholm scores, and MRI outcomes were determined by evaluating meniscus extrusion and articular cartilage status. Multiple regression analysis was performed to identify variables that independently affected clinical and MRI-determined outcomes. All clinical outcome measures significantly improved after surgery. Patients with Outerbridge grade 3 or 4 chondral lesions had poorer results than those with grade 1 or 2 lesions in terms of AKS function and Lysholm scores. Patients with varus alignment of >5° had poorer results than those with varus alignment of <5° in terms of VAS satisfaction, AKS function, and Lysholm scores. Mean meniscus extrusion increased from 3.6 mm preoperatively to 5.0 mm postoperatively. Chondral lesions progressed in 3 (9.7%) of 31 patients. Preoperative meniscus extrusion was found to be positively correlated with final extrusion. At a mean follow-up of 33 months

  19. A Contact Pressure Analysis Comparing an All-Inside and Inside-Out Surgical Repair Technique for Bucket-Handle Medial Meniscus Tears.

    PubMed

    Marchetti, Daniel Cole; Phelps, Brian M; Dahl, Kimi D; Slette, Erik L; Mikula, Jacob D; Dornan, Grant J; Bucci, Gabriella; Turnbull, Travis Lee; Singleton, Steven B

    2017-10-01

    To directly compare effectiveness of the inside-out and all-inside medial meniscal repair techniques in restoring native contact area and contact pressure across the medial tibial plateau at multiple knee flexion angles. Twelve male, nonpaired (n = 12), fresh-frozen human cadaveric knees underwent a series of 5 consecutive states: (1) intact medial meniscus, (2) MCL tear and repair, (3) simulated bucket-handle longitudinal tear of the medial meniscus, (4) inside-out meniscal repair, and (5) all-inside meniscal repair. Knees were loaded with a 1,000-N axial compressive force at 5 knee flexion angles (0°, 30°, 45°, 60°, 90°), and contact area, mean contact pressure, and peak contact pressure were calculated using thin film pressure sensors. No significant differences were observed between the inside-out and all-inside repair techniques at any flexion angle for contact area, mean contact pressure, and peak contact pressure (all P > .791). Compared with the torn meniscus state, inside-out and all-inside repair techniques resulted in increased contact area at all flexion angles (all P < .005 and all P < .037, respectively), decreased mean contact pressure at all flexion angles (all P < .007 and all P < .001, respectively) except for 0° (P = .097 and P = .39, respectively), and decreased peak contact pressure at all flexion angles (all P < .001, all P < .001, respectively) except for 0° (P = .080 and P = .544, respectively). However, there were significant differences in contact area and peak contact pressure between the intact state and inside-out technique at angles ≥45° (all P < .014 and all P < .032, respectively). Additionally, there were significant differences between the intact state and all-inside technique in contact area at 60° and 90° and peak contact pressure at 90° (both P < .005 and P = .004, respectively). Median values of intact contact area, mean contact pressure, and peak contact pressure over the tested flexion angles ranged

  20. Biomechanical Comparison of Parallel and Crossed Suture Repair for Longitudinal Meniscus Tears.

    PubMed

    Milchteim, Charles; Branch, Eric A; Maughon, Ty; Hughey, Jay; Anz, Adam W

    2016-04-01

    Longitudinal meniscus tears are commonly encountered in clinical practice. Meniscus repair devices have been previously tested and presented; however, prior studies have not evaluated repair construct designs head to head. This study compared a new-generation meniscus repair device, SpeedCinch, with a similar established device, Fast-Fix 360, and a parallel repair construct to a crossed construct. Both devices utilize self-adjusting No. 2-0 ultra-high molecular weight polyethylene (UHMWPE) and 2 polyether ether ketone (PEEK) anchors. Crossed suture repair constructs have higher failure loads and stiffness compared with simple parallel constructs. The newer repair device would exhibit similar performance to an established device. Controlled laboratory study. Sutures were placed in an open fashion into the body and posterior horn regions of the medial and lateral menisci in 16 cadaveric knees. Evaluation of 2 repair devices and 2 repair constructs created 4 groups: 2 parallel vertical sutures created with the Fast-Fix 360 (2PFF), 2 crossed vertical sutures created with the Fast-Fix 360 (2XFF), 2 parallel vertical sutures created with the SpeedCinch (2PSC), and 2 crossed vertical sutures created with the SpeedCinch (2XSC). After open placement of the repair construct, each meniscus was explanted and tested to failure on a uniaxial material testing machine. All data were checked for normality of distribution, and 1-way analysis of variance by ranks was chosen to evaluate for statistical significance of maximum failure load and stiffness between groups. Statistical significance was defined as P < .05. The mean maximum failure loads ± 95% CI (range) were 89.6 ± 16.3 N (125.7-47.8 N) (2PFF), 72.1 ± 11.7 N (103.4-47.6 N) (2XFF), 71.9 ± 15.5 N (109.4-41.3 N) (2PSC), and 79.5 ± 25.4 N (119.1-30.9 N) (2XSC). Interconstruct comparison revealed no statistical difference between all 4 constructs regarding maximum failure loads (P = .49). Stiffness values were also similar

  1. Diagnosis and Treatment of Discoid Meniscus

    PubMed Central

    Kim, Jae-Gyoon; Han, Seung-Woo; Lee, Dae-Hee

    2016-01-01

    There is a greater incidence of discoid meniscus in Asian countries than in Western countries, and bilateral discoid menisci are also common. The discoid meniscus may be a congenital anomaly, and genetics or family history may play a role in the development of discoid menisci. Because the histology of discoid meniscus is different from that of normal meniscus, it is prone to tearing. Individuals with a discoid meniscus can be asymptomatic or symptomatic. Asymptomatic discoid menisci do not require treatment. However, operative treatment is necessary if there are symptoms. Total meniscectomy leads to an increased risk of osteoarthritis. Therefore, total meniscectomy is generally reserved for rare unsalvageable cases. Partial meniscectomy (saucerization) with preservation of a stable peripheral rim combined with or without peripheral repair is effective, and good short-, mid-, and long-term clinical results have been reported. PMID:27894171

  2. Pullout repair of a medial meniscus posterior root tear using a FasT-Fix® all-inside suture technique.

    PubMed

    Kodama, Y; Furumatsu, T; Fujii, M; Tanaka, T; Miyazawa, S; Ozaki, T

    2016-11-01

    A medial meniscus posterior root tear (MMPRT) may increase the tibiofemoral contact pressure by decreasing the tibiofemoral contact area. Meniscal dysfunction induced by posterior root injury may lead to the development of osteoarthritic knees. Repair of a MMPRT can restore medial meniscus (MM) function and prevent knee osteoarthritis progression. Several surgical procedures have been reported for treating a MMPRT. However, these procedures are associated with several technical difficulties. Here, we describe a technique to stabilize a torn MM posterior root using the FasT-Fix ® all-inside meniscal suture device and a new aiming device. The uncut free-end of the FasT-Fix ® suture can be used as a thread for transtibial pullout repair. Our procedure might help overcome the technical difficulties in arthroscopic treatment of a MMPRT. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  3. Tear menisci after laser in situ keratomileusis with mechanical microkeratome and femtosecond laser.

    PubMed

    Xie, Wenjia; Zhang, Dong; Chen, Jia; Liu, Jing; Yu, Ye; Hu, Liang

    2014-08-21

    To investigate the effect on tear menisci after laser in situ keratomileusis (LASIK) with flap creation by either microkeratome or femtosecond laser. Sixty eyes of 30 myopes were analyzed. Fifteen patients underwent LASIK with Moria II microkeratome, and the other 15 patients with 60-KHz IntraLase femtosecond laser. Upper and lower tear meniscus parameters of height (UTMH, LTMH) and area (UTMA, LTMA) were measured by SD-OCT preoperatively and 1 week, 1 month, and 3 months postoperatively. Compared with the baseline values, all tear meniscus parameters decreased significantly at each postoperative time point (all P < 0.01) in both groups. LTMH increased significantly between 1 week and 1 month and between 1 and 3 months after surgery in the microkeratome (both P < 0.01) and femtosecond laser groups (P < 0.01, P = 0.012, respectively). There were significant increases in LTMA between 1 week and 1 month after surgery in the microkeratome group (P < 0.01) and in the femtosecond laser group (P = 0.028). There were no significant differences in UTMH, UTMA, LTMH, or LTMA between two groups. The depth of ablation was negatively correlated with the LTMA at 1 week after surgery (R = -0.256, P = 0.049) for all patients. There were no significant differences in the tear meniscus parameters between the microkeratome and femtosecond laser groups. The depth of ablation was significantly correlated with the LTMA only at 1 week after surgery. Copyright 2014 The Association for Research in Vision and Ophthalmology, Inc.

  4. Double transosseous pull out suture technique for transection of posterior horn of medial meniscus.

    PubMed

    Ahn, Jin Hwan; Wang, Joon Ho; Lim, Hong Chul; Bae, Ji Hoon; Park, Joon Soo; Yoo, Jae Chul; Shyam, Ashok Kumar

    2009-03-01

    Transection injury (complete radial tear, root tear) in the posterior horn of medial meniscus will lead to loss of hoop strain, extrusion of the meniscus and early degenerative changes. The posterior horn of medial meniscus is amenable to repair due to its good blood supply and repair is the procedure of choice for these injuries. In cases of transection of the medial meniscus posterior horn, the meniscus can be repaired by a pull out suture technique using trans-septal portal. The single transosseous pull out suturing technique is a point fixation technique with limited contact area having low and inhomogeneous contact pressure. This article describes a double transosseous pull out suture technique using trans-septal portal for the repair of transection of posterior horn of medial meniscus. Use of double transosseous technique provides more secure fixation, more homogeneous and wider contact pressure area between meniscus and the bone, improving the healing potential of the repair.

  5. Revision 1 size and position of the healthy meniscus, and its correlation with sex, height, weight, and bone area- a cross-sectional study.

    PubMed

    Bloecker, Katja; Englund, Martin; Wirth, Wolfgang; Hudelmaier, Martin; Burgkart, Rainer; Frobell, Richard B; Eckstein, Felix

    2011-10-28

    Meniscus extrusion or hypertrophy may occur in knee osteoarthritis (OA). However, currently no data are available on the position and size of the meniscus in asymptomatic men and women with normal meniscus integrity. Three-dimensional coronal DESSwe MRIs were used to segment and quantitatively measure the size and position of the medial and lateral menisci, and their correlation with sex, height, weight, and tibial plateau area. 102 knees (40 male and 62 female) were drawn from the Osteoarthritis Initiative "non-exposed" reference cohort, including subjects without symptoms, radiographic signs, or risk factors for knee OA. Knees with MRI signs of meniscus lesions were excluded. The tibial plateau area was significantly larger (p < 0.001) in male knees than in female ones (+23% medially; +28% laterally), as was total meniscus surface area (p < 0.001, +20% medially; +26% laterally). Ipsi-compartimental tibial plateau area was more strongly correlated with total meniscus surface area in men (r = .72 medially; r = .62 laterally) and women (r = .67; r = .75) than contra-compartimental or total tibial plateau area, body height or weight. The ratio of meniscus versus tibial plateau area was similar between men and women (p = 0.22 medially; p = 0.72 laterally). Tibial coverage by the meniscus was similar between men and women (50% medially; 58% laterally), but "physiological" medial meniscal extrusion was greater in women (1.83 ± 1.06mm) than in men (1.24mm ± 1.18mm; p = 0.011). These data suggest that meniscus surface area strongly scales with (ipsilateral) tibial plateau area across both sexes, and that tibial coverage by the meniscus is similar between men and women.

  6. Revision 1 Size and position of the healthy meniscus, and its Correlation with sex, height, weight, and bone area- a cross-sectional study

    PubMed Central

    2011-01-01

    Background Meniscus extrusion or hypertrophy may occur in knee osteoarthritis (OA). However, currently no data are available on the position and size of the meniscus in asymptomatic men and women with normal meniscus integrity. Methods Three-dimensional coronal DESSwe MRIs were used to segment and quantitatively measure the size and position of the medial and lateral menisci, and their correlation with sex, height, weight, and tibial plateau area. 102 knees (40 male and 62 female) were drawn from the Osteoarthritis Initiative "non-exposed" reference cohort, including subjects without symptoms, radiographic signs, or risk factors for knee OA. Knees with MRI signs of meniscus lesions were excluded. Results The tibial plateau area was significantly larger (p < 0.001) in male knees than in female ones (+23% medially; +28% laterally), as was total meniscus surface area (p < 0.001, +20% medially; +26% laterally). Ipsi-compartimental tibial plateau area was more strongly correlated with total meniscus surface area in men (r = .72 medially; r = .62 laterally) and women (r = .67; r = .75) than contra-compartimental or total tibial plateau area, body height or weight. The ratio of meniscus versus tibial plateau area was similar between men and women (p = 0.22 medially; p = 0.72 laterally). Tibial coverage by the meniscus was similar between men and women (50% medially; 58% laterally), but "physiological" medial meniscal extrusion was greater in women (1.83 ± 1.06mm) than in men (1.24mm ± 1.18mm; p = 0.011). Conclusions These data suggest that meniscus surface area strongly scales with (ipsilateral) tibial plateau area across both sexes, and that tibial coverage by the meniscus is similar between men and women. PMID:22035074

  7. Biomechanical evaluation of different suture techniques for arthroscopic transtibial pull-out repair of posterior medial meniscus root tears.

    PubMed

    Feucht, Matthias J; Grande, Eduardo; Brunhuber, Johannes; Burgkart, Rainer; Imhoff, Andreas B; Braun, Sepp

    2013-12-01

    A tear of the posterior medial meniscus root (PMMR) is increasingly recognized as a serious knee joint injury. Several suture techniques for arthroscopic transtibial pull-out repair have been described; however, only limited data about the biomechanical properties of these techniques are currently available. There are significant differences between the tested suture techniques, with more complex suture configurations providing superior biomechanical properties. Controlled laboratory study. A total of 40 porcine medial menisci were randomly assigned to 1 of 4 groups (10 specimens each) according to suture technique: two simple stitches (TSS), horizontal mattress suture (HMS), modified Mason-Allen suture (MMA), and two modified loop stitches (TLS). Meniscus-suture constructs were subjected to cyclic loading followed by load-to-failure testing in a servohydraulic material testing machine. During cyclic loading, the HMS and TLS groups showed a significantly higher displacement after 100, 500, and 1000 cycles compared with the TSS and MMA groups. After 1000 cycles, the highest displacement was found for the TLS group, with significant differences compared with all other groups. During load-to-failure testing, the highest maximum load and yield load were observed for the MMA group, with statistically significant differences compared with the TSS and TLS groups. With regard to stiffness, the TSS and MMA groups showed significantly higher values compared with the HMS and TLS groups. The MMA technique provided the best biomechanical properties with regard to cyclic loading and load-to-failure testing. The TSS technique seems to be a valuable alternative. Both the HMS and TLS techniques have the disadvantage of lower stiffness and higher displacement during cyclic loading. Using a MMA technique may improve healing rates and avoid progressive extrusion of the medial meniscus after transtibial pull-out repair of PMMR tears. The TSS technique may be used as an alternative that

  8. Clinical significance of condylar chondromalacia after arthroscopic resection of flap-tears of the medial meniscus. A prospective study of 93 cases.

    PubMed

    Aune, A K; Madsen, J E; Moen, H

    1995-01-01

    We describe the results after arthroscopic resection of flap-tears of the medial meniscus posterior horn in 93 patients with (40) or without (53) chondromalacia of the adjacent condylar cartilage at the time of operation. These were 93 consecutive patients presenting with medial flap-tears during the period 1988-1990 in our departments. The follow-up averaged 42 (range 26-50) months. There was a significant difference in the functional results at review depending on the presence or absence of condylar chondromalacia at arthroscopy. Among the 40 patients with chondromalacia, the Lysholm score was significantly lower (P < 0.004), and only about half the patients reported a satisfactory result. There was a significant increase in the presence of chondromalacia with age (P < 0.001). In conclusion, the presence of minor degenerative changes in the articular cartilage adjacent to meniscal flap-tears correlated with a less favourable outcome.

  9. Predictors of degenerative medial meniscus extrusion: radial component and knee osteoarthritis.

    PubMed

    Lee, Dae-Hee; Lee, Bum-Sik; Kim, Jong-Min; Yang, Kyung-Sook; Cha, Eun-Jong; Park, Ji-Hun; Bin, Seong-Il

    2011-02-01

    the purpose of this study was to determine the effect of a radial tear on degenerative medial meniscus posterior horn tear extrusion and to identify predictors of medial meniscus extrusion. we reviewed the records of 102 knees with medial meniscus posterior horn tears and degeneration that underwent a partial meniscectomy. Tears were classified as root (n = 17) and non-root (n = 85) tears, or as radial (n = 46) and non-radial (n = 56) tears. Groups were compared in terms of absolute and relative meniscal extrusion, and the proportion of knees with major (> 3 mm) extrusion. Multiple regression analysis was used to identify predictors of extrusion. the radial group had greater mean absolute (4 ± 1 vs. 3 ± 1 mm, P = 0.001) and relative (31 ± 11 vs. 23 ± 12%, P = 0.031) extrusion than the non-radial group. The radial group also had a greater proportion of major extrusions than the non-radial group (74% vs. 26%; P = 0.016). In contrast, the root tear and non-root tear groups were similar in terms of mean absolute (3 ± 1 vs. 3 ± 1 mm, P = n.s.) and relative (30 ± 7 vs. 26 ± 13%; P = n.s.) extrusion and in terms of proportion with major extrusions (59 vs. 55%; P = n.s.). Extrusion was found to be associated with a similar strength with both the presence of a radial component and the preoperative Kellgren-Lawrence grade. meniscal extrusion was greater and more severe in knees with a radial tear component than in knees without a radial component. The incidence and degree of major extrusion was similar in knees with root tears and non-root tears. A radial component and knee osteoarthritis severity were similarly predictive of absolute and relative extrusion. Meniscal extrusion in osteoarthritic knees was associated not only with degenerative meniscal tear but also with osteoarthritis severity. Therefore, arthroscopic meniscal procedures, especially meniscal repair, should be cautiously considered in patients with meniscal extrusion.

  10. Arthroscopic Repair of the Medial Meniscus Radial/Oblique Tear Prevents the Progression of Meniscal Extrusion in Mildly Osteoarthritic Knees.

    PubMed

    Furumatsu, Takayuki; Kodama, Yuya; Kamatsuki, Yusuke; Hino, Tomohito; Ozaki, Toshifumi

    2017-10-01

    Extrusion of the medial meniscus (MM) is associated with knee joint pain in osteoarthritic knees. The relationships among MM radial/oblique tears, MM extrusion (MME), and the effect of arthroscopic meniscal repair are not established. Here we evaluated the effects of arthroscopic all-inside MM repair on MME and the clinical outcomes in patients with radially oriented MM tears and mildly osteoarthritic knees. Twenty patients with a symptomatic radial or oblique tear of the MM posterior segment, MME ≥2.5 mm, and mildly osteoarthritic knees were treated using FasT-Fix 360 All-inside Meniscal Suture devices. We used magnetic resonance imaging (MRI) to measure the patients' MM body width (MMBW), absolute MME, and relative MME. The Japanese Knee Injury and Osteoarthritis Outcome Score, Lysholm, Tegner, IKDC Subjective Knee Evaluation, and Visual Analogue Scale scores were obtained. Arthroscopic all-inside MM repair prevented increases of absolute and relative MME. The preoperative and 3- and 12-month MRI-based MMBW values were similar. Over a 24-month follow-up after the MM repairs, the clinical scores showed significant improvements. Our results suggest that all-inside meniscal repairs would be useful in preventing the progression of MME in patients suffering from symptomatic MM radial/oblique tears associated with mildly osteoarthritic knees.

  11. The Effects of Increasing Ocular Surface Stimulation on Blinking and Tear Secretion

    PubMed Central

    Wu, Ziwei; Begley, Carolyn G.; Port, Nicholas; Bradley, Arthur; Braun, Richard; King-Smith, Ewen

    2015-01-01

    Purpose. To investigate the effect of varying levels of ocular surface stimulation on the timing and amplitude of the blink and tear secretion. Methods. Following instillation of fluorescein dye, increasing levels of air flow were directed toward the central corneas of 10 healthy subjects. Interblink interval (IBI), tear meniscus height (TMH), and fluorescence intensity were measured simultaneously. Because blinking can obscure changes in TMH, we developed novel measures of tear secretion by calculating tear meniscus fluorescein concentration (TMFC) from intensity using a mathematical model. The change of TMH and TMFC over trials and the slope of the TMFC within each IBI (IBI-TTR) were further calculated. Results. The mean IBI was decreased by 8.08 ± 8.54 seconds from baseline to maximum air stimulation. The TMH increase was highly variable (0.41 ± 0.39 mm) among subjects, compared to the fluorescence tear turnover metrics: decrease in TMFC of 2.84 ± 0.98 natural logarithm or ln(%) and IBI-TTR of 0.065 ± 0.032 ln(%)/sec. Ocular surface stimulation was highly correlated with the TMFC and IBI-TTR, but less so with TMH (Pearson's r = 0.71, 0.69, and 0.40, P < 0.01, respectively). Blinking and tearing were significantly correlated with each other (Pearson's r = 0.56, P < 0.01), but tearing lagged behind by an average of 6.54 ± 4.07 seconds. Conclusions. Blinking and tearing share a common origin with sensory stimulation at the ocular surface. Both showed a dose–response increase with surface stimulation and were correlated with each other. These methods can potentially be used to understand alterations in ocular surface sensory function and associated protective responses in dry eye and other disorders of the ocular surface. PMID:26132780

  12. The Effects of Increasing Ocular Surface Stimulation on Blinking and Tear Secretion.

    PubMed

    Wu, Ziwei; Begley, Carolyn G; Port, Nicholas; Bradley, Arthur; Braun, Richard; King-Smith, Ewen

    2015-07-01

    To investigate the effect of varying levels of ocular surface stimulation on the timing and amplitude of the blink and tear secretion. Following instillation of fluorescein dye, increasing levels of air flow were directed toward the central corneas of 10 healthy subjects. Interblink interval (IBI), tear meniscus height (TMH), and fluorescence intensity were measured simultaneously. Because blinking can obscure changes in TMH, we developed novel measures of tear secretion by calculating tear meniscus fluorescein concentration (TMFC) from intensity using a mathematical model. The change of TMH and TMFC over trials and the slope of the TMFC within each IBI (IBI-TTR) were further calculated. The mean IBI was decreased by 8.08 ± 8.54 seconds from baseline to maximum air stimulation. The TMH increase was highly variable (0.41 ± 0.39 mm) among subjects, compared to the fluorescence tear turnover metrics: decrease in TMFC of 2.84 ± 0.98 natural logarithm or ln(%) and IBI-TTR of 0.065 ± 0.032 ln(%)/sec. Ocular surface stimulation was highly correlated with the TMFC and IBI-TTR, but less so with TMH (Pearson's r = 0.71, 0.69, and 0.40, P < 0.01, respectively). Blinking and tearing were significantly correlated with each other (Pearson's r = 0.56, P < 0.01), but tearing lagged behind by an average of 6.54 ± 4.07 seconds. Blinking and tearing share a common origin with sensory stimulation at the ocular surface. Both showed a dose-response increase with surface stimulation and were correlated with each other. These methods can potentially be used to understand alterations in ocular surface sensory function and associated protective responses in dry eye and other disorders of the ocular surface.

  13. Arthroscopic suture anchor repair of posterior root attachment injury in medial meniscus: technical note.

    PubMed

    Kim, Jae-Hwa; Shin, Dong-Eun; Dan, Jin-Myong; Nam, Ki-Shik; Ahn, Tae-Keun; Lee, Dong-Hoon

    2009-08-01

    A root attachment injury (root tear) of the meniscus can abolish the ability of the meniscus to bear hoop stress and predispose to increase articular contact stress which contribute to femorotibial degenerative changes. A pull out suture technique to repair the root tear has been described, but the procedure making the tibial tunnel may be difficult and troublesome. This article describes a repair technique using a suture anchor and posterior trans-septal portal.

  14. Larger medial femoral to tibial condylar dimension may trigger posterior root tear of medial meniscus.

    PubMed

    Chung, Jun Young; Song, Hyung Keun; Jung, Myung Kuk; Oh, Hyeong Tak; Kim, Joon Ho; Yoon, Ji-Sang; Min, Byoung-Hyun

    2016-05-01

    The major meniscal functions are load bearing, load distribution, and shock absorption by increasing the tibiofemoral joint (TFJ) contact area and dissipating axial loads by conversion into hoop stresses. The increased hoop strain stretches the meniscus in outward direction towards radius, causing extrusion, which is associated with the root tear and resultant degenerative osteoarthritis. Since the larger contact area of medial TFJ may increase the hoop stresses, we hypothesized that the larger medial femoral to tibial condylar dimension would contribute to the development of medial meniscus posterior root tear (MMPRT). Thus, the purpose of the study was to assess the relationship between MMPRT and medial femoral to tibial condylar dimension. A case-control study was conducted to compare medial femoral to tibial condylar dimensions of patients with complete MMPRT (n = 59) with those of demography-matched controls (n = 59) during the period from 2010 to 2013. In each patient, MRIs were reviewed and several parameters were measured including articulation width of medial femoral condyle (MFC) at 0°, 30°, 60°, and 90°, medial tibial condyle (MTC) width, degree of meniscal extrusion, and medial femoral to tibial condylar width ratio (MFC/MTC) at 0°, 30°, 60°, and 90°, respectively. Demographic and radiographic data were assessed. A larger medial femoral to tibial condylar dimension was associated with MMPRT at 0° and 30° knee angles. Patients with MFC/MTC greater than 0.9 at 0° also showed about 2.5-fold increase in the chance of MMPRT. Those with meniscal extrusion greater than 3 mm also had about 17.1 times greater chance for the presence of MMPRT accordingly. A larger medial femoral to tibial condylar dimension may be considered as one of the regional contributors to the outbreak of MMPRT, and medial femoral to tibial condylar width ratio greater than 0.9 at 0° knee angle may be considered as a significant risk factor for MMPRT. III.

  15. The tear turnover and tear clearance tests - a review.

    PubMed

    Garaszczuk, Izabela K; Montes Mico, Robert; Iskander, D Robert; Expósito, Alejandro Cerviño

    2018-03-01

    The aim is to provide a summary of methods available for the assessment of tear turnover and tear clearance rates. The review defines tear clearance and tear turnover and describes their implication for ocular surface health. Additionally, it describes main types of techniques for measuring tear turnover, including fluorescein tear clearance tests, techniques utilizing electromagnetic spectrum and tracer molecule and novel experimental techniques utilizing optical coherence tomography and fluorescein profilometry. Areas covered: Internet databases (PubMed, Science Direct, Google Scholar) and most frequently cited references were used as a principal resource of information on tear turnover rate and tear clearance rate, presenting methodologies and equipment, as well as their definition and implications for the anterior eye surface health and function. Keywords used for data-search were as follows: tear turnover, tear clearance, fluorescein clearance, scintigraphy, fluorophotometry, tear flow, drainage, tear meniscus dynamics, Krehbiel flow and lacrimal functional unit. Expert commentary: After decades, the topic of tear turnover assessment has been reintroduced. Recently, new techniques have been developed to propose less invasive, less time consuming and simpler methodologies for the assessment of tear dynamics that have the potential to be utilized in clinical practice.

  16. Tibiofemoral Contact Mechanics with Horizontal Cleavage Tear and Resection of the Medial Meniscus in the Human Knee.

    PubMed

    Koh, Jason L; Yi, Seung Jin; Ren, Yupeng; Zimmerman, Todd A; Zhang, Li-Qun

    2016-11-02

    The meniscus is known to increase the contact area and decrease contact pressure in the tibiofemoral compartments of the knee. Radial tears of the meniscal root attachment along with partial resections of the torn meniscal tissue decrease the contact area and increase pressure; however, there is a lack of information on the effects of a horizontal cleavage tear (HCT) and partial leaf meniscectomy of such tears on tibiofemoral contact pressure and contact area. Twelve fresh-frozen human cadaveric knees were tested under 10 conditions: 5 serial conditions of posterior medial meniscectomy (intact meniscus, HCT, repaired HCT, inferior leaf resection, and resection of both inferior and superior leaves), each at 2 knee flexion angles (0° and 60°) under an 800-N axial load. Tekscan sensors (model 4000) were used to measure the contact pressure and contact area. HCT and HCT repair resulted in small changes in the contact area and an increase in contact pressure compared with the intact condition. Resection of the inferior leaf resulted in significantly decreased contact area (to a mean 82.3% of the intact condition at 0° of flexion and 81.8% at 60° of flexion; p < 0.05) and increased peak contact pressure (a mean 36.3% increase at 0° flexion and 43.2% increase at 60° flexion; p < 0.05) in the medial compartment. Further resection of the remaining superior leaf resulted in additional significant decreases in contact area (to a mean 60.1% of the intact condition at 0° of flexion and 49.7% at 60° of flexion; p < 0.05) and increases in peak contact pressure (a mean 79.2% increase at 0° of flexion and 74.9% increase at 60° of flexion; p < 0.05). Resection of meniscal tissue forming the inferior leaf of an HCT resulted in substantially decreased contact area and increased contact pressure. Additional resection of the superior leaf resulted in a further significant decrease in contact area and increase in contact pressure in the medial compartment. Repair or minimal

  17. Research progress on reconstruction of meniscus in tissue engineering.

    PubMed

    Zhang, Yu; Li, Pengsong; Wang, Hai; Wang, Yiwei; Song, Kedong; Li, Tianqing

    2017-05-01

    Meniscus damages are most common in sports injuries and aged knees. One third of meniscus lesions are known as white-white zone or nonvascular zones, which are composed of chondrocyte and extracellular matrix composition only. Due to low vascularization the ability of regeneration in such zones is inherently limited, leading to impossible self-regeneration post damage. Meniscus tissue engineering is known for emerging techniques for treating meniscus damage, but there are questions that need to be answered, including an optimal and suitable cell source, the usability of growth factor, the selectivity of optimal biomaterial scaffolds as well as the technology for improving partial reconstruction of meniscus tears. This review focuses on current research on the in vitro reconstruction of the meniscus using tissue engineering methods with the expectation to develop a series of tissue engineering meniscus products for the benefit of sports injuries. With rapid growth of clinical demand, the key breakthrough of meniscus tissue engineering research foundation is enlarged to a great extent. This review discusses aspects of meniscus tissue engineering, which is relative to the clinical treatment of meniscus injuries for further support and establishment of fundamental and clinical studies.

  18. The Meniscus-Deficient Knee

    PubMed Central

    Rao, Allison J.; Erickson, Brandon J.; Cvetanovich, Gregory L.; Yanke, Adam B.; Bach, Bernard R.; Cole, Brian J.

    2015-01-01

    Meniscal tears are the most common knee injury, and partial meniscectomies are the most common orthopaedic surgical procedure. The injured meniscus has an impaired ability to distribute load and resist tibial translation. Partial or complete loss of the meniscus promotes early development of chondromalacia and osteoarthritis. The primary goal of treatment for meniscus-deficient knees is to provide symptomatic relief, ideally to delay advanced joint space narrowing, and ultimately, joint replacement. Surgical treatments, including meniscal allograft transplantation (MAT), high tibial osteotomy (HTO), and distal femoral osteotomy (DFO), are options that attempt to decrease the loads on the articular cartilage of the meniscus-deficient compartment by replacing meniscal tissue or altering joint alignment. Clinical and biomechanical studies have reported promising outcomes for MAT, HTO, and DFO in the postmeniscectomized knee. These procedures can be performed alone or in conjunction with ligament reconstruction or chondral procedures (reparative, restorative, or reconstructive) to optimize stability and longevity of the knee. Complications can include fracture, nonunion, patella baja, compartment syndrome, infection, and deep venous thrombosis. MAT, HTO, and DFO are effective options for young patients suffering from pain and functional limitations secondary to meniscal deficiency. PMID:26779547

  19. Effect of repair of radial tears at the root of the posterior horn of the medial meniscus with the pullout suture technique: a biomechanical study using porcine knees.

    PubMed

    Seo, Jeong-Hee; Li, Guoan; Shetty, Gautam M; Kim, Ji-Hoon; Bae, Ji-Hoon; Jo, Myoung-Lae; Kim, Jung-Sung; Lee, Sung-Jae; Nha, Kyung-Wook

    2009-11-01

    Our purpose was to evaluate the result of radial tears at the root of the posterior horn of the medial meniscus (PHMM) in terms of tibiofemoral contact mechanics and the effectiveness of pullout sutures for such tears. Eleven mature pig knees each underwent 15 different testing conditions with an intact, simulated (incised) radial tear at the root of the PHMM and placement of pullout sutures in the radial tears of the medial meniscus at 5 different angles of flexion (0 degrees, 15 degrees, 30 degrees, 60 degrees, and 90 degrees ) under a 1,500-N axial load. A K-Scan pressure sensor (Tekscan, Boston, MA) was used to measure medial tibiofemoral contact area and peak tibiofemoral contact pressure. Data were analyzed to assess the difference in medial contact area and tibiofemoral peak contact pressure among the 3 meniscal conditions at various degrees of knee flexion. The mean contact area was significantly lower, and the peak tibiofemoral contact pressure was significantly high in knees with simulated radial tears at all angles of knee flexion compared with knees with intact menisci (P < .0001). The peak tibiofemoral contact pressure after the pullout suture technique was significantly high at 0 degrees and 15 degrees of flexion (P < .0001) compared with intact knee specimens. Failure of sutures occurred in 45% of the specimens at 0 degrees of flexion. Radial tears at the root of the PHMM in a porcine model significantly increased medial tibiofemoral contact pressure and decreased contact area. Although repair of tears of the PHMM with the pullout suture technique aids in significantly reducing tibiofemoral peak contact pressure between 30 degrees and 90 degrees , it remains significantly high at 0 degrees and 15 degrees of flexion. Pullout sutures for radial tears at the root of the PHMM may lead to an increase in peak medial tibiofemoral contact pressure and may be prone to mechanical failure, especially during the stance (loading) phase of gait (mean, 15 degrees

  20. Quantitative analysis of the difference between an intact complete discoid lateral meniscus and a torn complete discoid meniscus on MR imaging: a feasibility study for a new classification.

    PubMed

    Lee, Mi Hee; Choi, Sang-Hee; Woo, Sook Young

    2010-12-01

    To determine the quantitative difference between an intact complete discoid lateral meniscus (CDLM) and a torn CDLM on MR imaging. Between May 2005 to November 2009, 137 patients with a CDLM (107 intact CDLM and 30 torn CDLM) and 92 patients with a normal meniscus were included in this study. The evaluated parameters were the height of the posterior horn of the lateral and medial menisci on the sagittal images and their ratio as assessed by two observers twice at an interval of 1 month. Each parameter was analyzed based on the Kruskal Wallis test, and the analysis using the mixed model. Intraclass correlation coefficient (ICC) was used to determine the interobserver reliabilities at session 2. The mean heights of the posterior horn of the lateral and medial menisci on the sagittal images for an intact CDLM, a torn CLDM, and a normal meniscus were 6.5, 7.3, 5.7 and 6.6, 6.4, 6.7 mm at session 1, respectively. The mean heights of the posterior horn of the lateral and medial menisci on the sagittal images for an intact CDLM, a torn CDLM, and a normal meniscus for both observers were 6.5, 7.2, 5.7 and 6.6, 6.3, 6.8 mm at session 2, respectively. The ratio of the height of the lateral to the height of the medial meniscus for an intact CDLM at both sessions for both observers was 1.0. The ratios were 1.2 and 0.8 for a torn CDLM and for a normal meniscus, respectively, at both sessions for observer 1. The ratios were 1.2 and 0.9 for a torn CDLM and for a normal meniscus, respectively, at session 2 for observer 2. The heights of the posterior horn of the lateral meniscus on the sagittal images and the ratios of the heights of the lateral to the medial menisci in all three groups were statistically significantly different for both sessions (p < 0.0001). The interobserver ICCs for each parameter of both an intact CDLM and a torn CDLM at session 2 showed high correlations (p < 0.0001). The height of the lateral meniscus and the ratio of the height of the lateral to

  1. Acute torn meniscus combined with acute cruciate ligament injury. Second look arthroscopy after 3-month conservative treatment.

    PubMed

    Ihara, H; Miwa, M; Takayanagi, K; Nakayama, A

    1994-10-01

    The purpose of this study was to evaluate arthroscopically the natural healing of an acute torn meniscus combined with an acute cruciate ligament injury treated nonoperatively. There were 30 lateral and 10 medial meniscus tears associated with 25 acute anterior cruciate ligament and 7 posterior cruciate ligament injuries in 32 patients. There was more than 1 tear on some menisci for a total of 51 tear sites. Injuries to the menisci and ligaments were allowed to heal without surgery, but were given protective mobilization immediately in order to stimulate stress oriented healing of injured collagen fibers and promote circulation of synovial fluid to the meniscus and ligament. A Kyuro knee brace with a coil spring traction system was used to add adequate but not excessive stress to the associated injured cruciate ligament. All knees were examined and arthroscoped before and after a 3-month treatment period. Results indicated that 69% of the lateral menisci healed completely and 18% healed partially, whereas 58% of the medial menisci healed completely and none healed partially. Twenty of 25 anterior cruciate ligaments and 3 of 7 posterior cruciate ligaments healed satisfactorily. This study indicated that acute tears of the meniscus, even when they occur in association with a cruciate ligament injury, can heal morphologically with nonsurgical treatment.

  2. The role of medial meniscus posterior root tear and proximal tibial morphology in the development of spontaneous osteonecrosis and osteoarthritis of the knee.

    PubMed

    Yamagami, Ryota; Taketomi, Shuji; Inui, Hiroshi; Tahara, Keitaro; Tanaka, Sakae

    2017-03-01

    Medial meniscus posterior root tear (MMPRT) has been reported to play a key role in the development of spontaneous osteonecrosis of the knee (SONK) and osteoarthritis (OA) of the knee. However, little is known about the differences in the development of SONK and OA after MMPRT. The purpose of this study was to investigate the factors contributing to the development of these conditions. We evaluated the existence of MMPRT and the extent of medial meniscal extrusion in preoperative magnetic resonance images and proximal tibial morphology in radiographs of 45 patients with SONK and 104 patients with OA who underwent knee surgery. There were no significant differences in age, gender, height, weight, and body mass index between the two groups. The incidence of MMPRT and the mean posterior tibial slope (PTS) were significantly higher in SONK than in OA patients (62.2% versus 34.3%, P=0.002, and 12.8° versus 10.5°, P<0.001, respectively). The mean extent of meniscal extrusion was larger in OA than in SONK patients (7.5mm versus 5.3mm, P<0.001). The mean tibial varus angle was 4.8° in SONK and 5.4° in OA, with no significant difference between the two (P=0.088). Multivariable logistic regression analysis showed that compared with OA, SONK was more closely associated with the existence of MMPRT and had a smaller extent of medial meniscus extrusion and higher PTS. MMRPT and higher PTS were more closely associated with the development of SONK than with that of OA. Copyright © 2016 Elsevier B.V. All rights reserved.

  3. Avulsion of the anterior medial meniscus root: case report and surgical technique.

    PubMed

    Feucht, Matthias J; Minzlaff, Philipp; Saier, Tim; Lenich, Andreas; Imhoff, Andreas B; Hinterwimmer, Stefan

    2015-01-01

    Injuries of the meniscus roots have become increasingly recognised as a serious pathology of the knee joint. However, the current available literature focuses primarily on posterior meniscus root tears. In this article, a case with an isolated avulsion of the anterior medial meniscus root is presented, and a new arthroscopic technique to treat this type of injury is described. The anterior horn of the medial meniscus was sutured with a double-looped nonabsorbable suture and reattached to the tibial plateau using a knotless suture anchor. This technique may also be useful to treat avulsion injuries of the anterolateral or posteromedial meniscus root, and symptomatic subluxation of the medial meniscus in case of a variant insertion anatomy with an absent attachment of the anterior horn of the medial meniscus to the tibial plateau. Level of evidence V.

  4. Dynamic changes in ocular Zernike aberrations and tear menisci measured with a wavefront sensor and an anterior segment OCT.

    PubMed

    Xu, Jingjing; Bao, Jinhua; Deng, Jun; Lu, Fan; He, Ji C

    2011-07-29

    To measure dynamic change characteristics of spatial and temporal variations in the post-blink tear film of normal eyes. A wavefront sensor was used to measure dynamic changes in wavefront aberrations, up to the seventh order, for 10 seconds in a group of 33 normal young adults. Tear menisci were imaged with an anterior segment optical coherence tomography (AS-OCT) system and tear film break-up times (TFBUTs) were determined. Systematic changes in main axis astigmatism (R(2) = 0.933, P < 0.0001), vertical coma (R(2) = 0.935, P < 0.0001) and spherical aberrations (R(2) = 0.879, P = 0.0002) occurred during the 10-second post-blink period. Both lower tear meniscus height and area increased by 10 seconds compared with the initial levels (P < 0.0001 for each). The change of vertical coma had significant correlation with the increase of lower tear meniscus areas during the 10-second post-blink period (R(2) = 0.181, P = 0.014). Subjects with TFBUTs < 15 seconds had significantly increased main axis astigmatism, vertical coma, and spherical aberrations by 10 seconds. Subjects with longer TFBUTs did not have any significant wavefront aberrations during that period. Systematic changes in some Zernike aberrations after blinking are associated with the changes in tear menisci and TFBUT. There was a substantial individual variation in dynamic changes of Zernike aberrations, suggesting the necessity to explore individual differences in tear quality and tear performance. Dynamic wavefront measurement combined with anterior segment optical coherence tomography could provide a useful tool to understand spatial and temporal processes of the tear film in clinical practice.

  5. Symptomatic Bilateral Torn Discoid Medial Meniscus Treated with Saucerization and Suture

    PubMed Central

    2016-01-01

    Discoid meniscus is an anatomical congenital anomaly more often found in the lateral meniscus. A discoid medial meniscus is a very rare anomaly, and even more rare is to diagnose a bilateral discoid medial meniscus although the real prevalence of this situation is unknown because not all the discoid medial menisci are symptomatic and if the contralateral knee is not symptomatic then it is not usually studied. The standard treatment of this kind of pathology is partial meniscectomy. Currently the tendency is to be very conservative so suture and saucerization of a torn discoid meniscus when possible are gaining support. We present the case of a 13-year-old patient who was diagnosed with symptomatic torn bilateral discoid medial meniscus treated by suturing the tear and saucerization. To the best of our knowledge this is the first case reported of bilateral torn discoid medial meniscus treated in this manner in the same patient. PMID:27656305

  6. Arthroscopic repair of the posterior horn of the medial meniscus with opening wedge high tibial osteotomy: surgical technique.

    PubMed

    Jung, Kwang Am; Kim, Sung Jae; Lee, Su Chan; Jeong, Jae Hoon; Song, Moon Bok; Lee, Choon Key

    2009-07-01

    Simultaneous repair of a radial tear at the tibial attachment site of the posterior horn of the medial meniscus under special circumstances requiring tibial valgus osteotomy is technically difficult. First, most patients who need an osteotomy have a narrowed medial tibiofemoral joint space. In such a situation, the pull-out suture technique is more difficult to perform than in a normal joint space. Second, pulling out suture strands that penetrate the posterior horn of the medial meniscus to the anterior tibial cortex increases the risk of transection during osteotomy. We performed a meniscus repair combined with an opening wedge tibial valgus osteotomy without complications and present our technique as a new method for use in selective cases necessitating both meniscus repair of a complete radial tear and opening wedge tibial osteotomy.

  7. Influence of Health Insurance Status on the Timing of Surgery and Treatment of Bucket-Handle Meniscus Tears

    PubMed Central

    Sood, Amit; Gonzalez-Lomas, Guillem; Gehrmann, Robin

    2015-01-01

    Background Lack of insurance has been shown to lead to delays in seeking care as well as fewer preventive medicine visits and poorer overall health status. Purpose To investigate the effects of insurance status on the timing and treatment of patients with bucket-handle meniscus tears. Study Design Cohort study; Level of evidence, 3. Methods Charts from 2004 to 2013 were retrospectively reviewed for patients diagnosed with bucket-handle meniscus tears. Patients were divided into 2 groups: insured or underinsured. The insured group included patients with commercial insurance or Medicare. The underinsured group included patients with Medicaid or Charity Care. Time intervals were categorized as <6 weeks or ≥6 weeks. Results A total of 52 patients were included in this study: 15 (29%) insured and 37 (71%) underinsured. Underinsured patients experienced delays in initial presentation to an orthopaedic surgeon (P = .004), time from magnetic resonance imaging to surgery (P = .01), and time from injury to surgery (P = .007). Repair rates were 40% and 38% (P > .999) for the insured and underinsured, respectively. Repair rates for <6 weeks from injury to surgery were 75% for insured (P = .007) and 100% for underinsured patients (P = .001). Repair rates for ≥6 weeks from injury to surgery were 0% for insured and 30% for underinsured patients. Overall, patients with an injury-to-surgery time of <6 weeks had a significantly higher repair rate (87%) than those managed >6 weeks (19%) (P < .001). Conclusion Underinsured patients experience significant delays in time to presentation and overall time to surgery. However, the overall repair rate between the insured and underinsured is similar. Regardless of insurance status, patients undergoing arthroscopy within 6 weeks of injury have a significantly higher repair rate than those after 6 weeks. Clinical Relevance Patients undergoing arthroscopy within 6 weeks of injury have a significantly higher repair rate than those after 6

  8. Articular cartilage scores in cranial cruciate ligament-deficient dogs with or without bucket handle tears of the medial meniscus.

    PubMed

    Kaufman, Kathryn; Beale, Brian S; Thames, Howard D; Saunders, W Brian

    2017-01-01

    To compare articular cartilage scores in cranial cruciate ligament (CCL)-deficient dogs with or without concurrent bucket handle tears (BHT) of the medial meniscus. Retrospective case series. Client-owned dogs treated with arthroscopy and tibial plateau leveling osteotomy or extracapsular repair for complete CCL rupture (290 stifles from 264 dogs). Medical records and arthroscopic images were reviewed. Medial femoral condyle (MFC) and medial tibial plateau (MTP) cartilage was scored using the modified Outerbridge scale. Periarticular osteophytosis (PAO) and injury to the medial meniscus were recorded. Data were analyzed using Student's t-tests, Wilcoxon rank-sum test, and Fisher's exact test for changes in the stifle based on meniscal condition, body weight, and duration of lameness. PAO, MFC, and MTP articular cartilage scores were not significantly different in dogs with or without BHT. There were no significant differences in MFC or MTP scores when dogs were evaluated based on bodyweight and the presence or absence of a BHT. However, PAO formation was significantly increased in dogs weighing >13.6 kg and concurrent meniscal injury vs. dogs weighing <13.6 kg and concurrent meniscal injury (P < .001). Significantly more stifles with chronic lameness (40 of 89; 44.9%) had the highest PAO score of 2 reported compared to only 42 of 182 stifles (23.1%) with acute lameness (P < .001). The presence of a BHT of the medial meniscus was not associated with more severe arthroscopic articular cartilage lesions in the medial joint compartment at the time of surgery. © 2016 The American College of Veterinary Surgeons.

  9. Mechanical function near defects in an aligned nanofiber composite is preserved by inclusion of disorganized layers: Insight into meniscus structure and function.

    PubMed

    Bansal, Sonia; Mandalapu, Sai; Aeppli, Céline; Qu, Feini; Szczesny, Spencer E; Mauck, Robert L; Zgonis, Miltiadis H

    2017-07-01

    The meniscus is comprised of circumferentially aligned fibers that resist the tensile forces within the meniscus (i.e., hoop stress) that develop during loading of the knee. Although these circumferential fibers are severed by radial meniscal tears, tibial contact stresses do not increase until the tear reaches ∼90% of the meniscus width, suggesting that the severed circumferential fibers still bear load and maintain the mechanical functionality of the meniscus. Recent data demonstrates that the interfibrillar matrix can transfer strain energy to disconnected fibrils in tendon fascicles. In the meniscus, interdigitating radial tie fibers, which function to stabilize and bind the circumferential fibers together, are hypothesized to function in a similar manner by transmitting load to severed circumferential fibers near a radial tear. To test this hypothesis, we developed an engineered fibrous analog of the knee meniscus using poly(ε-caprolactone) to create aligned scaffolds with variable amounts of non-aligned elements embedded within the scaffold. We show that the tensile properties of these scaffolds are a function of the ratio of aligned to non-aligned elements, and change in a predictable fashion following a simple mixture model. When measuring the loss of mechanical function in scaffolds with a radial tear, compared to intact scaffolds, the decrease in apparent linear modulus was reduced in scaffolds containing non-aligned layers compared to purely aligned scaffolds. Increased strains in areas adjacent to the defect were also noted in composite scaffolds. These findings indicate that non-aligned (disorganized) elements interspersed within an aligned network can improve overall mechanical function by promoting strain transfer to nearby disconnected fibers. This finding supports the notion that radial tie fibers may similarly promote tear tolerance in the knee meniscus, and will direct changes in clinical practice and provide guidance for tissue engineering

  10. A mass and solute balance model for tear volume and osmolarity in the normal and the dry eye.

    PubMed

    Gaffney, E A; Tiffany, J M; Yokoi, N; Bron, A J

    2010-01-01

    Tear hyperosmolarity is thought to play a key role in the mechanism of dry eye, a common symptomatic condition accompanied by visual disturbance, tear film instability, inflammation and damage to the ocular surface. We have constructed a model for the mass and solute balance of the tears, with parameter estimation based on extensive data from the literature which permits the influence of tear evaporation, lacrimal flux and blink rate on tear osmolarity to be explored. In particular the nature of compensatory events has been estimated in aqueous-deficient (ADDE) and evaporative (EDE) dry eye. The model reproduces observed osmolarities of the tear meniscus for the healthy eye and predicts a higher concentration in the tear film than meniscus in normal and dry eye states. The differential is small in the normal eye, but is significantly increased in dry eye, especially for the simultaneous presence of high meniscus concentration and low meniscus radius. This may influence the interpretation of osmolarity values obtained from meniscus samples since they need not fully reflect potential damage to the ocular surface caused by tear film hyperosmolarity. Interrogation of the model suggests that increases in blink rate may play a limited role in compensating for a rise in tear osmolarity in ADDE but that an increase in lacrimal flux, together with an increase in blink rate, may delay the development of hyperosmolarity in EDE. Nonetheless, it is predicted that tear osmolarity may rise to much higher levels in EDE than ADDE before the onset of tear film breakup, in the absence of events at the ocular surface which would independently compromise tear film stability. Differences in the predicted responses of the pre-ocular tears in ADDE compared to EDE or hybrid disease to defined conditions suggest that no single, empirically-accessible variable can act as a surrogate for tear film concentration and the potential for ocular surface damage. This emphasises the need to measure

  11. Effectiveness of Combined Tear Film Therapy in Patients with Evaporative Dry Eye with Short Tear Film Breakup Time.

    PubMed

    Kim, Yung Hui; Kang, Yeon Soo; Lee, Hyo Seok; Choi, Won; You, In Cheon; Yoon, Kyung Chul

    2017-10-01

    The aim of this study was to evaluate the effectiveness of combined tear film therapy targeted to aqueous, mucin, and lipid layers in patients with refractory evaporative dry eye (EDE) with short tear film breakup time (TBUT). The patients who had EDE with short TBUT and severe symptoms refractory to artificial tears were treated with hyaluronic acid (HA) 0.15% and diquafosol tetrasodium (DQS) 3% (Group 1), HA and carbomer-based lipid-containing eyedrops (Liposic EDO Gel, LPO) (Group 2), or HA, DQS, and LPO (Group 3). Ocular Surface Disease Index (OSDI) score, visual analog scale (VAS) symptom score, TBUT, Schirmer score, and corneal and conjunctival staining scores were evaluated, and noninvasive tear film breakup time (NIBUT) and tear meniscus height were measured using Keratograph ® 5 M before and 1 and 3 months after treatment. OSDI scores, VAS scores, TBUT, and NIBUT were improved at 1 and 3 months after treatment in all groups (all P < 0.05). At each follow-up visit, the total OSDI, OSDI symptom, and all VAS scores were significantly lower in group 3 compared with groups 1 and 2 (all P < 0.05). In addition, TBUT and NIBUT were significantly higher in group 3 compared with groups 1 and 2 (all P < 0.05). No significant adverse effects were noted in the groups during treatment. Mucin or lipid-targeting agents combined with aqueous supplements in patients with refractory EDE with short TBUT might improve subjective symptoms and TBUT. Of this, targeting whole tear film layers was most effective in improving ocular symptoms and tear film quality.

  12. Evaluation of the Effects of Conjunctivochalasis Excision on Tear Stability and Contrast Sensitivity

    PubMed Central

    Qiu, Weiqiang; Zhang, Mingzhou; Xu, Ting; Liu, Ziyuan; Lv, Huibin; Wang, Wei; Li, Xuemin

    2016-01-01

    Conjunctivochalasis (CCh) disrupts tear flow and damages tear film stability. This study sought to evaluate the tear stability and contrast sensitivity of patients with CCh on whom CCh excision was performed. The study included 39 eyes from 39 patients; all patients had eyes with grade 2 or 3 CCh, underwent CCh excision, and were evaluated before and three months after the surgery. The evaluated variables included the ocular surface disease index (OSDI), the tear break-up time (TBUT), corneal fluorescein staining, corneal surface irregularity, Schirmer’s I test, the tear meniscus area (TMA), and contrast sensitivity. A follow-up of three months was achieved in 36 eyes for 36 patients. All parameters improved significantly after surgery (p < 0.05), except Schirmer’s I test, thus suggesting that CCh excision is an effective method for reconstructing the lower tear meniscus and improving both tear film stability and corneal surface irregularity. The results further demonstrated a simultaneous increase in contrast sensitivity after surgery. PMID:27892479

  13. Posterior Root Meniscal Tears: Preoperative, Intraoperative, and Postoperative Imaging for Transtibial Pullout Repair.

    PubMed

    Palisch, Andrew R; Winters, Ronald R; Willis, Marc H; Bray, Collin D; Shybut, Theodore B

    2016-10-01

    The menisci play an important biomechanical role in axial load distribution of the knees by means of hoop strength, which is contingent on intact circumferentially oriented collagen fibers and meniscal root attachments. Disruption of the meniscal root attachments leads to altered biomechanics, resulting in progressive cartilage loss, osteoarthritis, and subchondral edema, with the potential for development of a subchondral insufficiency fracture. Identification of meniscal root tears at magnetic resonance (MR) imaging is crucial because new arthroscopic surgical techniques (transtibial pullout repair) have been developed to repair meniscal root tears and preserve the tibiofemoral cartilage of the knee. An MR imaging classification of posterior medial meniscal root ligament lesions has been recently described that is dedicated to the posterior root of the medial meniscus. An arthroscopic classification of meniscal root tears has been described that can be applied to the anterior and posterior roots of both the medial meniscus and the lateral meniscus. This arthroscopic classification includes type 1, partial stable root tears; type 2, complete radial root tears; type 3, vertical longitudinal bucket-handle tears; type 4, complex oblique tears; and type 5, bone avulsion fractures of the root attachments. Knowledge of these classifications and the potential contraindications to meniscal root repair can aid the radiologist in the preoperative reporting of meniscal root tear types and the evaluation of the tibiofemoral cartilage. As more patients undergo arthroscopic repair of meniscal root tears, familiarity with the surgical technique and the postoperative radiographic and MR imaging appearance is important to adequately report the imaging findings. © RSNA, 2016.

  14. Medial Meniscus Posterior Root Repair Using a Transtibial Technique.

    PubMed

    Woodmass, Jarret M; Mohan, Rohith; Stuart, Michael J; Krych, Aaron J

    2017-06-01

    The meniscal roots are critical in maintaining the normal shock absorbing function of the meniscus. If a meniscal root tear is left untreated, meniscal extrusion can occur rendering the meniscus nonfunctional resulting in degenerative arthritis. Two main repair techniques are described: (1) suture anchors (direct fixation) and (2) sutures pulled through a tibial tunnel (indirect fixation). Meniscal root repair using a suture anchor technique is technically challenging requiring a posterior portal and a curved suture passing device that can be difficult to manipulate within the knee. We present a technique for posterior medial meniscus root repair using 3 sutures (1 leader, 2 cinch), standard arthroscopy portals, and transtibial fixation. Overall, this technique simplifies a challenging procedure and allows for familiarity and efficiency.

  15. Spectral-domain optical coherence tomography study on dynamic changes of human tears after instillation of artificial tears.

    PubMed

    Napoli, Pietro Emanuele; Satta, Giovanni Maria; Coronella, Franco; Fossarello, Maurizio

    2014-07-01

    To analyze in vivo the dynamic changes induced by different artificial tears (ATs) in the precorneal tear film (PCTF) and lower tear meniscus (LTM) by using spectral-domain (SD) anterior segment optical coherence tomography (OCT). We prospectively examined 42 normal human eyes by using SD-OCT imaging. On the day before OCT imaging, all enrolled subjects were evaluated for abnormalities of ocular surface. All tear film images were obtained before and after instillation of three different types of ATs (mucomimetic, lipid-based, and saline) in five serial scans: immediately (within 30 seconds), at the first, fifth, 10th, and 20th minute. Subjects received a drop of 35 μL in one randomly selected eye. All examinations were conducted in the same conditions of temperature, brightness, humidity, and time of day. Changes in the morphological pattern of both LTM and PCTF were associated with the type of artificial tear instilled on the ocular surface. Similarly, the radius of curvature (rc), the height (h), and the depth (d) showed dynamic variations depending on treatment. Although by the 20th minute, both h and d returned to baseline values in all groups, a significant difference in rc (compared with baseline) was detected for mucomimetic ATs (P = 0.04) and lipid ATs (P = 0.02). Spectral-domain OCT imaging has preliminarily proved to be a noninvasive tool to evaluate, in real time, the different changes induced by ATs instillation. An important stride in understanding the clinical response to various tear substitutes can be achieved by this objective and quantitative approach. Copyright 2014 The Association for Research in Vision and Ophthalmology, Inc.

  16. Retropatellar chondromalacia associated with medial osteoarthritis after meniscus injury. One year of observations in sheep.

    PubMed

    Burger, C; Kabir, K; Mueller, M; Rangger, C; Minor, T; Tolba, R H

    2006-01-01

    In an ovine meniscal repair model, the patellofemoral (PF) osteoarthritis due to a non-sutured tear or failed repair was investigated. A radial meniscus tear was either sutured with polydioxanone (PDS), with a slow degrading polylactide long-term suture(LTS) or left without treatment. Knee joint cartilage in the PF and medial compartment was evaluated compared to normal knees (healthy controls). Retropatellar osteoarthritis in the non-sutured and sutured animals was intense in contrast to the control knees after 6 months in all groups (p < 0.001), and after 12 months in the PDS group (p < 0.001), LTS group and non-sutured animals (p < 0.05). Non-sutured meniscus tears and failed repair lead fast to intense PF osteoarthritis corresponding with tibial damage of the injured compartment.

  17. Silicon Sheet Quality is Improved By Meniscus Control

    NASA Technical Reports Server (NTRS)

    Yates, D. A.; Hatch, A. E.; Goldsmith, J. M.

    1983-01-01

    Better quality silicon crystals for solar cells are possible with instrument that monitors position of meniscus as sheet of solid silicon is drawn from melt. Using information on meniscus height, instrument generates feedback signal to control melt temperature. Automatic control ensures more uniform silicon sheets.

  18. Noninvasive Dry Eye Assessment Using High-Technology Ophthalmic Examination Devices.

    PubMed

    Yamaguchi, Masahiko; Sakane, Yuri; Kamao, Tomoyuki; Zheng, Xiaodong; Goto, Tomoko; Shiraishi, Atsushi; Ohashi, Yuichi

    2016-11-01

    Recently, the number of dry eye cases has dramatically increased. Thus, it is important that easy screening, exact diagnoses, and suitable treatments be available. We developed 3 original and noninvasive assessments for this disorder. First, a DR-1 dry eye monitor was used to determine the tear meniscus height quantitatively by capturing a tear meniscus digital image that was analyzed by Meniscus Processor software. The DR-1 meniscus height value significantly correlated with the fluorescein meniscus height (r = 0.06, Bland-Altman analysis). At a cutoff value of 0.22 mm, sensitivity of the dry eye diagnosis was 84.1% with 90.9% specificity. Second, the Tear Stability Analysis System was used to quantitatively measure tear film stability using a topographic modeling system corneal shape analysis device. Tear film stability was objectively and quantitatively evaluated every second during sustained eye openings. The Tear Stability Analysis System is currently installed in an RT-7000 autorefractometer and topographer to automate the diagnosis of dry eye. Third, the Ocular Surface Thermographer uses ophthalmic thermography for diagnosis. The decrease in ocular surface temperature in dry eyes was significantly greater than that in normal eyes (P < 0.001) at 10 seconds after eye opening. Decreased corneal temperature correlated significantly with the tear film breakup time (r = 0.572; P < 0.001). When changes in the ocular surface temperature of the cornea were used as indicators for dry eye, sensitivity was 0.83 and specificity was 0.80 after 10 seconds. This article describes the details and potential of these 3 noninvasive dry eye assessment systems.

  19. Similar failure rate in immediate post-operative weight bearing versus protected weight bearing following meniscal repair on peripheral, vertical meniscal tears.

    PubMed

    Perkins, Bryan; Gronbeck, Kyle R; Yue, Ruixian Alexander; Tompkins, Marc A

    2017-08-16

    Post-operative weight bearing after meniscal repair is a point of debate among physicians. This study sought to evaluate whether patients adhering to an immediate WBAT rehabilitation programme have a higher failure rate compared to those adhering to a more traditional, protected, NWB status following meniscal repair. The null hypothesis was that there would be no difference in failure between the two groups. A retrospective review of meniscal repair patients greater than 5 years from surgery was performed for patients receiving meniscal repair treatment. Patients were categorized by post-surgical weight-bearing status, either NWB or WBAT, and then analysed for failure of repair. Failure was defined as re-operation on the torn meniscus. The study controlled for variables including age at surgery, sex, height, weight, and BMI, classification of tear type, acuity of the tear, repair location (medial or lateral), repair location within the meniscus, repair technique, and concomitant procedures. Re-operations were performed in 61 of 157 patients [38.9%]. There was no difference between weight-bearing groups for failure of meniscus repair (n.s.). The tears were acute vertical tears located in the posterior horn and body. For the 61 patients with re-operation, the average time to re-operation was 2.2 years with 10 [16%] > 5 years from surgery, 17 [28%] 2-5 years from surgery, and 34 [56%] < 2 years from surgery. In isolated meniscal repair patients (n = 62), there was no difference between weight-bearing groups for rate of re-operation (n.s.). Weight bearing as tolerated after meniscal repair for peripheral, vertical tears does not result in a higher failure rate than traditional, non-weight bearing over a five-year follow-up period. The clinical relevance is that, based on these data, it may be appropriate to allow weight bearing as tolerated following meniscal repair of peripheral, vertical tears. Retrospective cohort study, Level III.

  20. Incidence and treatment of intra-articular lesions associated with anterior cruciate ligament tears.

    PubMed

    Todor, Adrian; Nistor, Dan; Buescu, Cristian; Pojar, Adina; Lucaciu, Dan

    2014-01-01

    The aim of the study is to retrospectively review the patients admitted and treated in the "Alexandru Rădulescu" Orthopedics and Traumatology Clinic, Cluj-Napoca for an anterior cruciate ligament tear over a 2-year period and document the intra-articular lesions found at arthroscopy as well as the treatment used for these associated lesions. The case records of 88 patients operated for anterior cruciate ligament tear over a period of 2 years were reviewed. There were 67 males and 21 females with a mean age of 28.9 years, ranging from 14 to 49 years. After recording the patient demographics, we documented all the intra-articular lesions found during knee arthroscopy, as well as all procedures undertaken concomitant with the ACL reconstruction. 50 of the 88 patients (56.8%) had associated intra-articular lesions at the time of anterior cruciate ligament reconstruction. The most common injury found was a meniscus tear, 48 patients (54.5%) had a meniscal pathology at the time of ligament reconstruction, medial meniscus being the most frequent injured one, found in 37 patients. Meniscectomy and meniscus suture were the procedures performed for these lesions, meniscectomy being more frequent. Chondral defects were the next associated injuries found with an incidence of 15.9% of the cases. The medial side of the knee was the most common site of chondral pathology. ACL tears are frequently associated with other intra-articular lesions, especially medial meniscus tears and chondral defects affecting the medial compartment. Such pathology most often needs surgical attention during the anterior cruciate ligament reconstruction.

  1. Non-operative management of medial meniscus posterior horn root tears is associated with worsening arthritis and poor clinical outcome at 5-year follow-up.

    PubMed

    Krych, Aaron J; Reardon, Patrick J; Johnson, Nick R; Mohan, Rohith; Peter, Logan; Levy, Bruce A; Stuart, Michael J

    2017-02-01

    Medial meniscus posterior root tears (MMPRTs) are a significant source of pain and dysfunction, but little is known about the natural history and outcome and for non-operative management of these lesions. The purpose of this study was to evaluate (1) the mid-term clinical and radiographic outcomes of non-operative treatment of MMPRTs and (2) risk factors for worse outcomes. A retrospective review was performed for patients with symptomatic, unrepaired MMPRTs and a minimum 2-year follow-up for IKDC and Tegner outcome scores. Baseline and final radiographs were reviewed and graded according to Kellgren-Lawrence scores. Baseline MRIs were reviewed for the presence of meniscal extrusion, subchondral oedema, and insufficiency fractures. Failure was defined as conversion to arthroplasty or severely abnormal patient subjective IKDC score. Fifty-two patients (21M:31F) with a mean age of 58 ± 10 years were diagnosed with symptomatic MMPRTs clinically and confirmed by MRI and followed for a mean of 62 ± 30 months. Sixteen patients (31 %) underwent total knee arthroplasty at a mean of 30 ± 32 months after diagnosis with higher Kellgren-Lawrence grades associated with increased rates of arthroplasty (p = 0.01). Mean IKDC scores for the remaining patients were 61.2 ± 21 with significantly lower scores in females compared to males (75 ± 12 vs. 49 ± 20; p = 0.03). Mean Kellgren-Lawrence grades and rates of arthritis progressed over time on radiographs (1.5 ± 0.7 vs. 2.4 ± 1.0; p < 0.001 and 78 % vs. 51 %; p = 0.01). Overall, 87 % of patients failed non-operative treatment. Non-operative treatment of medial meniscus posterior horn root tears is associated with poor clinical outcome, worsening arthritis, and a relatively high rate of arthroplasty at 5-year follow-up. Female gender was associated with lower subjective scores and higher rate of arthroplasty. The current study provides a natural history benchmark for clinical outcomes that can be

  2. Association of parameniscal cysts with underlying meniscal tears as identified on MRI and arthroscopy.

    PubMed

    De Smet, Arthur A; Graf, Ben K; del Rio, Alejandro Munoz

    2011-02-01

    Although patients with parameniscal cysts usually have underlying meniscal tears, we noted that this association was less common with anterior lateral cysts. We wished to determine whether the frequency of a meniscal tear underlying a parameniscal cyst varied with cyst location. We reviewed a database of 7,771 knee MR examinations and identified 134 patients with an MR diagnosis of 138 parameniscal cysts and correlative arthroscopy in 78 patients. We reviewed their medical records and MR studies to determine the location of the cysts and presence of an underlying meniscal tear as determined by MRI or arthroscopy. There were 50 lateral and 88 medial parameniscal cysts. Medial meniscal tears were found underlying a cyst in 96% of arthroscopy patients and 86% of patients who had only MR examinations without a location difference in tears (p = 0.68). Meniscal tears were found on MRI or arthroscopy in all 28 patients with a lateral cyst overlying the body or posterior horn of the lateral meniscus, whereas a tear was found on MRI or arthroscopy in only 14 (64%) of 22 patients with cysts adjacent to or extending to the lateral meniscus anterior horn (p = 0.006). Anterior lateral cysts extended medially either into the root or into Hoffa fat-pad, but the type of extension did not correlate with the presence of an underlying meniscal tear. In contrast to medial parameniscal cysts or cysts at other locations adjacent to the lateral meniscus, anteriorly located lateral parameniscal cysts are less likely to have underlying meniscal tears.

  3. A clinical sign to detect root avulsions of the posterior horn of the medial meniscus.

    PubMed

    Seil, Romain; Dück, Klaus; Pape, Dietrich

    2011-12-01

    The goal of the present report was to describe a new clinical sign to make a clinical diagnosis of meniscal extrusion related to medial meniscal root avulsion. Description of an easy clinical sign to detect extrusion of the medial meniscus at the anteromedial joint line. A varus stress test was applied in full extension before and after transosseous repair of an isolated traumatic avulsion of the posterior root of the medial meniscus in a 21-year-old patient. The clinical sign was verified by sectioning of the meniscotibial ligament during knee arthroplasty surgery in 3 patients. With a deficient posterior root, the clinical sign was positive, showing anteromedial extrusion under varus stress. After repair and at clinical follow-up, extrusion was normalized. Making the clinical diagnosis of medial meniscus extrusion after knee injury by applying a simple varus stress test to the knee and palpating the anteromedial meniscal extrusion might help physicians to suspect a medial meniscus root tear in the early stages after the injury as well as to evaluate its reduction after repair. A varus stress test in full extension should be performed systematically in patients where a root tear of the medial meniscus is suspected as well as after surgery to evaluate the success of the repair.

  4. Cost effectiveness of meniscal allograft for torn discoid lateral meniscus in young women.

    PubMed

    Ramme, Austin J; Strauss, Eric J; Jazrawi, Laith; Gold, Heather T

    2016-09-01

    A discoid meniscus is more prone to tears than a normal meniscus. Patients with a torn discoid lateral meniscus are at increased risk for early onset osteoarthritis requiring total knee arthroplasty (TKA). Optimal management for this condition is controversial given the up-front cost difference between the two treatment options: the more expensive meniscal allograft transplantation compared with standard partial meniscectomy. We hypothesize that meniscal allograft transplantation following excision of a torn discoid lateral meniscus is more cost-effective compared with partial meniscectomy alone because allografts will extend the time to TKA. A decision analytic Markov model was created to compare the cost effectiveness of two treatments for symptomatic, torn discoid lateral meniscus: meniscal allograft and partial meniscectomy. Probability estimates and event rates were derived from the scientific literature, and costs and benefits were discounted by 3%. One-way sensitivity analyses were performed to test model robustness. Over 25 years, the partial meniscectomy strategy cost $10,430, whereas meniscal allograft cost on average $4040 more, at $14,470. Partial meniscectomy postponed TKA an average of 12.5 years, compared with 17.30 years for meniscal allograft, an increase of 4.8 years. Allograft cost $842 per-year-gained in time to TKA. Meniscal allografts have been shown to reduce pain and improve function in patients with discoid lateral meniscus tears. Though more costly, meniscal allografts may be more effective than partial meniscectomy in delaying TKA in this model. Additional future long term clinical studies will provide more insight into optimal surgical options.

  5. Clinical and Radiographic Outcomes of Meniscus Surgery and Future Targets for Biologic Intervention: A review of data from the MOON Group

    PubMed Central

    Westermann, Robert W.; Jones, Morgan; Wasserstein, David; Spindler, Kurt P.

    2017-01-01

    Meniscus injury and treatment occurred with the majority of anterior cruciate ligament reconstructions (ACLR) in the multicenter orthopaedic outcomes (MOON) cohort. We describe the patient reported outcomes, radiographic outcomes and predictors of pain from meniscus injuries and treatment in the setting of ACLR. Patient reported outcomes improve significantly following meniscus repair with ACLR, but differences exist based on the meniscus injury laterally (medial or lateral). Patients undergoing medial meniscus repair have worse patient-reported outcomes and more pain compared to those with uninjured menisci. However, lateral meniscal tears can be repaired with similar outcomes as uninjured menisci. Medial meniscal treatment (meniscectomy or repair) results in a significant loss of joint space at 2 years compared to uninjured menisci. Menisci treated with excision had a greater degree of joint space loss compared to those treated with repair. Clinically significant knee pain is more common following injuries to the medial meniscus and increased in patients who undergo early re-operation after initial ACLR. Future research efforts aimed at improving outcomes after combined ACLR and meniscus treatment should focus on optimizing biologic and mechanical environments that promote healing of medial meniscal tears sustained during ACL injury. PMID:28282214

  6. Cam impingement of the posterior femoral condyle in medial meniscal tears.

    PubMed

    Suganuma, Jun; Mochizuki, Ryuta; Yamaguchi, Kenji; Inoue, Yutaka; Yamabe, Eikou; Ueda, Yoshiyuki; Fujinaka, Tarou

    2010-02-01

    The aim of this study was to compare the results of meniscal repair of the medial meniscus with or without decompression of the posterior segment of the medial meniscus for the treatment of posteromedial tibiofemoral incongruence at full flexion (PMTFI), which induces deformation of the posterior segment on sagittal magnetic resonance imaging (MRI). For more than 2 years, we followed up 27 patients with PMTFI who were classified into the following 2 groups. Group 1 included 8 patients (5 male joints and 3 female joints) with a medial meniscal tear with instability at the site of the tear who underwent meniscal repair. The mean age was 23.6 years. Group 2 included 19 patients (16 male joints and 3 female joints) who had a meniscal tear with instability at the site of the tear and underwent meniscal repair and decompression. The mean age was 26.5 years. In decompression of the posterior segment, redundant bone tissue on the most proximal part of the medial femoral condyle was excised. The patients were assessed by use of the Lysholm score, sagittal MRI at full flexion, and arthroscopic examination. There were no statistical differences in mean Lysholm score between the 2 groups before surgery, but the mean score in group 2 was significantly higher than that in group 1 after surgery. Meniscal deformation of the posterior segment at full flexion on MRI disappeared in all cases after decompression. On second-look arthroscopy, the rate of complete healing at the site of the tear was 0% in group 1 but 57% in group 2, and it was significantly different between these groups. The addition of decompression of the posterior segment of the medial meniscus to meniscal repair of knee joints with PMTFI allowed more room for the medial meniscus to accommodate and improved both function of the knee joint and the rate of success of repair of isolated medial meniscal tears in patients who regularly performed full knee flexion. (c) 2010 Arthroscopy Association of North America

  7. Isolated medial meniscal tear in a Border Collie.

    PubMed

    Ridge, P A

    2006-01-01

    A three-year-old, female Border Collie was successfully treated for an isolated, torn, medial meniscus by arthroscopic meniscal tear resection. The dog returned to agility competition without recurrence of lameness.

  8. Arthroscopic Meniscectomy and Meniscoplasty for a Torn Discoid Medial Meniscus: Case Report, Surgical Technique, and Literature Review

    PubMed Central

    Abhay, Gokhale Nikhil; Ashwin, Samant; Sunil, Shahane; Hardik, Kapopara

    2016-01-01

    Introduction: Normal menisci of the knee are semilunar structures. Sometimes, a meniscus may be found to be thickened and disc like and is called a discoid meniscus. Such a discoid variant is usually found in the lateral meniscus. Its occurrence in the medial meniscus is extremely rare. Case Report: We report a case of an 18-year-old female, who presented to us with knee pain and was found to have a discoid medial meniscus with a tear. We operated on her arthroscopically and performed meniscectomy and meniscoplasty. Postoperatively, the patient was free of her knee pain. Conclusion: Discoid medial meniscus is a rare phenomenon which can present as a cause of knee pain. If discoid meniscus is symptomatic, the management includes arthroscopic meniscectomy and meniscoplasty. PMID:28164061

  9. [Arthroscopic repair of meniscus injury with Fast-fix under local anesthesia].

    PubMed

    Wang, Jiang-tao; Liu, Yu-jie; Wang, Jun-liang; Qu, Feng; Yuan, Bang-tuo; Zhao, Gang; Shen, Xue-zhen; Zhu, Juan-li; Liu, Yang

    2014-08-01

    To evaluate the clinical outcome of arthroscopic repair method of meniscus injury with Fast-fix under local anesthesia. From October 2005 to September 2012,106 patients with meniscus injuries admitted into our - hospital were studied, including 74 males and 32 females, ranging in age from 13 to 71 years old, averaged 27.6 years old. The duration of the disease ranged from 15 days to 5 years. The main clinical manifestations included knee joint pain after exercise, joint locking, pressing pain of knee joint and positive McMurray signs. The MRI showed meniscus tear or degeneration. Arthroscopic repairing surgeries were performed with Fast-fix under local anesthesia. Each patient was assessed with VAS pain evaluation and Lysholm knee-joint score system before and after operation. All the patients were followed up more than 1 year. One hundred and 2 patients were followed up by recording subjective symptoms, clinical examinations and questions naires for an average of 2.6 years (ranged, 1.1 to 8 years), and 4 patients lost follow-up. All the 102 patients had no anesthetic complications. Ninety-six patients had normal subjective symptom and clinical examinations. Four patients had a mild ache with activities,2 patients had moderate pain after activities with joint space pressing pain. VAS pain evaluation and Lysholm knee-joint score after operation both were much better than that before operation. onclusion: Local anesthesia can provide nice circumstances for surgeries. Arthroscopic repair using Fast-fix is an idea method for meniscus injury, especially for the posterior horn tear of medial meniscus, which is simple and convenient with less complications, and satisfactory results.

  10. Tensile strength of the pullout repair technique for the medial meniscus posterior root tear: a porcine study.

    PubMed

    Fujii, Masataka; Furumatsu, Takayuki; Xue, Haowei; Miyazawa, Shinichi; Kodama, Yuya; Hino, Tomohito; Kamatsuki, Yusuke; Ozaki, Toshifumi

    2017-10-01

    The purpose of this study was to compare the load-to-failure of different common suturing techniques with a new technique for the medial meniscus posterior root tear (MMPRT). Thirty porcine medial menisci were randomly assigned to three suturing techniques used for transtibial pullout repair of the MMPRT (n = 10 per group). Three different meniscal suture configurations were studied: the two simple suture (TSS) technique, the conventional modified Mason-Allen suture (MMA) technique, and the new MMA technique using the FasT-Fix combined with the Ultrabraid (F-MMA). The ultimate failure load was tested using a tensile testing machine. The MMA and F-MMA groups demonstrated significantly higher failure loads than the TSS group (P = 0.0003 and P = 0.0005, respectively). No significant differences were observed between the MMA and F-MMA groups (P = 0.734). The ultimate failure load was significantly greater in the F-MMA than the TSS group and similar to the conventional MMA technique.

  11. Arthroscopic Medial Meniscus Posterior Root Reconstruction Using Auto-Gracilis Tendon.

    PubMed

    Lee, Dhong Won; Haque, Russel; Chung, Kyu Sung; Kim, Jin Goo

    2017-08-01

    There have been several techniques to repair the medial meniscus posterior root tears (MMPRTs) with the goal of restoring the anatomic and firm fixation of the meniscal root to bone. Many anatomic studies about the menisci also have been developed, so a better understanding of the anatomy could help surgeons perform correct fixation of the MMPRTs. The meniscal roots have ligament-like structures that firmly attach the menisci to the tibial plateau, and this structural concept is important to restore normal biomechanics after anatomic root repair. We present arthroscopic transtibial medial meniscus posterior root reconstruction using auto-gracilis tendon.

  12. Medial meniscus posterior root tear induces pathological posterior extrusion of the meniscus in the knee-flexed position: An open magnetic resonance imaging analysis.

    PubMed

    Masuda, S; Furumatsu, T; Okazaki, Y; Kodama, Y; Hino, T; Kamatsuki, Y; Miyazawa, S; Ozaki, T

    2018-04-10

    A medial meniscus posterior root tear (MMPRT) is defined as an injury to the posterior meniscal insertion on the tibia. In MMPRT, the medial meniscus (MM) hoop function is damaged, and the MM undergoes a medial extrusion into the interior from the superior articular surface of the tibia. However, the details of MM position and movement during knee joint movement are unclear in MMPRT cases. The present study aims to evaluate MM position and movement via magnetic resonance imaging (MRI) examination of the MM posterior extrusion (MMPE) at knee flexion angles of 10° and 90°. We hypothesized that, during knee flexion, the MM will shift to the posterior and the posterior extrusion will increase compared to that when the knee is extended. Twenty-four patients were diagnosed with symptomatic MMPRT on open MRI examination. Preoperative MMPE, anteroposterior interval (API) of the MM, and MM medial extrusion (MMME) at knee flexion angles of 10° and 90° were measured. For patients with MMPRT, the MMPE increased from -4.77±1.43mm to 3.79±1.17mm (p<0.001) when the knee flexion angle increased from 10° to 90°. Further, flexing the knee from 10° to 90° decreased the API of the MM from 20.19±4.22mm to 16.41±5.14mm (p<0.001). MMME showed no significant change between knee flexion angles of 10° and 90°. This study demonstrated that, in cases of MMPRT, the MMPE clearly increases when the knee is flexed to 90°, while MMME does not change. Our results suggest that open MRI examination can be used to evaluate the dynamic position of the posterior MM by scanning the knee as it flexes to 90°. IV: retrospective cohort study. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

  13. The absent bow tie sign in bucket-handle tears of the menisci in the knee.

    PubMed

    Helms, C A; Laorr, A; Cannon, W D

    1998-01-01

    Bucket-handle tears of the menisci are one of the most frequently missed diagnoses in MR examinations of the knee. This article describes the "absent bow tie sign," which can be used to identify bucket-handle tears on routine MR examinations of the knee. The arthroscopic surgical reports (n = 350) from a single orthopedic surgeon's practice during a 24-month period were examined for patients who had a diagnosis of bucket-handle tear and who underwent MR imaging before surgery (n = 32). The MR examinations were retrospectively evaluated for the presence of a bow tie sign. The bow tie sign was considered normal when two sagittal images showed the body segment (a bow tie appearance). The bow tie sign was considered abnormal, consistent with a bucket-handle tear, when only one or no body segment was seen (the absent bow tie sign). Coronal images were evaluated for a truncated meniscus. Also, each MR examination was scrutinized for a displaced fragment and a double posterior cruciate ligament (PCL) sign. Thirty-three bucket-handle tears were found at arthroscopy in 32 patients. One patient had tears of the medial and lateral menisci. The absent bow tie sign was seen in 32 of the 33 cases (sensitivity, 97%) and correlated with the medial or lateral meniscus that was reported torn at arthroscopy. The single false-negative result occurred in a patient with a nondisplaced bucket-handle tear. The findings in 31 contralateral normal menisci were all negative for an absent bow tie sign (specificity, 100%). A displaced fragment was found in 30 (94%) of 32 cases. The coronal images showed a truncated meniscus in 21 (64%) of 33 cases. A double PCL sign was seen in 10 (30%) of 33 cases. The absent bow tie sign is an easily applied finding that can be used with good sensitivity to diagnose bucket-handle tears of the menisci on MR imaging. This sign has a higher accuracy rate than other findings common with bucket-handle tears, such as displaced fragments, a truncated appearance of

  14. Degenerative meniscus: Pathogenesis, diagnosis, and treatment options

    PubMed Central

    Howell, Richard; Kumar, Neil S; Patel, Nimit; Tom, James

    2014-01-01

    The symptomatic degenerative meniscus continues to be a source of discomfort for a significant number of patients. With vascular penetration of less than one-third of the adult meniscus, healing potential in the setting of chronic degeneration remains low. Continued hoop and shear stresses upon the degenerative meniscus results in gross failure, often in the form of complex tears in the posterior horn and midbody. Patient history and physical examination are critical to determine the true source of pain, particularly with the significant incidence of simultaneous articular pathology. Joint line tenderness, a positive McMurray test, and mechanical catching or locking can be highly suggestive of a meniscal source of knee pain and dysfunction. Radiographs and magnetic resonance imaging are frequently utilized to examine for osteoarthritis and to verify the presence of meniscal tears, in addition to ruling out other sources of pain. Non-operative therapy focused on non-steroidal anti-inflammatory drugs and physical therapy may be able to provide pain relief as well as improve mechanical function of the knee joint. For patients refractory to conservative therapy, arthroscopic partial meniscectomy can provide short-term gains regarding pain relief, especially when combined with an effective, regular physiotherapy program. Patients with clear mechanical symptoms and meniscal pathology may benefit from arthroscopic partial meniscectomy, but surgery is not a guaranteed success, especially with concomitant articular pathology. Ultimately, the long-term outcomes of either treatment arm provide similar results for most patients. Further study is needed regarding the short and long-term outcomes regarding conservative and surgical therapy, with a particular focus on the economic impact of treatment as well. PMID:25405088

  15. The role of biomaterials in the treatment of meniscal tears

    PubMed Central

    Brown, Robert J.

    2017-01-01

    Extensive investigations over the recent decades have established the anatomical, biomechanical and functional importance of the meniscus in the knee joint. As a functioning part of the joint, it serves to prevent the deterioration of articular cartilage and subsequent osteoarthritis. To this end, meniscus repair and regeneration is of particular interest from the biomaterial, bioengineering and orthopaedic research community. Even though meniscal research is previously of a considerable volume, the research community with evolving material science, biology and medical advances are all pushing toward emerging novel solutions and approaches to the successful treatment of meniscal difficulties. This review presents a tactical evaluation of the latest biomaterials, experiments to simulate meniscal tears and the state-of-the-art materials and strategies currently used to treat tears. PMID:29158995

  16. Potential Market for New Meniscus Repair Strategies: Evaluation of the MOON Cohort

    PubMed Central

    Fetzer, Gary B.; Spindler, Kurt P.; Amendola, Annunziato; Andrish, Jack T.; Bergfeld, John A.; Dunn, Warren R.; Flanigan, David C.; Jones, Morgan; Kaeding, Christopher C.; Marx, Robert G.; Matava, Matthew J.; McCarty, Eric C.; Parker, Richard D.; Wolcott, Michelle; Vidal, Armando; Wolf, Brian R.; Wright, Rick W.

    2013-01-01

    Background An estimated 200,000 ACL reconstructions are performed each year in the United States. The presence of concomitant meniscus tears and subsequent treatment at the time of ACL reconstruction may determine long-term outcomes of these knees. The authors contend that a substantial number of these meniscal tears are treated in a fashion that reduces meniscal function and that new technologies are needed to treat meniscal tears in a fashion that preserves function. A large cohort of patients with meniscal tears is needed to demonstrate this need. The purpose of this study is to determine the incidence of meniscal tears, describe tear morphology, and selected treatment in the MOON prospective longitudinal cohort of ACL reconstruction. We also will demonstrate based on national statistics the large potential market that exists for future tissue engineering aimed at preserving meniscal function. Methods A multicenter cohort of 1014 patients undergoing ACL reconstruction between January 2002 and December 2003 were evaluated. All procedures were performed by nine fellowship trained sports medicine orthopaedic surgeons. Data on patient demographics, presence of a meniscus tear at time of ACL reconstruction, tear morphology, and meniscal treatment were collected prospectively. Meniscal tears were categorized into three potential tissue engineering treatment strategies: all-biologic repair, advanced repair, and scaffold replacement. Results 1014 ACL reconstructions were performed over the two year period. The median age at the time of surgery was 24 years. Thirty-six percent of the knees had medial meniscal tears and 44% of the knees had lateral meniscal tears. Longitudinal tears were the most common tear morphology. The most frequent treatment modality was partial meniscectomy (60%). Thirty percent of medial meniscal tears and 10% of lateral meniscal tears could be treated with all-biologic repair, 32% of medial meniscal tears and 28% of lateral meniscal tears could

  17. Regenerative Repair of Damaged Meniscus with Autologous Adipose Tissue-Derived Stem Cells

    PubMed Central

    Pak, Jaewoo; Lee, Jung Hun; Lee, Sang Hee

    2014-01-01

    Mesenchymal stem cells (MSCs) are defined as pluripotent cells found in numerous human tissues, including bone marrow and adipose tissue. Such MSCs, isolated from bone marrow and adipose tissue, have been shown to differentiate into bone and cartilage, along with other types of tissues. Therefore, MSCs represent a promising new therapy in regenerative medicine. The initial treatment of meniscus tear of the knee is managed conservatively with nonsteroidal anti-inflammatory drugs and physical therapy. When such conservative treatment fails, an arthroscopic resection of the meniscus is necessary. However, the major drawback of the meniscectomy is an early onset of osteoarthritis. Therefore, an effective and noninvasive treatment for patients with continuous knee pain due to damaged meniscus has been sought. Here, we present a review, highlighting the possible regenerative mechanisms of damaged meniscus with MSCs (especially adipose tissue-derived stem cells (ASCs)), along with a case of successful repair of torn meniscus with significant reduction of knee pain by percutaneous injection of autologous ASCs into an adult human knee. PMID:24592390

  18. Arthroscopic Transtibial Pullout Repair for Posterior Medial Meniscus Root Tears: A Systematic Review of Clinical, Radiographic, and Second-Look Arthroscopic Results.

    PubMed

    Feucht, Matthias J; Kühle, Jan; Bode, Gerrit; Mehl, Julian; Schmal, Hagen; Südkamp, Norbert P; Niemeyer, Philipp

    2015-09-01

    To systematically review the results of arthroscopic transtibial pullout repair (ATPR) for posterior medial meniscus root tears. A systematic electronic search of the PubMed database and the Cochrane Library was performed in September 2014 to identify studies that reported clinical, radiographic, or second-look arthroscopic outcomes of ATPR for posterior medial meniscus root tears. Included studies were abstracted regarding study characteristics, patient demographic characteristics, surgical technique, rehabilitation, and outcome measures. The methodologic quality of the included studies was assessed with the modified Coleman Methodology Score. Seven studies with a total of 172 patients met the inclusion criteria. The mean patient age was 55.3 years, and 83% of patients were female patients. Preoperative and postoperative Lysholm scores were reported for all patients. After a mean follow-up period of 30.2 months, the Lysholm score increased from 52.4 preoperatively to 85.9 postoperatively. On conventional radiographs, 64 of 76 patients (84%) showed no progression of Kellgren-Lawrence grading. Magnetic resonance imaging showed no progression of cartilage degeneration in 84 of 103 patients (82%) and showed reduced medial meniscal extrusion in 34 of 61 patients (56%). On the basis of second-look arthroscopy and magnetic resonance imaging in 137 patients, the healing status was rated as complete in 62%, partial in 34%, and failed in 3%. Overall, the methodologic quality of the included studies was fair, with a mean modified Coleman Methodology Score of 63. ATPR significantly improves functional outcome scores and seems to prevent the progression of osteoarthritis in most patients, at least during a short-term follow-up. Complete healing of the repaired root and reduction of meniscal extrusion seem to be less predictable, being observed in only about 60% of patients. Conclusions about the progression of osteoarthritis and reduction of meniscal extrusion are limited by

  19. Corneal Sensitivity in Tear Dysfunction and its Correlation with Clinical Parameters and Blink Rate

    PubMed Central

    Rahman, Effie Z.; Lam, Peter K.; Chu, Chia-Kai; Moore, Quianta; Pflugfelder, Stephen C.

    2015-01-01

    Purpose To compare corneal sensitivity in tear dysfunction due to a variety of causes using contact and non-contact esthesiometers and to evaluate correlations between corneal sensitivity, blink rate and clinical parameters. Design Comparative observational case series. Methods Ten normal and 33 subjects with tear dysfunction [meibomian gland disease (n = 11), aqueous tear deficiency (n = 10) - without (n = 7) and with (n = 3) Sjögren syndrome (SS) and conjunctivochalasis (n = 12)] were evaluated. Corneal sensitivity was measured with Cochet-Bonnet and air jet esthesiometers and blink rate by electromyelography. Eye irritation symptoms, tear meniscus height, tear break-up time (TBUT), and corneal and conjunctival dye staining were measured. Between group means were compared and correlations calculated. Results Compared with control (Cochet-Bonnet 5.45 mm, air esthesiometer 3.62 mg), mean sensory thresholds were significantly higher in aqueous tear deficiency using either Cochet-Bonnet (3.6 mm; P = 0.003) or air (11.7 mg; P = 0.046) esthesiometers, but were not significantly different in the other groups. Reduced corneal sensitivity significantly correlated with more rapid TBUT and blink rate, and greater irritation and ocular surface dye staining with one or both esthesiometers. Mean blink rates were significantly higher in both aqueous tear deficiency and conjunctivochalasis compared with control. Among all subjects, blink rate positively correlated with ocular surface staining and irritation and inversely correlated with TBUT. Conclusion Amongst conditions causing tear dysfunction, reduced corneal sensitivity is associated with greater irritation, tear instability, ocular surface disease and blink rate. Rapid blinking is associated with worse ocular surface disease and tear stability. PMID:26255576

  20. Comparison of Tibiofemoral Contact Mechanics After Various Transtibial and All-Inside Fixation Techniques for Medial Meniscus Posterior Root Radial Tears in a Porcine Model.

    PubMed

    Chung, Kyu Sung; Choi, Choong Hyeok; Bae, Tae Soo; Ha, Jeong Ku; Jun, Dal Jae; Wang, Joon Ho; Kim, Jin Goo

    2018-04-01

    To compare tibiofemoral contact mechanics after fixation for medial meniscus posterior root radial tears (MMPRTs). Seven fresh knees from mature pigs were used. Each knee was tested under 5 conditions: normal knee, MMPRT, pullout fixation with simple sutures, fixation with modified Mason-Allen sutures, and all-inside fixation using Fastfix 360. The peak contact pressure and contact surface area were evaluated using a capacitive sensor positioned between the meniscus and tibial plateau, under a 1,000-N compression force, at different flexion angles (0°, 30°, 60°, and 90°). The peak contact pressure was significantly higher in MMPRTs than in normal knees (P = .018). Although the peak contact pressure decreased significantly after fixation at all flexion angles (P = .031), it never recovered to the values noted in the normal meniscus. No difference was observed among fixation groups (P = .054). The contact surface area was significantly lower in MMPRTs than in the normal meniscus (P = .018) and increased significantly after fixation at all flexion angles (P = .018) but did not recover to within normal limits. For all flexion angles except 60°, the contact surface area was significantly higher for fixation with Mason-Allen sutures than for fixation with simple sutures or all-inside fixation (P = .027). At 90° of flexion, the contact surface area was significantly better for fixation with simple sutures than for all-inside fixation (P = .031). The peak contact pressure and contact surface area improved significantly after fixation, regardless of the fixation method, but did not recover to the levels noted in the normal meniscus after any type of fixation. Among the fixation methods evaluated in this time 0 study, fixation using modified Mason-Allen sutures provided a superior contact surface area compared with that noted after fixation using simple sutures or all-inside fixation, except at 60° of flexion. However, this study had insufficient power to

  1. Surgical Management of Degenerative Meniscus Lesions: The 2016 ESSKA Meniscus Consensus

    PubMed Central

    Beaufils, P.; Becker, R.; Kopf, S.; Englund, M.; Verdonk, R.; Ollivier, M.; Seil, R.

    2017-01-01

    Purpose  A degenerative meniscus lesion is a slowly developing process typically involving a horizontal cleavage in a middle-aged or older person. When the knee is symptomatic, arthroscopic partial meniscectomy has been practised for a long time with many case series reporting improved patient outcomes. Since 2002, several randomised clinical trials demonstrated no additional benefit of arthroscopic partial meniscectomy compared to non-operative treatment, sham surgery or sham arthroscopic partial meniscectomy. These results introduced controversy in the medical community and made clinical decision-making challenging in the daily clinical practice. To facilitate the clinical decision-making process, a consensus was developed. This initiative was endorsed by ESSKA. Methods  A degenerative meniscus lesion was defined as a lesion occurring without any history of significant acute trauma in a patient older than 35 years. Congenital lesions, traumatic meniscus tears and degenerative lesions occurring in young patients, especially in athletes, were excluded. The project followed the so-called formal consensus process, involving a steering group, a rating group and a peer-review group. A total of 84 surgeons and scientists from 22 European countries were included in the process. Twenty questions, their associated answers and an algorithm based on extensive literature review and clinical expertise, were proposed. Each question and answer set was graded according to the scientific level of the corresponding literature. Results  The main finding was that arthroscopic partial meniscectomy should not be proposed as a first line of treatment for degenerative meniscus lesions. Arthroscopic partial meniscectomy should only be considered after a proper standardised clinical and radiological evaluation and when the response to non-operative management has not been satisfactory. Magnetic resonance imaging of the knee is typically not indicated in the first-line work-up, but

  2. Transcriptome Analysis of Human Injured Meniscus Reveals a Distinct Phenotype of Meniscus Degeneration with Aging

    PubMed Central

    Rai, Muhammad Farooq; Patra, Debabrata; Sandell, Linda J.; Brophy, Robert H.

    2013-01-01

    Objective Meniscus tears are associated with a heightened risk for osteoarthritis. We aimed to advance our understanding of the metabolic state of human injured meniscus at the time of arthroscopic partial meniscectomy through transcriptome-wide analysis of gene expression in relation to patient age and degree of cartilage chondrosis. Methods The degree of chondrosis of knee cartilage was recorded at the time of meniscectomy in symptomatic patients without radiographic osteoarthritis. RNA preparations from resected menisci (N=12) were subjected to transcriptome-wide microarray and QuantiGene Plex analyses. The relative changes in gene expression variation with age and chondrosis were analyzed and integrated biological processes were investigated computationally. Results We identified a set of genes in torn meniscus that were differentially expressed with age and chondrosis. There were 866 genes differentially regulated (≥1.5-fold; P<0.05) with age and 49 with chondrosis. In older patients, genes associated with cartilage and skeletal development and extracellular matrix synthesis were repressed while those involved in immune response, inflammation, cell cycle, and cellular proliferation were stimulated. With chondrosis, genes representing cell catabolism (cAMP catabolic process) and tissue and endothelial cell development were repressed and those involved in T cell differentiation and apoptosis were elevated. Conclusion Differences in age-related gene expression suggest that in older adults, meniscal cells might de-differentiate and initiate a proliferative phenotype. Conversely, meniscal cells in younger patients appear to respond to injury, but maintain the differentiated phenotype. Definitive molecular signatures identified in damaged meniscus could be segregated largely with age and, to a lesser extent, with chondrosis. PMID:23658108

  3. Can the optimum artificial tear treatment for dry eye disease be predicted from presenting signs and symptoms?

    PubMed

    Essa, Laika; Laughton, Deborah; Wolffsohn, James S

    2018-02-01

    To assess dry eye treatment with four preservative-free dry eye artificial tear treatments to facilitate evidence-based prescribing. A randomised, single masked crossover trial of Clinitas Soothe, Hyabak, Tears Again and TheraTears artificial tears was conducted on 50 symptomatic dry eye patients, aged 60.8±14.2years. At baseline and after trialling each treatment for 4 weeks, signs and symptoms were assessed using the Ocular Surface Disease Index (OSDI), non-invasive tear break-up time, fluorescein tear break-up time, tear meniscus height (TMH), Phenol Red test, lid-parallel conjunctival folds (LIPCOF), ocular surface staining, and lipid layer grading and osmolarity (baseline visit only). OSDI (p=0.002), LIPCOF (p=0.014) and conjunctival staining (p<0.001) significantly improved from baseline, however, the impact of each dry eye treatment on ocular symptoms and signs was similar. Clinitas Soothe and Hyabak were preferred by 34%/30% of participants, but only subjective comparison with the other drops influenced this choice. TheraTears was preferred (by 24%) by those with a lower baseline tear volume (p=0.01) and Tears Again (by 12%) by those with a thinner baseline lipid layer (p=0.04). The treatment that afforded the greatest improvement in clinical signs did not consistently match each individual's preferred treatment. If prescribed to a general dry eye population, the artificial tears performed similarly, improving symptoms and conjunctival signs. However, osmolarity balanced artificial tears were the preferred treatment in individuals with low baseline tear volume and lipisomal spray for individuals with a baseline lipid layer deficiency. Copyright © 2017 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.

  4. Tears of Wine

    NASA Astrophysics Data System (ADS)

    Rathore, Prerana; Sharma, Vivek

    `Tears of wine' refer to the rows of wine-drops that spontaneously emerge within a glass of strong wine. Evaporation-driven Marangoni flows near the meniscus of water-alcohol mixtures drive liquid upward forming a thin liquid film, and a rim or ridge forms near the moving contact line. Eventually the rim undergoes an instability forming drops, that roll back into bulk reservoir forming so called tears or legs of wine. Most studies in literature argue the evaporation of more volatile, lower surface tension component (alcohol) results in a concentration-dependent surface tension gradient that drives the climbing flow within the thin film. Though it is well-known that evaporative cooling can create temperature gradients that could provide additional contribution to the climbing flows, the role of thermocapillary flows is less well-understood. Furthermore, the patterns, flows and instabilities that occur near the rim, and determine the size and periodicity of tears, are not well-studied. Using experiments and theory, we visualize and analyze the formation and growth of tears of wine. The sliding drops, released from the rim towards the bulk reservoir, show oscillations and a cascade of fascinating flows that are analyzed for the first time.

  5. Influence of meniscus shape in the cross sectional plane on the knee contact mechanics.

    PubMed

    Łuczkiewicz, Piotr; Daszkiewicz, Karol; Witkowski, Wojciech; Chróścielewski, Jacek; Zarzycki, Witold

    2015-06-01

    We present a three dimensional finite element analysis of stress distribution and menisci deformation in the human knee joint. The study is based on the Open Knee model with the geometry of the lateral meniscus which shows some degenerative disorders. The nonlinear analysis of the knee joint under compressive axial load is performed. We present results for intact knee, knee with complete radial posterior meniscus root tear and knee with total meniscectomy of medial or lateral meniscus. We investigate how the meniscus shape in the cross sectional plane influences knee-joint mechanics by comparing the results for flat (degenerated) lateral and normal medial meniscus. Specifically, the deformation of the menisci in the coronal plane and the corresponding stress values in cartilages are studied. By analysing contact resultant force acting on the menisci in axial plane we have shown that restricted extrusion of the torn lateral meniscus can be attributed to small slope of its cross section in the coronal plane. Additionally, the change of the contact area and the resultant force acting on the menisci as the function of compressive load are investigated. Copyright © 2015 Elsevier Ltd. All rights reserved.

  6. MR imaging of meniscal tears: comparison of intermediate-weighted FRFSE imaging with intermediate-weighted FSE imaging.

    PubMed

    Tokuda, Osamu; Harada, Yuko; Ueda, Takaaki; Iida, Etsushi; Shiraishi, Gen; Motomura, Tetsuhisa; Fukuda, Kouji; Matsunaga, Naofumi

    2012-11-01

    We compared intermediate-weighted fast spin-echo (IW-FSE) images with intermediate-weighted fast-recovery FSE (IW-FRFSE) images in the diagnosis of meniscal tears. First, 64 patients were recruited, and the arthroscopic findings (n = 40) and image analysis (n = 19) identified 59 torn menisci with 36 patients. Both the diagnostic performance and image quality in assessing meniscal tears was evaluated for IW-FSE and IW-FRFSE images using a four-point scale. Signal-to-noise ratio (SNR) calculation was performed for both sets of images. IW-FRFSE image specificity (100 %) for diagnosing the posterior horn of the medial meniscus (MM) tear with reader 1 was significantly higher than that of IW-FSE images (90 %). Mean ratings of the contrast between the lesion and normal signal intensity within the meniscus were significantly higher for the IW-FRFSE image ratings than the IW-FSE images in most meniscal tears. Mean SNRs were significantly higher for IW-FSE images than for IW-FRFSE images (P < 0.05). IW-FRFSE imaging can be used as an alternative to the IW-FSE imaging to evaluate meniscal tears.

  7. Meniscus Imaging for Crystal-Growth Control

    NASA Technical Reports Server (NTRS)

    Sachs, E. M.

    1983-01-01

    Silicon crystal growth monitored by new video system reduces operator stress and improves conditions for observation and control of growing process. System optics produce greater magnification vertically than horizontally, so entire meniscus and melt is viewed with high resolution in both width and height dimensions.

  8. Tear dynamics in healthy and dry eyes.

    PubMed

    Cerretani, Colin F; Radke, C J

    2014-06-01

    Dry-eye disease, an increasingly prevalent ocular-surface disorder, significantly alters tear physiology. Understanding the basic physics of tear dynamics in healthy and dry eyes benefits both diagnosis and treatment of dry eye. We present a physiological-based model to describe tear dynamics during blinking. Tears are compartmentalized over the ocular surface; the blink cycle is divided into three repeating phases. Conservation laws quantify the tear volume and tear osmolarity of each compartment during each blink phase. Lacrimal-supply and tear-evaporation rates are varied to reveal the dependence of tear dynamics on dry-eye conditions, specifically tear osmolarity, tear volume, tear-turnover rate (TTR), and osmotic water flow. Predicted periodic-steady tear-meniscus osmolarity is 309 and 321 mOsM in normal and dry eyes, respectively. Tear osmolarity, volume, and TTR all match available clinical measurements. Osmotic water flow through the cornea and conjunctiva contribute 10 and 50% to the total tear supply in healthy and dry-eye conditions, respectively. TTR in aqueous-deficient dry eye (ADDE) is only half that in evaporative dry eye (EDE). The compartmental periodic-steady tear-dynamics model accurately predicts tear behavior in normal and dry eyes. Inclusion of osmotic water flow is crucial to match measured tear osmolarity. Tear-dynamics predictions corroborate the use of TTR as a clinical discriminator between ADDE and EDE. The proposed model is readily extended to predict the dynamics of aqueous solutes such as drugs or fluorescent tags.

  9. Outside-In Deep Medial Collateral Ligament Release During Arthroscopic Medial Meniscus Surgery.

    PubMed

    Todor, Adrian; Caterev, Sergiu; Nistor, Dan Viorel

    2016-08-01

    Arthroscopic partial medial meniscectomy is a very common orthopaedic procedure performed for symptomatic, irreparable meniscus tears. It is usually associated with a very good outcome and minimal complications. In some patients with tight medial compartment, the posterior horn of the medial meniscus can be difficult to visualize, and access in this area with instruments may be challenging. To increase the opening of the medial compartment, after valgus-extension stress position of the knee, different techniques of deep medial collateral ligament release have been described. The outside-in pie-crusting technique shown in this technical note has documented effectiveness and good outcomes with minimal or no morbidity.

  10. Medial meniscal posterior root/horn radial tears correlate with cartilage degeneration detected by T1ρ relaxation mapping.

    PubMed

    Takahashi, Kenji; Hashimoto, Sanshiro; Nakamura, Hiroshi; Mori, Atsushi; Sato, Akiko; Majima, Tokifumi; Takai, Shinro

    2015-06-01

    This study aimed to identify factors on routine pulse sequence MRI associated with cartilage degeneration observed on T1ρ relaxation mapping. This study included 137 subjects with knee pain. T1ρ values were measured in the regions of interest on the surface layer of the cartilage on mid-coronal images of the femorotibial joint. Assessment of cartilage, subchondral bone, meniscus and ligaments was performed using routine pulse sequence MRI. Radiographic evaluation for osteoarthritis was also performed. Multiple regression analysis revealed posterior root/horn tears to be independent factors increasing the T1ρ values of the cartilage in the medial compartment of the femorotibial joint. Even when adjusted for radiographically defined early-stage osteoarthritis, medial posterior meniscal radial tears significantly increased the T1ρ values. This study showed that posterior root/horn radial tears in the medial meniscus are particularly important MRI findings associated with cartilage degeneration observed on T1ρ relaxation mapping. Morphological factors of the medial meniscus on MRI provide findings useful for screening early-stage osteoarthritis. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  11. [Factors influencing the measurement of tear film lipid layer thickness with interferometry].

    PubMed

    Finis, D; Pischel, N; Borrelli, M; Schrader, S; Geerling, G

    2014-06-01

    The quantitative measurement of the tear film lipid layer thickness is a relatively new and promising method. However, so far it has not been investigated whether there is a diurnal or a day to day variability and whether certain factors are confounding the measurement of the lipid layer thickness. In three different experimental settings, 10 subjects without known sicca syndrome were examined at three different time points on one day, on three different days and before and after therapeutic expression of the Meibomian glands. As a comparison, the parameters tear film break-up time, tear meniscus height, diagnostic expression of the Meibomian glands and subjective symptoms, determined using the OSDI (ocular surface disease index) questionnaire, were measured. The results of the study showed a smaller variation of the lipid layer thickness measurements during the day and from day to day compared to the tear film break-up time. The expression of the Meibomian glands significantly increased the lipid layer thickness. There was a correlation between the baseline values of tear film break-up time and the lipid layer thickness. Our data showed that the lipid layer thickness as measured with the Lipiview® interferometer appears to be a relatively constant parameter over time. In addition, the expression of the Meibomian glands could be identified as a potential confounding factor. In this study we included only healthy subjects without known sicca syndrome. For the future our findings need to be validated in dry eye patients. Georg Thieme Verlag KG Stuttgart · New York.

  12. Repair of meniscal tears with the absorbable Clearfix screw: results after 1-3 years.

    PubMed

    Frosch, K H; Fuchs, M; Losch, A; Stürmer, K M

    2005-11-01

    Total meniscus resection usually leads to osteoarthritis of the knee joint. Preservation and refixation of the injured menisci are therefore of great clinical importance. The present study examines 40 meniscal injuries in 37 patients that were arthroscopically treated with Clearfix meniscal screws (Mitek, Norderstedt, Germany) in the period from August 1999 to December 2002. The mean patient age was 27.7 (range 16-62) years. Nine patients were female. A total of 24 patients (27 meniscal tears) also had an anterior cruciate ligament (ACL) lesion, and 5 patients had cartilage injuries. Twenty-two patients were treated within the first 2 weeks following the trauma, 10 patients within 8 weeks, and 5 patients after 8 weeks. The lesions were a bucket-handle tear of the medial meniscus in 11 cases and a bucket-handle tear of the lateral meniscus in 2 cases. The posterior horn of the medial meniscus was torn in 13 cases, and the pars intermedia in 3 cases. The posterior horn of the lateral meniscus was torn in 8 cases, and the pars intermedia in 3 cases. The mean tear length was 2.9 (+/- 1.5) cm and was fixed with an average of 1.8 (+/- 0.7) screws. In 7 cases, the anterior horn was treated with an additional meniscal suture. A total of 35 patients were examined after an average of 18 (range 7-45) months. In the event of a moderate outcome, MRI was performed as part of the follow-up investigation. The average Lysholm score was 93 (+/- 7.4), the Tegner activity index was 6.3 (+/- 2.0) before the accident and 5.8 (+/- 2.0) at the follow-up, the Marshall knee score was 47 (+/- 3.8). The VAS pain assessment was 1.6 (+/- 1.3) and the VAS function assessment was 7.9 (+/- 1.6). Of the 7 patients with a moderate result, 2 patients without additional ligament lesions suffered re-ruptures after and 13 months, respectively. The other 5 patients with a moderate result each had multiple accompanying injuries or pre-existing damage to the affected knee joint. The Clearfix screws

  13. Partial meniscectomy provides no benefit for symptomatic degenerative medial meniscus posterior root tears.

    PubMed

    Krych, Aaron J; Johnson, Nick R; Mohan, Rohith; Dahm, Diane L; Levy, Bruce A; Stuart, Michael J

    2018-04-01

    Medial meniscus posterior root tears (MMPRTs) are recognized as a source of pain and dysfunction, but treatment options remain a challenge. The purpose of the study was to determine (1) the efficacy of partial meniscectomy to treat MMPRTs compared to a matched group of non-operatively treated MMPRTs, and (2) risk factors for worse clinical and radiographic outcome. This retrospective comparative study was performed to include patients with complete, isolated MMPRTs with documented clinical symptoms and were treated with arthroscopic partial meniscectomy (PMM) and a minimum 2-year follow-up. These patients were then matched by age, gender, and BMI to patients with the same diagnosis who were treated non-operatively. Clinical and radiographic outcomes were compared between the two groups. Analysis was performed to determine risk factors for worse clinical and radiographic outcome in the PMM group alone. Overall, 52 patients were included in the study. Twenty-six patients (9M:17F) with a mean age of 55 ± 9 and a mean BMI of 32.8 ± 5.3 were treated with PMM and followed for 5.5 ± 2.0 years (range 2.3-9.3 years). In the PMM group, final median Tegner score was 3, mean IKDC score was 67.8 ± 20, and more patients had grade II or higher arthritis at final follow-up than baseline (91.3 vs. 36%, p < 0.01). Overall, 14 of the 26 patients (54%) treated operatively progressed to total knee arthroplasty at a mean of 54.3 months. There was no significant difference in final Tegner scores, IKDC, K-L grades, progression to arthroplasty, or overall failure rate between the PMM group and non-operative group. Following PMM, female patients had lower final IKDC scores (44.0 ± 2.8 vs. 74.6 ± 16.7, p = 0.02) compared to males, as well as a higher rate of arthroplasty (70.6 vs. 20.0%, p = 0.009). Higher BMI correlated with lower IKDC scores (r = -0.91, p = 0.01) and meniscal extrusion was associated with higher rate of arthritis at final

  14. Improved arthroscopic one-piece excision technique for the treatment of symptomatic discoid medial meniscus.

    PubMed

    Wang, Hong-De; Li, Tong; Gao, Shi-Jun

    2017-10-30

    Discoid medial meniscus is an extremely rare abnormality of the knee. During arthroscopic meniscectomy for symptomatic discoid medial meniscus, it is difficult to remove the posterior portion of the meniscus because of the confined working space within the compartment and the obstruction caused by the anterior cruciate ligament and the tibial intercondylar eminence. To overcome these problems, we describe an improved arthroscopic technique for one-piece excision of symptomatic discoid medial meniscus through three unique portals. Three improved portals were made in the injured knee: a standard anteromedial portal, a central transpatellar tendon portal, and a high anterolateral portal. The anterior side of the discoid medial meniscus was cut 7 mm from the periphery of the meniscus. Next, the anterior portion of the free discoid meniscus fragment was pulled in the anterolateral direction with tension. A curve-shaped cut was made along the longitudinal tear to the posterior horn using basket forceps through the standard anteromedial portal. Then, the anterior portion of the free discoid meniscus was pulled in the anteromedial direction. Pulling the fragment under tension made it easier to cut the posterior side of the discoid meniscus. The posterior side of the discoid meniscus was cut 7 mm from the periphery of the meniscus with straight scissors or basket forceps through the central transpatellar tendon portal. This technique resulted in satisfactory results. Excellent visualization of the posterior part of the discoid medial meniscus was gained during the procedure, and it was easy to cut the posterior part of the discoid medial meniscus. No recurrent symptoms were found. This improved arthroscopic one-piece excision technique for the treatment of symptomatic discoid medial meniscus enables the posterior part of the meniscus to be cut satisfactorily. Moreover, compared with previous techniques, this novel technique causes less formation of foreign bodies and less

  15. Neurovascular safety and clinical outcome of outside-in repair of tears of the posterior horn of the medial meniscus.

    PubMed

    Sobhy, Mohamed Hassan; AbouElsoud, Maged M Samy; Kamel, Ezzat Mohamed; Desouki, Ahmed Mohamed

    2010-12-01

    The purpose of this study was to evaluate the safety and clinical outcome of a new posterior approach for the known outside-in technique for repair of tears of the posterior horn of the medial meniscus (PHMM). First, a cadaveric study was performed on 6 cadaveric knees to assess the safety of a point just lateral to the semitendinosus tendon as an entry point for outside-in repair. Dissection was done to measure the clearance of this point to the nearby popliteal bundle and saphenous nerve. A prospective case series study was then performed to assess the clinical outcome of such an approach. We treated 41 consecutive cases with PHMM tears by the outside-in technique using a shuttle relay method through the same point. Clinical assessments, magnetic resonance imaging findings, Lysholm scores, and International Knee Documentation Committee subjective scores were recorded for all patients. After a minimum postoperative period of 2 years, all cases were re-evaluated and re-scored. The cadaveric study showed a mean clearance distance of 2.4 cm for the popliteal bundle and 4.6 cm for the saphenous nerve. The case series study was done on 41 meniscal repairs; 15 of 41 cases (37%) were performed in conjunction with anterior cruciate ligament reconstruction. There were 22 right knees (54%) and 19 left knees (36%). After a mean follow-up period of 27 months, patients showed a clinical success rate of 88% in terms of disappearance of pain, locking, and swelling, together with improved Lysholm scores (from 34 to 88) and International Knee Documentation Committee scores (from 25 to 88). These improvements were statistically significant (P < .05). An outside-in repair technique with a posterior entry central to the semitendinosus tendon was used safely with 88% satisfactory clinical results for treatment of PHMM tears. Level IV, therapeutic case series. Copyright © 2010 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  16. Complications in posteromedial arthroscopic suture of the medial meniscus.

    PubMed

    Jan, N; Sonnery-Cottet, B; Fayard, J-M; Kajetanek, C; Thaunat, M

    2016-12-01

    All-inside posteromedial suture for lesions of the posterior horn of the medial meniscus in anterior cruciate ligament (ACL) repair provides effective freshening and good healing. The posteromedial portal provides satisfactory healing rates without increasing morbidity or complications rates. Intra- and postoperative complications were collected for a consecutive single-center series of 132 patients undergoing posteromedial hook suture of the medial meniscus in ACL repair. Meniscal healing was assessed as the rate of recurrence of symptomatic medial meniscus lesions (Barret criteria) and on revision surgery, if any, in terms of the aspect and extent of the iterative lesion. The severity of any sensory disorder was assessed by questionnaire. The intraoperative complications rate was 1.5% (2 saphenous vein punctures). At a mean 31months (range, 28-35months), there was no loss to follow-up. Twelve patients (9%) showed symptomatic recurrence of the medial meniscus lesion, requiring 10 repeat surgeries. In 6 cases (4.5%), the iterative lesion involved a smaller, more central part of the meniscus anterior to the sutures, of "postage-stamp" effect, possibly implicating the suture hook and/or non-absorbable sutures. There were no cases of infection or fistula. Postoperative hematoma occurred in 7% of patients. In total, 1.8% reported dysesthesia areas equal to or greater than the size of a credit card (45cm 2 ). Some retears, or "partial failures", may implicate a new lesion caused by the suture hook and possibly prolonged by non-resorbable sutures. Hematoma and sensory disorder rates were comparable to those reported in isolated ACL repair without posteromedial portal. The present results show that posteromedial arthroscopic hook suture in posterior medial meniscus tear provides good healing rates without increased morbidity due to the supplementary portal. IV. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  17. Discoid Meniscus Associated With Achondroplasia.

    PubMed

    Hoernschemeyer, Daniel G; Atanda, Alfred; Dean-Davis, Ellen; Gupta, Sumit K

    2016-05-01

    Achondroplasia is the most common skeletal dysplasia. This form of dwarfism is caused by a point mutation in the fibroblast growth factor receptor 3 (FGFR3) gene, leading to inhibition of endochondral ossification for these patients. This results in a normal trunk height but shortened limbs. The discoid meniscus may be an important associated finding to better understand the common complaints of leg pain for these patients. Although the incidence for a discoid meniscus is between 3% and 5% for the general population, it is unknown with achondroplasia. This case series includes 4 patients, with ages ranging from adolescence to early adulthood, with symptoms of knee pain that were not attributable to some of the more common findings seen in this patient population. Typically, patients with achondroplasia who experience knee pain are evaluated for more common and well-known etiologies such as genu varum, ligamentous instability, and neurogenic claudication. However, the authors propose that symptomatic discoid lateral meniscus should be added to the differential diagnosis for lower-extremity pain in the achondroplasia population. A thorough history and physical examination, in combination with magnetic resonance imaging, can aid in making the diagnosis. Treatment with arthroscopic debridement, saucerization of the meniscus, and repair for unstable injuries has yielded good outcomes for this patient population. [Orthopedics. 2016; 39(3):e498-e503.]. Copyright 2016, SLACK Incorporated.

  18. Biological Strategies to Enhance Healing of the Avascular Area of the Meniscus

    PubMed Central

    Longo, Umile Giuseppe; Campi, Stefano; Romeo, Giovanni; Spiezia, Filippo; Maffulli, Nicola; Denaro, Vincenzo

    2012-01-01

    Meniscal injuries in the vascularized peripheral part of the meniscus have a better healing potential than tears in the central avascular zone because meniscal healing principally depends on its vascular supply. Several biological strategies have been proposed to enhance healing of the avascular area of the meniscus: abrasion therapy, fibrin clot, organ culture, cell therapy, and applications of growth factors. However, data are too heterogeneous to achieve definitive conclusions on the use of these techniques for routine management of meniscal lesions. Although most preclinical and clinical studies are very promising, they are still at an experimental stage. More prospective randomised controlled trials are needed to compare the different techniques for clinical results, applicability, and cost-effectiveness. PMID:22220179

  19. Autologous mesenchymal stem cells or meniscal cells: what is the best cell source for regenerative meniscus treatment in an early osteoarthritis situation?

    PubMed

    Zellner, Johannes; Pattappa, Girish; Koch, Matthias; Lang, Siegmund; Weber, Johannes; Pfeifer, Christian G; Mueller, Michael B; Kujat, Richard; Nerlich, Michael; Angele, Peter

    2017-10-10

    Treatment of meniscus tears within the avascular region represents a significant challenge, particularly in a situation of early osteoarthritis. Cell-based tissue engineering approaches have shown promising results. However, studies have not found a consensus on the appropriate autologous cell source in a clinical situation, specifically in a challenging degenerative environment. The present study sought to evaluate the appropriate cell source for autologous meniscal repair in a demanding setting of early osteoarthritis. A rabbit model was used to test autologous meniscal repair. Bone marrow and medial menisci were harvested 4 weeks prior to surgery. Bone marrow-derived mesenchymal stem cells (MSCs) and meniscal cells were isolated, expanded, and seeded onto collagen-hyaluronan scaffolds before implantation. A punch defect model was performed on the lateral meniscus and then a cell-seeded scaffold was press-fit into the defect. Following 6 or 12 weeks, gross joint morphology and OARSI grade were assessed, and menisci were harvested for macroscopic, histological, and immunohistochemical evaluation using a validated meniscus scoring system. In conjunction, human meniscal cells isolated from non-repairable bucket handle tears and human MSCs were expanded and, using the pellet culture model, assessed for their meniscus-like potential in a translational setting through collagen type I and II immunostaining, collagen type II enzyme-linked immunosorbent assay (ELISA), and gene expression analysis. After resections of the medial menisci, all knees showed early osteoarthritic changes (average OARSI grade 3.1). However, successful repair of meniscus punch defects was performed using either meniscal cells or MSCs. Gross joint assessment demonstrated donor site morbidity for meniscal cell treatment. Furthermore, human MSCs had significantly increased collagen type II gene expression and production compared to meniscal cells (p < 0.05). The regenerative potential of the

  20. Discoid Medial Meniscus Tear, with a Literature Review of Treatments

    PubMed Central

    Song, In Soo; Kim, Jun Bum; Lee, Jong Keun; Park, Byeong-Seop

    2017-01-01

    The present study reports our experience of treating four cases of symptomatic discoid medial meniscus, three of which were bilateral. We performed partial meniscectomy with a four-portal technique using a knife leaving a 6 mm peripheral margin after confirmation of magnetic resonance imaging findings. Clinical results were assessed at the end of 2-year follow-up using the Knee Injury and Osteoarthritis Outcome Score and a visual analogue scale. We obtained satisfactory clinical results without recurrence of the symptoms in all cases. PMID:28854771

  1. Arthroscopic repair of the posterior root of the medial meniscus using knotless suture anchor: A technical note.

    PubMed

    Eun, Sang Soo; Lee, Sang Ho; Sabal, Luigi Andrew

    2016-08-01

    There are numerous methods for repairing posterior root tears of the medial meniscus (PRTMM). Repair techniques using suture anchors through a high posteromedial portal have been reported. The present study found that using a knotless suture anchor instead of suture anchor seemed easier and faster because it avoided passing the sutures through the meniscus and tying a knot in a small space. This study describes a knotless suture anchor technique through a high posteromedial portal, and its clinical results. Copyright © 2016 Elsevier B.V. All rights reserved.

  2. Simultaneous avulsion fracture of the posterior medial and posterior lateral meniscus root: a case report and review of the literature.

    PubMed

    Feucht, Matthias J; Salzmann, Gian M; Pestka, Jan M; Südkamp, Norbert P; Niemeyer, Philipp

    2014-04-01

    Injuries of the meniscus roots are increasingly recognized as a serious knee joint pathology. An avulsion fracture of the meniscus root is a rare variant of this injury pattern. In this article, a case of a traumatic simultaneous avulsion fracture of both the posterior medial and posterior lateral meniscus root associated with a tear of the anterior cruciate ligament is presented. Both avulsion fractures were treated by indirect arthroscopic transtibial pullout fixation of the bony fragment. Based on the findings of our literature review, root avulsion fractures seem to be more common in young male patients after an acute trauma to the knee joint.

  3. Study of role of meniscus and viscous forces during liquid-mediated contacts separation

    NASA Astrophysics Data System (ADS)

    Dhital, Prabin

    Menisci may form between two solid surfaces with the presence of an ultra-thin liquid film. When the separation operation is needed, meniscus and viscous forces contribute to an adhesion leading stiction, high friction, possibly high wear and potential failure of the contact systems, for instance microdevices, magnetic head disks and diesel fuel injectors. The situation may become more pronounced when the contacting surfaces are ultra-smooth and the normal load is small. Various design parameters, such as contact angle, initial separation height, surface tension and liquid viscosity, have been investigated during liquid-mediated contact separation. However, how the involved forces will change roles for various liquid is of interest and is necessary to be studied. In this study, meniscus and viscous forces due to water and liquid lubricants during separation of two flat surfaces are studied. Previously established mathematical model for meniscus and viscous forces during flat on flat contact separation is simulated. The effect of meniscus and viscous force on critical meniscus area at which those forces change role is studied with different liquid properties for flat on flat contact surfaces. The roles of the involved forces at various meniscus areas are analyzed. Experiments are done in concerns to studying the effect of surface roughness on contact angle. The impact of liquid properties, initial separation heights and contact angle on critical meniscus area for different liquid properties are analyzed. The study provides a fundamental understanding of the forces of the separation process and its value for the design of interfaces. The effect of surface roughness and liquid properties on contact angle are studied.

  4. Effects of a warm compress containing menthol on the tear film in healthy subjects and dry eye patients

    NASA Astrophysics Data System (ADS)

    Arita, Reiko; Morishige, Naoyuki; Sakamoto, Ichiro; Imai, Natsuko; Shimada, Yuko; Igaki, Michihito; Suzuki, Atsushi; Itoh, Kouzo; Tsubota, Kazuo

    2017-04-01

    Menthol is thought to stimulate lacrimation via activation of cold-sensitive primary afferent neurons in the cornea. We evaluated a warm compress containing menthol as a potential treatment for dry eye by examining its effects on the tear film in healthy subjects (n = 20) and dry eye patients (n = 35). Disposable eyelid-warming steamers that either did (MH) or did not (HO) contain menthol were applied to one eye of each subject either once only for 10 min or repeatedly over 2 weeks. Single application of MH significantly increased tear meniscus volume (P = 8.6 × 10-5, P = 1.3 × 10-5) and tear film breakup time (P = 0.006, P = 0.002) as well as improved meibum condition in healthy subjects and dry eye patients, respectively. Repeated application of MH significantly increased tear meniscus volume (P = 0.004, P = 1.7 × 10-4) and tear film breakup time (P = 0.037, P = 0.010) in healthy subjects and dry eye patients, respectively. Repeated application of MH thus induced persistent increases in tear fluid volume and tear film stability in dry eye patients, suggesting that repeated use of a warm compress containing menthol is a potential novel treatment for dry eye disease.

  5. Second-look arthroscopic findings after open-wedge high tibia osteotomy focusing on the posterior root tears of the medial meniscus.

    PubMed

    Nha, Kyung-Wook; Lee, Yong Seuk; Hwang, Dae-Hee; Kwon, Jae Ho; Chae, Dong Ju; Park, Young Jee; Kim, Jong In

    2013-02-01

    This study examined, at second-look arthroscopy, the results of open-wedge high tibial osteotomy (HTO) focusing on root tear of the medial meniscus posterior horn (RTMMP). Among 31 consecutive patients who underwent HTO without a meniscectomy or pullout repair for RTMMP, 20 patients were available for second-look arthroscopic evaluation. All patients had medial unicompartmental arthritis. The healing status of the RTMMP was classified as complete, incomplete, and no healing. The difference in the weight bearing line from presurgery to the last follow-up was evaluated. Osteoarthritis and chondral lesions were evaluated, as were clinical results. Correlations between healing status and other variables (weight bearing line, cartilage status, and clinical scores) were assessed. The healed (10 patients) and nonhealed (incomplete 6 patients + no healing 4 patients) groups were also evaluated with respect to other variables. There were 10 (50%) cases with complete healing, 6 (30%) with incomplete healing, and 4 (20%) with no healing. Kellgren-Lawrence grade did not improve according to the standing plain radiograph (P = .09). Progression of chondral lesions was not observed at second-look arthroscopy; some improvement was even observed (P = .002). The median Lysholm score improved from 58 preoperatively to 88.5 at the last follow-up. The median Hospital for Special Surgery (HSS) score also increased significantly from 62.4 (range, 50 to 76) to 87.2 (range, 80 to 92; P = .003). The comparison between healed and nonhealed groups revealed no statistical differences in all variables. This study revealed a high rate of healing of RTMMP after HTO without attempted repair. Healing of the meniscus was not associated with an improved clinical outcome. Level IV, therapeutic case series. Copyright © 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  6. Hidden lesions of the posterior horn of the medial meniscus: a systematic arthroscopic exploration of the concealed portion of the knee.

    PubMed

    Sonnery-Cottet, Bertrand; Conteduca, Jacopo; Thaunat, Mathieu; Gunepin, François Xavier; Seil, Romain

    2014-04-01

    Anterior cruciate ligament (ACL) tears are frequently associated with meniscal lesions. Despite improvements in meniscal repair techniques, failure rates remain significant, especially for the posterior horn of the medial meniscus. To determine whether a systematic arthroscopic exploration of the posterior horn of the medial meniscus with an additional posteromedial portal is useful to identify otherwise unrecognized lesions. Case series; Level of evidence, 4. In a consecutive series of 302 ACL reconstructions, a systematic arthroscopic exploration of the posterior horn of the medial meniscus was performed. The first stage of the exploration was achieved through anterior visualization via a standard anterolateral portal. In the second stage, the posterior horn of the medial meniscus was visualized posteriorly via the anterolateral portal with the scope positioned deep in the notch. In the third stage, the posterior horn was probed through an additional posteromedial portal. A χ2 test and logistic regression analysis were performed to determine if the time from injury to surgery was associated with the meniscal tear pattern. A medial meniscal tear was diagnosed in 125 of the 302 patients (41.4%). Seventy-five lesions (60%) located in the meniscal body were diagnosed at the first stage of the arthroscopic exploration. Fifty lesions located in the ramp area were diagnosed: 29 (23.2%) at the second stage and 21 lesions (16.8%) at the third stage after minimal debridement of the superficial soft tissue layer. The latter type of lesion is called a "hidden lesion." Altogether, the prevalence of ramp lesions in this population was 40%. Meniscal body lesions (odds ratio, 2.6; 95% confidence interval, 1.18-5.18; P < .02) were found to be significantly correlated with a longer delay between injury and surgery. Posterior visualization and posteromedial probing of the posterior horn of the medial meniscus can help in discovering a higher rate of lesions that could be easily

  7. Effect of the meniscus contact angle during early regimes of spontaneous imbibition in nanochannels.

    PubMed

    Karna, Nabin Kumar; Oyarzua, Elton; Walther, Jens H; Zambrano, Harvey A

    2016-11-30

    Nanoscale capillarity has been extensively investigated; nevertheless, many fundamental questions remain open. In spontaneous imbibition, the classical Lucas-Washburn equation predicts a singularity as the fluid enters the channel consisting of an anomalous infinite velocity of the capillary meniscus. Bosanquet's equation overcomes this problem by taking into account fluid inertia predicting an initial imbibition regime with constant velocity. Nevertheless, the initial constant velocity as predicted by Bosanquet's equation is much greater than those observed experimentally. In the present study, large scale atomistic simulations are conducted to investigate capillary imbibition of water in slit silica nanochannels with heights between 4 and 18 nm. We find that the meniscus contact angle remains constant during the inertial regime and its value depends on the height of the channel. We also find that the meniscus velocity computed at the channel entrance is related to the particular value of the meniscus contact angle. Moreover, during the subsequent visco-inertial regime, as the influence of viscosity increases, the meniscus contact angle is found to be time dependent for all the channels under study. Furthermore, we propose an expression for the time evolution of the dynamic contact angle in nanochannels which, when incorporated into Bosanquet's equation, satisfactorily explains the initial capillary rise.

  8. Long-term results of treatment with diquafosol ophthalmic solution for aqueous-deficient dry eye.

    PubMed

    Koh, Shizuka; Ikeda, Chikako; Takai, Yoshihiro; Watanabe, Hitoshi; Maeda, Naoyuki; Nishida, Kohji

    2013-09-01

    To evaluate the preliminary long-term efficacy of diquafosol ophthalmic solution for aqueous-deficient dry eye. Fifteen patients with mild-to-moderate aqueous-deficient dry eye were enrolled. After a washout period, the patients were treated with 3 % diquafosol ophthalmic solution for 6 months. We assessed 12 subjective dry eye symptoms, corneal and conjunctival staining with fluorescein, tear film break-up time (BUT), lower tear meniscus height measured with anterior-segment optical coherence tomography, Schirmer's testing, and adverse reactions at baseline and 1, 3, and 6 months after the start of treatment. Treatment with diquafosol ophthalmic solution significantly improved dry eye symptoms, corneal staining, BUT, and tear meniscus height at 1 month and maintained the effectiveness for 6 months. Conjunctival staining significantly improved 3 and 6 months after treatment. No significant adverse reactions developed. Prolonged use of diquafosol ophthalmic solution for 6 months produced significant improvement both subjectively (dry eye symptom score) and objectively (ocular staining score and tear function tests) for aqueous-deficient dry eye.

  9. Squat Winnowing: Cause of Meniscus Injuries in Non-Athletic Females.

    PubMed

    Kamal, Younis; Ahmad Khan, Hayat; Ahmad Latoo, Irfan; Gani, Naseemul; Farooq, Munir; Gul, Snobar

    2016-02-01

    Sports activities were thought to be the major cause of meniscus injury in both men and woman, but our observations of non-athletic females show that the cause of meniscus injury was unrelated to any type of sports activity. This study revealed squat winnowing to be a major cause of meniscus injury in non-athletic females. This retrospective study was conducted in a tertiary care orthopaedic hospital which caters to a population of 10 million people. We assessed 120 non-athletic females who had received treatment in our hospital over a period of 2 years. The most probable cause of knee injury, per initial patient history, was recorded for all non-athletic females who presented clinical signs and symptoms of meniscus injury. The diagnoses were confirmed by relevant MRI and arthroscopy of patients' knees. All females who engaged in athletic activity and other females with unrelated, non-traumatic knee pathologies were excluded from the study. Through our study, we found that 42% (n = 50) of females suffered an injury during squat winnowing of rice, either at home or at work. Another 29% (n = 35) of females cited a history of slipping and spraining their knee as a cause of knee injury, while 19% (n = 16) of females suffered a knee injury during complex accidents such as a traffic accident. Finally, 13% (n = 16) of the females had no definite history of knee injury. Our observations add to the knowledge base of the various causes of meniscus tears; this study also revealed that socio-cultural factors influence and contribute to the mechanism of various types of knee injury.

  10. Squat Winnowing: Cause of Meniscus Injuries in Non-Athletic Females

    PubMed Central

    Kamal, Younis; Ahmad Khan, Hayat; Ahmad Latoo, Irfan; Gani, Naseemul; Farooq, Munir; Gul, Snobar

    2016-01-01

    Background: Sports activities were thought to be the major cause of meniscus injury in both men and woman, but our observations of non-athletic females show that the cause of meniscus injury was unrelated to any type of sports activity. Objectives: This study revealed squat winnowing to be a major cause of meniscus injury in non-athletic females. Patients and Methods: This retrospective study was conducted in a tertiary care orthopaedic hospital which caters to a population of 10 million people. We assessed 120 non-athletic females who had received treatment in our hospital over a period of 2 years. The most probable cause of knee injury, per initial patient history, was recorded for all non-athletic females who presented clinical signs and symptoms of meniscus injury. The diagnoses were confirmed by relevant MRI and arthroscopy of patients’ knees. All females who engaged in athletic activity and other females with unrelated, non-traumatic knee pathologies were excluded from the study. Results: Through our study, we found that 42% (n = 50) of females suffered an injury during squat winnowing of rice, either at home or at work. Another 29% (n = 35) of females cited a history of slipping and spraining their knee as a cause of knee injury, while 19% (n = 16) of females suffered a knee injury during complex accidents such as a traffic accident. Finally, 13% (n = 16) of the females had no definite history of knee injury. Conclusions: Our observations add to the knowledge base of the various causes of meniscus tears; this study also revealed that socio-cultural factors influence and contribute to the mechanism of various types of knee injury. PMID:27218040

  11. A novel arthroscopic all-inside suture technique using the Fast-Fix 360 system for repairing horizontal meniscal tears in young athletes

    PubMed Central

    Atsumi, Satoru; Hara, Kunio; Arai, Yuji; Yamada, Manabu; Mizoshiri, Naoki; Kamitani, Aguri; Kubo, Toshikazu

    2018-01-01

    Abstract Rationale: Considering the risk of osteoarthritis following resection of a horizontally torn meniscus of the knee, repairing and preserving the meniscus as much as possible is preferred. We report 3 cases of restoration of horizontally torn menisci using a novel arthroscopic method we have called “all-inside interleaf vertical suture” that afforded preservation. Patient concerns: The 3 patients (aged 14, 17, and 21 years) had knee pain through sports activity. Diagnoses: All patients had horizontal tears in the posteromedial part of the meniscus. Interventions: The method uses Fast-Fix, whereby a first anchor is inserted from the tibial surface of the tear's superior leaflet and a second anchor is inserted from the femoral surface of the tear's inferior leaflet, and the 2 leaflets are closed using vertical suture. In all cases, the suture knots were embedded between the superior leaflet and inferior leaflet, avoiding contact with the articular cartilage, and superior leaflet and inferior leaflet crimping was good. Outcomes: All 3 were able to resume competing in sport and ≥ 1 year after surgery they had no pain and their postoperative mean Lysholm scores were 99.7. There were no complications or recurrence. On magnetic resonance imaging, the signal intensity of all the horizontal tears was high before surgery but low after surgery, suggesting that the repaired tear was healing. Lessons: The all-inside interleaf vertical suture procedure is a new surgical technique that can repair posteromedial horizontal meniscal tears of the knee of young people by easy crimping of the superior and inferior leaflets without the suture knots causing complications. PMID:29443758

  12. Allergy and allergic mediators in tears.

    PubMed

    Leonardi, Andrea

    2013-12-01

    The identification of inflammatory mediators in the tear fluid have been extensively used in ocular allergy to find either a 'disease marker', to better understand the immune mechanisms involved in the ocular surface inflammation, or to identify potential targets for therapeutic interventions. While the clinical characteristics allow a relatively convincing diagnosis of ocular allergic diseases, in the initial, non active phases, or in the chronic stages, the diagnosis may not be clear. Although not highly specific, total tear IgE can be measured with local tests by inserting a paper strip in the lower meniscus. The measurement of tear specific inflammatory markers, such as histamine, tryptase, ECP, IL-4, IL-5 and eotaxin, may be useful for the diagnosis or monitoring ocular allergy. New technologies such as multiplex bead assays, membrane-bound antibody array and proteomic techniques can characterize the distribution of a wide range of bioactive trace proteins in tears. Dozens of mediators, cytokines, chemokines, growth factors, angiogenic modulators, enzymes and inhibitors were thus identified in small tear samples using these techniques, providing the possible identification of specific biomarker for either specific disease or disease activity. However, to date, there is no a single specific laboratory test suitable for the diagnosis and monitoring of allergic conjunctivitis. Copyright © 2013 Elsevier Ltd. All rights reserved.

  13. Incidence and patterns of meniscal tears accompanying the anterior cruciate ligament injury: possible local and generalized risk factors.

    PubMed

    Mansori, Ashraf El; Lording, Timothy; Schneider, Antoine; Dumas, Raphael; Servien, Elvire; Lustig, Sebastien

    2018-05-26

    Injury to the anterior cruciate ligament (ACL) is frequently accompanied by tears of the menisci. Some of these tears occur at the time of injury, but others develop over time in the ACL-deficient knee. The aim of this study was to evaluate the effects of the patient characteristics, time from injury (TFI), and posterior tibial slope (PTS) on meniscal tear patterns. Our hypothesis was that meniscal tears would occur more frequently in ACL-deficient knees with increasing age, weight, TFI, PTS, and in male patients. Of the ACL-injured patients, 362 were analyzed, and details of meniscal lesions were collected. The medial and lateral tibial slopes (MTS, LTS) were measured via computed tomography. Patient demographics, TFI, MTS, and LTS were correlated with the diagnosed meniscal tears. Of the patients, 113 had a medial meniscus (MM) tear, 54 patients had a lateral meniscus (LM) tear, 34 patients had tears of both menisci, and 161 patients had no meniscal tear. The most common tear location was the posterior horn (PH) of the MM, followed by tear involving the whole MM. Patient age, BMI, and TFI were significantly associated with the incidence of MM tear. Female patients had a higher incidence of injury than males in all tear sites except in the body and PH. Male patients had more vertical and peripheral tears. The median MTS and LTS for patients with MM tears were 7.0°and 8.7°, respectively, while those of patients with LM tears were 6.9° and 8.1°. Steeper LTS was significantly associated with tears of LM and of both menisci. Older age, male sex, increased BMI, and prolonged TFI were significant factors for the development of MM tears. An increase in the tibial slope, especially of the lateral plateau, seems to increase the risk of tear of the LM and of both menisci. Level III.

  14. Do Cartilage Repair Procedures Prevent Degenerative Meniscus Changes? Longitudinal T1ρ and Morphological Evaluation at 3.0T

    PubMed Central

    Jungmann, Pia M.; Li, Xiaojuan; Nardo, Lorenzo; Subburaj, Karupppasamy; Lin, Wilson; Ma, C. Benjamin; Majumdar, Sharmila; Link, Thomas M.

    2014-01-01

    Background Cartilage repair (CR) procedures are widely accepted for treatment of isolated cartilage defects at the knee joint. However, it is not well known whether these procedures prevent degenerative joint disease. Hypothesis/Purpose CR procedures prevent accelerated qualitative and quantitative progression of meniscus degeneration in individuals with focal cartilage defects. Study Design Cohort Study; Level of evidence 2b Methods A total of 94 subjects were studied. CR procedures were performed on 34 patients (n=16 osteochondral transplantation, n=18 microfracture); 34 controls were matched. An additional 13 patients received CR and anterior cruciate ligament (ACL) reconstruction (CR&ACL) and 13 patients received only ACL reconstruction. 3.0T MRI with T1ρ mapping and sagittal fat-saturated intermediate-weighted fast spin echo (FSE) sequences was performed to analyze menisci quantitatively and qualitatively (Whole-Organ Magnetic Resonance Imaging Score, WORMS). CR and CR&ACL patients were examined 4 months (n=34; n=13), 1 (n=21; n=8) and 2 (n=9; n=5) years post CR. Control subjects were scanned at baseline and after 1 and 2 years, ACL patients after 1 and 2 years. Results At baseline, global meniscus T1ρ values were higher in individuals with CR (14.2±0.6ms; P=0.004) and in individuals with CR&ACL (17.1±0.9ms; P<0.001) when compared to controls (12.8±0.6ms). After two years, there was a statistical difference between T1ρ at the overlying meniscus above cartilage defects (16.4±1.0ms) and T1ρ of the subgroup of control knees without cartilage defects (12.1±0.8ms; P<0.001) and a statistical trend to the CR group (13.3±1.0 ms; P=0.088). At baseline, 35% of subjects with CR showed morphological meniscus tears at the overlying meniscus; 10% of CR subjects showed an increase of WORMS meniscus score within the first year, none progressed in the second year. Control subjects with (without) cartilage defects showed meniscus tears in 30% (5%) at baseline; 38% (19

  15. Meniscal tears, repairs and replacement: their relevance to osteoarthritis of the knee.

    PubMed

    McDermott, Ian

    2011-04-01

    The menisci of the knee are important load sharers and shock absorbers in the joint. Meniscal tears are common, and whenever possible meniscal tears should be surgically repaired. Meniscectomy leads to a significant increased risk of osteoarthritis, and various options now exist for replacing missing menisci, including the use of meniscal scaffolds or the replacement of the entire meniscus by meniscal allograft transplantation. The field of meniscal surgery continues to develop apace, and the future may lie in growing new menisci by tissue engineering techniques.

  16. The influence of a change in the meniscus cross-sectional shape on the medio-lateral translation of the knee joint and meniscal extrusion

    PubMed Central

    Daszkiewicz, Karol; Witkowski, Wojciech; Chróścielewski, Jacek; Ferenc, Tomasz; Baczkowski, Boguslaw

    2018-01-01

    Objective The purpose of this study was to evaluate the influence of a change in the meniscus cross sectional shape on its position and on the biomechanics of a knee joint. Methods One main finite element model of a left knee joint was created on the basis of MRI images. The model consisted of bones, articular cartilages, menisci and ligaments. Eight variants of this model with an increased or decreased meniscus height were then prepared. Nonlinear static analyses with a fixed flexion/extension movement for a compressive load of 1000 N were performed. The additional analyses for those models with a constrained medio-lateral relative bone translation allowed for an evaluation of the influence of this translation on a meniscus external shift. Results It was observed that a decrease in the meniscus height caused a decrease in the contact area, together with a decrease in the contact force between the flattened meniscus and the cartilage. For the models with an increased meniscus height, a maximal value of force acting on the meniscus in a medio-lateral direction was obtained. The results have shown that the meniscus external shift was approximately proportional to the meniscus slope angle, but that relationship was modified by a medio-lateral relative bone translation. It was found that the translation of the femur relative to the tibia may be dependent on the geometry of the menisci. Conclusions The results have suggested that a change in the meniscus geometry in the cross sectional plane can considerably affect not only the meniscal external shift, but also the medio-lateral translation of the knee joint as well as the congruency of the knee joint. PMID:29447236

  17. The influence of a change in the meniscus cross-sectional shape on the medio-lateral translation of the knee joint and meniscal extrusion.

    PubMed

    Luczkiewicz, Piotr; Daszkiewicz, Karol; Witkowski, Wojciech; Chróścielewski, Jacek; Ferenc, Tomasz; Baczkowski, Boguslaw

    2018-01-01

    The purpose of this study was to evaluate the influence of a change in the meniscus cross sectional shape on its position and on the biomechanics of a knee joint. One main finite element model of a left knee joint was created on the basis of MRI images. The model consisted of bones, articular cartilages, menisci and ligaments. Eight variants of this model with an increased or decreased meniscus height were then prepared. Nonlinear static analyses with a fixed flexion/extension movement for a compressive load of 1000 N were performed. The additional analyses for those models with a constrained medio-lateral relative bone translation allowed for an evaluation of the influence of this translation on a meniscus external shift. It was observed that a decrease in the meniscus height caused a decrease in the contact area, together with a decrease in the contact force between the flattened meniscus and the cartilage. For the models with an increased meniscus height, a maximal value of force acting on the meniscus in a medio-lateral direction was obtained. The results have shown that the meniscus external shift was approximately proportional to the meniscus slope angle, but that relationship was modified by a medio-lateral relative bone translation. It was found that the translation of the femur relative to the tibia may be dependent on the geometry of the menisci. The results have suggested that a change in the meniscus geometry in the cross sectional plane can considerably affect not only the meniscal external shift, but also the medio-lateral translation of the knee joint as well as the congruency of the knee joint.

  18. Assessment of the Relationship between the Shape of the Lateral Meniscus and the Risk of Extrusion Based on MRI Examination of the Knee Joint.

    PubMed

    Szarmach, Arkadiusz; Luczkiewicz, Piotr; Skotarczak, Monika; Kaszubowski, Mariusz; Winklewski, Pawel J; Dzierzanowski, Jaroslaw; Piskunowicz, Maciej; Szurowska, Edyta; Baczkowski, Bogusław

    2016-01-01

    Meniscus extrusion is a serious and relatively frequent clinical problem. For this reason the role of different risk factors for this pathology is still the subject of debate. The goal of this study was to verify the results of previous theoretical work, based on the mathematical models, regarding a relationship between the cross-section shape of the meniscus and the risk of its extrusion. Knee MRI examination was performed in 77 subjects (43 men and 34 women), mean age 34.99 years (range: 18-49 years), complaining of knee pain. Patients with osteoarthritic changes (grade 3 and 4 to Kellgren classification), varus or valgus deformity and past injuries of the knee were excluded from the study. A 3-Tesla MR device was used to study the relationship between the shape of the lateral meniscus (using slope angle, meniscus-cartilage height and meniscus-bone angle) and the risk of extrusion. Analysis revealed that with values of slope angle and meniscus-bone angle increasing by one degree, the risk of meniscus extrusion raises by 1.157 and 1.078 respectively. Also, an increase in meniscus-cartilage height by 1 mm significantly elevates the risk of extrusion. At the same time it was demonstrated that for meniscus-bone angle values over 42 degrees and slope angle over 37 degrees the risk of extrusion increases significantly. This was the first study to demonstrate a tight correlation between slope angle, meniscus-bone angle and meniscus-cartilage height values in the assessment of the risk of lateral meniscus extrusion. Insertion of the above parameters to the radiological assessment of the knee joint allows identification of patients characterized by an elevated risk of development of this pathology.

  19. Gene Expression in Human Meniscal Tears has Limited Association with Early Degenerative Changes in Knee Articular Cartilage

    PubMed Central

    Brophy, Robert H.; Sandell, Linda J.; Cheverud, James M.; Rai, Muhammad Farooq

    2018-01-01

    Purpose/Aim Meniscus tears are a common injury to the knee associated with the development of osteoarthritis. Gene expression in the injured meniscus may be associated with early degeneration in the articular cartilage. The purpose of this study was to test the hypothesis that gene expression in meniscus tears is associated with early degenerative changes in the articular cartilage at the time of partial meniscectomy. Materials and Methods Torn meniscus was removed at the time of partial meniscectomy in 63 patients without radiographic osteoarthritis. Meniscal mRNA expression was measured by quantitative PCR for multiple molecular markers of osteoarthritis and cartilage homeostasis. The presence of early degenerative changes in the knee was recorded by X-ray (N=63), magnetic resonance imaging (MRI, N=48) and arthroscopy (N=63). Gene expression was tested for correlation with the presence/absence of degenerative changes after adjusting for age, sex and body mass index. Results Overall gene expression varied significantly with degenerative changes based on X-ray (P=0.047) and MRI (P=0.018). The linear combination of gene variation was also significant. However, only adiponectin (ADIPOQ) (P=0.015) was expressed at a significantly lower level in patients with chondrosis on MRI while the expression of ADIPOQ (P=0.035) and resistin (RETN) (P=0.017) was higher in patients with early degenerative changes on X-ray. Conclusions There is an overall association of gene expression in meniscal tears to early degenerative changes in the knee, but only a limited number of specific genes demonstrate this relationship. The roles of adiponectin and resistin in knee injury and osteoarthritis deserve further study. PMID:27435997

  20. The triple PCL sign: bucket handle tears of both medial and lateral menisci in a chronically ACL-deficient knee.

    PubMed

    Kakel, Rafid; Russell, Robert; VanHeerden, Pieter

    2010-10-11

    Bucket handle tears of both menisci in the setting of acute or chronic anterior cruciate ligament (ACL) tears of the same knee have rarely been reported in the literature. This article presents a case of a bucket handle tear affecting both the medial and lateral menisci in a patient with chronic ACL rupture. Both bucket handle tears were displaced and locked in the intercondylar notch. A new magnetic resonance image (MRI) sign suggested on sagittal view is called the triple PCL sign, comprising the intact posterior cruciate ligament (PCL) and the 2 displaced fragments in the intercondylar notch from the two bucket handle tears. The precise diagnosis of this condition is of obvious importance for optimal operative planning. While finding the displaced fragment from the medial meniscus is expected to cause the double PCL sign, the torn ACL may have made it easier to visualize the bucket handle tear of the lateral meniscus in the same sagittal plane as the PCL. Only 5 other reports mention bimeniscal bucket handle tears of both the medial and lateral menisci in association with an ACL tear. None have shown the suggested triple PCL sign because of lack of overlap between the 2 bucket handle tears in the coronal plane while lying in the intercondylar notch causing them not to fall in the same sagittal plane. Our patient showed some overlap between the 2 meniscal fragments while lying in the notch to create the triple PCL sign on sagittal MRI. Copyright 2010, SLACK Incorporated.

  1. New testing options for diagnosing and grading dry eye disease.

    PubMed

    Foulks, Gary N; Pflugfelder, Stephen C

    2014-06-01

    To describe new options for diagnosis and severity grading of dry eye disease. Perspective on technological advancements to identify tear dysfunction and their value in diagnosing and grading dry eye disease. Evidence is presented on new and evolving technologies to measure tear stability, composition, and meniscus height and their role in dry eye diagnosis and therapeutic efficacy grading is assessed. Evolving concepts regarding pathogenesis and new technologies to evaluate the tears and ocular surface have improved the ability to diagnose, classify, and grade the severity of dry eye disease. New technologies include noninvasive imaging of tear stability and tear meniscus height as a measure of tear volume and tear composition (osmolarity, lacrimal factors, inflammatory mediators, growth and differentiation factors). Approved tests, such as tear osmolarity and tear imaging, are being integrated into clinical practice and may eventually supplant certain traditional tests that have greater variability and less sensitivity. Other tests, such as molecular assays of tears and conjunctival cells, are currently being used in studies investigating pathogenesis and therapeutic mechanism of action. They may eventually translate to routine clinical practice. New technologies have emerged that can noninvasively evaluate the tears and measure disease-associated compositional changes. These tests are being integrated into clinical practice and therapeutic trials for diagnosis, classification, and severity grading of dry eye disease. Copyright © 2014 Elsevier Inc. All rights reserved.

  2. Stem cell-based tissue-engineering for treatment of meniscal tears in the avascular zone.

    PubMed

    Zellner, Johannes; Hierl, Katja; Mueller, Michael; Pfeifer, Christian; Berner, Arne; Dienstknecht, Thomas; Krutsch, Werner; Geis, Sebastian; Gehmert, Sebastian; Kujat, Richard; Dendorfer, Sebastian; Prantl, Lukas; Nerlich, Michael; Angele, Peter

    2013-10-01

    Meniscal tears in the avascular zone have a poor self-healing potential, however partial meniscectomy predisposes the knee for early osteoarthritis. Tissue engineering with mesenchymal stem cells and a hyaluronan collagen based scaffold is a promising approach to repair meniscal tears in the avascular zone. 4 mm longitudinal meniscal tears in the avascular zone of lateral menisci of New Zealand White Rabbits were performed. The defect was left empty, sutured with a 5-0 suture or filled with a hyaluronan/collagen composite matrix without cells, with platelet rich plasma or with autologous mesenchymal stem cells. Matrices with stem cells were in part precultured in chondrogenic medium for 14 days prior to the implantation. Menisci were harvested at 6 and 12 weeks. The developed repair tissue was analyzed macroscopically, histologically and biomechanically. Untreated defects, defects treated with suture alone, with cell-free or with platelet rich plasma seeded implants showed a muted fibrous healing response. The implantation of stem cell-matrix constructs initiated fibrocartilage-like repair tissue, with better integration and biomechanical properties in the precultured stem cell-matrix group. A hyaluronan-collagen based composite scaffold seeded with mesenchymal stem cells is more effective in the repair avascular meniscal tear with stable meniscus-like tissue and to restore the native meniscus. Copyright © 2013 Wiley Periodicals, Inc., a Wiley Company.

  3. Effect of posterior cruciate ligament rupture on the radial displacement of lateral meniscus.

    PubMed

    Lei, Pengfei; Sun, Rongxin; Hu, Yihe; Li, Kanghua; Liao, Zhan

    2015-06-01

    The relationship between lateral meniscus tear and posterior cruciate ligament injury is not well understood. The present study aims to investigate and assess the effect of posterior cruciate ligament rupture on lateral meniscus radial displacement at different flexion angles under static loading conditions. Twelve fresh human cadaveric knee specimens were divided into four groups such as posterior cruciate ligament intact, anterolateral band rupture, posteromedial band rupture and posterior cruciate ligament complete rupture groups, according to the purpose and order of testing. Radial displacement of lateral meniscus was measured under different loads (200-1000N) at 0°, 30°, 60°, and 90° of knee flexion. Compared with posterior cruciate ligament intact group, the displacement values of lateral meniscus in anterolateral band rupture group increased at 0° flexion with 600N, 800N, and 1000N and at 30°, 60° and 90° flexion under all loading conditions. Posteromedial band rupture group exhibited higher displacement at 0° flexion under all loading conditions, at 30° and 60° flexion with 600, 800N and 1000N, and at 90° flexion with 400N, 600N, 800N, and 1000N than the posterior cruciate ligament intact group. The posterior cruciate ligament complete rupture group had a higher displacement value of lateral medial meniscus at 0°, 30°, 60° and 90° flexion under all loading conditions, as compared to the posterior cruciate ligament intact group. The study concludes that partial and complete rupture of the posterior cruciate ligament can trigger the increase of radial displacement on lateral meniscus. Copyright © 2015 Elsevier Ltd. All rights reserved.

  4. Posteromedial meniscal tears may be missed during anterior cruciate ligament reconstruction.

    PubMed

    Peltier, Adrien; Lording, Timothy D; Lustig, Sébastien; Servien, Elvire; Maubisson, Laurent; Neyret, Philippe

    2015-04-01

    This study aimed to assess the benefit of using an arthroscopic intercondylar view and a posterior medial viewing portal during anterior cruciate ligament (ACL) reconstruction in the diagnosis of posterior horn of the medial meniscus (PHMM) tears. A secondary objective was to determine clinical and radiological risk factors for the PHMM. Forty-one patients undergoing isolated ACL reconstruction were prospectively evaluated. At ACL reconstruction, the PHMM was assessed using a standard 30° arthroscope in 3 sequential stages: a "classic" anterolateral portal view, an intercondylar view, and a view through a posteromedial portal. Thirty-nine patients were included (12 female patients and 27 male patients). A posteromedial tear of the medial meniscus was found in 17 patients using the anterolateral portal view. The intercondylar view identified 4 new additional lesions and extensions of 3 previously identified lesions. The posteromedial portal view identified 6 new lesions and 5 extensions of known lesions compared with the anterolateral portal view. Two lesions seen through the posteromedial portal were not identified by either the anterolateral portal view or the intercondylar view. Tears of the PHMM may be underdiagnosed by intraoperative assessment using only an anterolateral portal view during ACL reconstruction. The intercondylar view combined with a posteromedial portal aids in the diagnosis of PHMM tears and should be considered in routine ACL reconstruction to assess meniscal status, particularly when the interval from injury to surgery is prolonged. Level IV, therapeutic case series. Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  5. A new aiming guide can create the tibial tunnel at favorable position in transtibial pullout repair for the medial meniscus posterior root tear.

    PubMed

    Furumatsu, T; Kodama, Y; Fujii, M; Tanaka, T; Hino, T; Kamatsuki, Y; Yamada, K; Miyazawa, S; Ozaki, T

    2017-05-01

    Injuries to the medial meniscus (MM) posterior root lead to accelerated cartilage degeneration of the knee. An anatomic placement of the MM posterior root attachment is considered to be critical in transtibial pullout repair of the medial meniscus posterior root tear (MMPRT). However, tibial tunnel creation at the anatomic attachment of the MM posterior root is technically difficult using a conventional aiming device. The aim of this study was to compare two aiming guides. We hypothesized that a newly-developed guide, specifically designed, creates the tibial tunnel at an adequate position rather than a conventional device. Twenty-six patients underwent transtibial pullout repairs. Tibial tunnel creation was performed using the Multi-use guide (8 cases) or the PRT guide that had a narrow twisting/curving shape (18 cases). Three-dimensional computed tomography images of the tibial surface were evaluated using the Tsukada's measurement method postoperatively. Expected anatomic center of the MM posterior root attachment and tibial tunnel center were evaluated using the percentage-based posterolateral location on the tibial surface. Percentage distance between anatomic center and tunnel center was calculated. Anatomic center of the MM posterior root footprint located at a position of 78.5% posterior and 39.4% lateral. Both tunnels were anteromedial but tibial tunnel center located at a more favorable position in the PRT group: percentage distance was significantly smaller in the PRT guide group (8.7%) than in the Multi-use guide group (13.1%). The PRT guide may have great advantage to achieve a more anatomic location of the tibial tunnel in MMPRT pullout repair. III. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  6. The Relationship between Chondromalacia Patella, Medial Meniscal Tear and Medial Periarticular Bursitis in Patients with Osteoarthritis.

    PubMed

    Resorlu, Mustafa; Doner, Davut; Karatag, Ozan; Toprak, Canan Akgun

    2017-12-01

    This study investigated the presence of bursitis in the medial compartment of the knee (pes anserine, semimembranosus-tibial collateral ligament, and medial collateral ligament bursa) in osteoarthritis, chondromalacia patella and medial meniscal tears. Radiological findings of 100 patients undergoing magnetic resonance imaging with a preliminary diagnosis of knee pain were retrospectively evaluated by two radiologists. The first radiologist assessed all patients in terms of osteoarthritis, chondromalacia patella and medial meniscal tear. The second radiologist was blinded to these results and assessed the presence of bursitis in all patients. Mild osteoarthritis (grade I and II) was determined in 55 patients and severe osteoarthritis (grade III and IV) in 45 cases. At retropatellar cartilage evaluation, 25 patients were assessed as normal, while 29 patients were diagnosed with mild chondromalacia patella (grade I and II) and 46 with severe chondromalacia patella (grade III and IV). Medial meniscus tear was determined in 51 patients. Severe osteoarthritis and chondromalacia patella were positively correlated with meniscal tear (p < 0.001 and p = 0.018, respectively). Significant correlation was observed between medial meniscal tear and bursitis in the medial compartment (p = 0.038). Presence of medial periarticular bursitis was positively correlated with severity of osteoarthritis but exhibited no correlation with chondromalacia patella (p = 0.023 and p = 0.479, respectively). Evaluation of lateral compartment bursae revealed lateral collateral ligament bursitis in 2 patients and iliotibial bursitis in 5 patients. We observed a greater prevalence of bursitis in the medial compartment of the knee in patients with severe osteoarthritis and medial meniscus tear.

  7. Riboflavin-induced photo-crosslinking of collagen hydrogel and its application in meniscus tissue engineering.

    PubMed

    Heo, Jiseung; Koh, Rachel H; Shim, Whuisu; Kim, Hwan D; Yim, Hyun-Gu; Hwang, Nathaniel S

    2016-04-01

    A meniscus tear is a common knee injury, but its regeneration remains a clinical challenge. Recently, collagen-based scaffolds have been applied in meniscus tissue engineering. Despite its prevalence, application of natural collagen scaffold in clinical setting is limited due to its extremely low stiffness and rapid degradation. The purpose of the present study was to increase the mechanical properties and delay degradation rate of a collagen-based scaffold by photo-crosslinking using riboflavin (RF) and UV exposure. RF is a biocompatible vitamin B2 that showed minimal cytotoxicity compared to conventionally utilized photo-initiator. Furthermore, collagen photo-crosslinking with RF improved mechanical properties and delayed enzyme-triggered degradation of collagen scaffolds. RF-induced photo-crosslinked collagen scaffolds encapsulated with fibrochondrocytes resulted in reduced scaffold contraction and enhanced gene expression levels for the collagen II and aggrecan. Additionally, hyaluronic acid (HA) incorporation into photo-crosslinked collagen scaffold showed an increase in its retention. Based on these results, we demonstrate that photo-crosslinked collagen-HA hydrogels can be potentially applied in the scaffold-based meniscus tissue engineering.

  8. Randomized Controlled Study to Investigate the Effect of Topical Diquafosol Tetrasodium on Corneal Sensitivity in Short Tear Break-Up Time Dry Eye.

    PubMed

    Kaido, Minako; Kawashima, Motoko; Shigeno, Yuta; Yamada, Yoshiaki; Tsubota, Kazuo

    2018-05-01

    Complex mechanisms underlie dry eye (DE) symptom provocation. In particular, corneal hypersensitivity may provoke symptoms in short tear break-up time (BUT) DE characterized by tear film instability. We hypothesized that improved tear film stability may alleviate corneal sensitivity in patients with short tear BUT DE. Therefore, we investigated the effect of topical diquafosol tetrasodium (DQS) on corneal sensitivity in unstable tear film DE. This prospective, randomized study included 27 subjects (age: 39.1 ± 8.4 years; range: 25-59 years) with short tear BUT DE, defined based on the presence of DE symptoms and tear film instability. Subjects were randomly divided into DQS (3% DQS, 12 subjects) and artificial tear (AT; preservative-free AT, 15 subjects) groups. Subjects applied the medication 6 times a day for 5 weeks. The perception of touch (S-touch) and pain (S-pain) sensitivity was measured using a Cochet-Bonnet esthesiometer. Tear evaluation, corneal sensitivity, and DE symptoms were compared before and after DQS or AT administration. The correlation between the improvement degrees of corneal sensitivity and DE symptoms following medication was analyzed. DQS significantly improved tear BUT and tear meniscus height (TMH) scores (p < 0.05), while AT significantly improved tear BUT (p < 0.05) but not TMH score. Mean S-pain and DE symptom scores were lower after medication use in the DQS (S-pain and DE symptoms: p  < 0.05) and AT groups (S-pain: p  = 0.05; DE symptoms: p  < 0.05). However, S-touch did not change significantly in either group. A positive correlation was observed between the improvement degrees of S-pain and DE symptoms in the overall subjects studied. Both DQS and AT alleviate corneal hypersensitivity and DE symptoms in eyes with short tear BUT DE. However, DQS seems to be more effective to adjust tear environment, leading to the normalization of corneal sensitivity and DE symptoms. UMIN Clinical Trials Registry

  9. Societal and Economic Effect of Meniscus Scaffold Procedures for Irreparable Meniscus Injuries.

    PubMed

    Rongen, Jan J; Govers, Tim M; Buma, Pieter; Grutters, Janneke P C; Hannink, Gerjon

    2016-07-01

    Meniscus scaffolds are currently evaluated clinically for their efficacy in preventing the development of osteoarthritis as well as for their efficacy in treating patients with chronic symptoms. Procedural costs, therapeutic consequences, clinical efficacy, and future events should all be considered to maximize the monetary value of this intervention. To examine the socioeconomic effect of treating patients with irreparable medial meniscus injuries with a meniscus scaffold. Economic and decision analysis; Level of evidence, 2. Two Markov simulation models for patients with an irreparable medial meniscus injury were developed. Model 1 was used to investigate the lifetime cost-effectiveness of a meniscus scaffold compared with standard partial meniscectomy by the possibility of preventing the development of osteoarthritis. Model 2 was used to investigate the short-term (5-year) cost-effectiveness of a meniscus scaffold compared with standard partial meniscectomy by alleviating clinical symptoms, specifically in chronic patients with previous meniscus surgery. For both models, probabilistic Monte Carlo simulations were applied. Treatment effectiveness was expressed as quality-adjusted life-years (QALYs), while costs (estimated in euros) were assessed from a societal perspective. We assumed €20,000 as a reference value for the willingness to pay per QALY. Next, comprehensive sensitivity analyses were performed to identify the most influential variables on the cost-effectiveness of meniscus scaffolds. Model 1 demonstrated an incremental cost-effectiveness ratio of a meniscus scaffold treatment of €54,463 per QALY (€5991/0.112). A threshold analysis demonstrated that a meniscus scaffold should offer a relative risk reduction of at least 0.34 to become cost-effective, assuming a willingness to pay of €20,000. Decreasing the costs of the meniscus scaffold procedure by 33% (€10,160 instead of €15,233; an absolute change of €5073) resulted in an incremental

  10. A Computer-Aided Type-II Fuzzy Image Processing for Diagnosis of Meniscus Tear.

    PubMed

    Zarandi, M H Fazel; Khadangi, A; Karimi, F; Turksen, I B

    2016-12-01

    Meniscal tear is one of the prevalent knee disorders among young athletes and the aging population, and requires correct diagnosis and surgical intervention, if necessary. Not only the errors followed by human intervention but also the obstacles of manual meniscal tear detection highlight the need for automatic detection techniques. This paper presents a type-2 fuzzy expert system for meniscal tear diagnosis using PD magnetic resonance images (MRI). The scheme of the proposed type-2 fuzzy image processing model is composed of three distinct modules: Pre-processing, Segmentation, and Classification. λ-nhancement algorithm is used to perform the pre-processing step. For the segmentation step, first, Interval Type-2 Fuzzy C-Means (IT2FCM) is applied to the images, outputs of which are then employed by Interval Type-2 Possibilistic C-Means (IT2PCM) to perform post-processes. Second stage concludes with re-estimation of "η" value to enhance IT2PCM. Finally, a Perceptron neural network with two hidden layers is used for Classification stage. The results of the proposed type-2 expert system have been compared with a well-known segmentation algorithm, approving the superiority of the proposed system in meniscal tear recognition.

  11. Conservative treatment of torn medial meniscus via mechanical force, manually assisted short lever chiropractic adjusting procedures.

    PubMed

    Polkinghorn, B S

    1994-09-01

    To present the first reported case of successful chiropractic intervention in treatment of a torn medial meniscus of the knee, the meniscal tear being documented by magnetic resonance imaging (MRI). A 54-yr-old woman complaining of right knee pain of several months' duration with accompanying marked functional impairment was diagnosed as having a tear in the posterior horn of the ipsilateral medial meniscus, verified by MRI studies of the same. Independent consultation with three medical specialists resulted in the unanimous decision that surgical intervention for the purpose of meniscectomy provided the only therapeutic approach indicated for the problem. However, the patient was reticent to undergo said surgical procedure and chose, instead, to utilize chiropractic care and conservative management in an effort to resolve her condition without having to resort to surgery. The patient received chiropractic treatment to the knee via mechanical force, manually assisted short lever chiropractic adjusting procedures (MFMA) utilizing an Activator Adjusting Instrument. Auxiliary treatment included the use of homeopathic therapy as an adjunct to chiropractic care. Said treatment resulted in a complete resolution of the patient's disability, the patient recovering full function of the knee joint and achieving an asymptomatic status without having to submit to surgical intervention and its possible adverse sequelae. Conservative management of meniscal tears via chiropractic treatment may provide a therapeutically effective and financially cost containing alternative to routine meniscectomy in certain cases involving torn medial menisci of the knee.

  12. In-vivo evaluation of the kinematic behavior of an artificial medial meniscus implant: A pilot study using open-MRI.

    PubMed

    De Coninck, Tineke; Elsner, Jonathan J; Linder-Ganz, Eran; Cromheecke, Michiel; Shemesh, Maoz; Huysse, Wouter; Verdonk, René; Verstraete, Koenraad; Verdonk, Peter

    2014-09-01

    In this pilot study we wanted to evaluate the kinematics of a knee implanted with an artificial polycarbonate-urethane meniscus device, designed for medial meniscus replacement. The static kinematic behavior of the implant was compared to the natural medial meniscus of the non-operated knee. A second goal was to evaluate the motion pattern, the radial displacement and the deformation of the meniscal implant. Three patients with a polycarbonate-urethane implant were included in this prospective study. An open-MRI was used to track the location of the implant during static weight-bearing conditions, within a range of motion of 0° to 120° knee flexion. Knee kinematics were evaluated by measuring the tibiofemoral contact points and femoral roll-back. Meniscus measurements (both natural and artificial) included anterior-posterior meniscal movement, radial displacement, and meniscal height. No difference (P>0.05) was demonstrated in femoral roll-back and tibiofemoral contact points during knee flexion between the implanted and the non-operated knees. Meniscal measurements showed no significant difference in radial displacement and meniscal height (P>0.05) at all flexion angles, in both the implanted and non-operated knees. A significant difference (P ≤ 0.05) in anterior-posterior movement during flexion was observed between the two groups. In this pilot study, the artificial polycarbonate-urethane implant, indicated for medial meniscus replacement, had no influence on femoral roll-back and tibiofemoral contact points, thus suggesting that the joint maintains its static kinematic properties after implantation. Radial displacement and meniscal height were not different, but anterior-posterior movement was slightly different between the implant and the normal meniscus. Copyright © 2014 Elsevier Ltd. All rights reserved.

  13. Tear film dynamics with evaporation, wetting, and time-dependent flux boundary condition on an eye-shaped domain

    PubMed Central

    Li, Longfei; Braun, R. J.; Maki, K. L.; Henshaw, W. D.; King-Smith, P. E.

    2014-01-01

    We study tear film dynamics with evaporation on a wettable eye-shaped ocular surface using a lubrication model. The mathematical model has a time-dependent flux boundary condition that models the cycles of tear fluid supply and drainage; it mimics blinks on a stationary eye-shaped domain. We generate computational grids and solve the nonlinear governing equations using the OVERTURE computational framework. In vivo experimental results using fluorescent imaging are used to visualize the influx and redistribution of tears for an open eye. Results from the numerical simulations are compared with the experiment. The model captures the flow around the meniscus and other dynamic features of human tear film observed in vivo. PMID:24926191

  14. Force measurements in the medial meniscus posterior horn attachment: effects of anterior cruciate ligament removal.

    PubMed

    Markolf, Keith L; Jackson, Steven R; McAllister, David R

    2012-02-01

    Tears of the medial meniscus posterior horn attachment (PHA) occur clinically, and an anterior cruciate ligament (ACL)-deficient knee may be more vulnerable to this injury. The PHA forces from applied knee loadings will increase after removal of the ACL. Controlled laboratory study. A cap of bone containing the medial meniscus PHA was attached to a load cell that measured PHA tensile force. Posterior horn attachment forces were recorded before and after ACL removal during anteroposterior (AP) laxity testing at ±200 N and during passive knee extension tests with 5 N·m tibial torque and varus-valgus moment. Selected tests were also performed with 500 N joint load. For AP tests with no joint load, ACL removal increased laxity between 0° and 90° and increased PHA force generated by applied anterior tibial force between 30° and 90°. For AP tests with an intact ACL, application of joint load approximately doubled PHA forces. Anteroposterior testing of ACL-deficient knees was not possible with joint load because of bone cap failures from high PHA forces. Removal of the ACL during knee extension tests under joint load significantly increased PHA forces between 20° and 90° of flexion. For unloaded tests with applied tibial torque and varus-valgus moment, ACL removal had no significant effect on PHA forces. Applied anterior tibial force and external tibial torque were loading modes that produced relatively high PHA forces, presumably by impingement of the medial femoral condyle against the medial meniscus posterior horn rim. Under joint load, an ACL-deficient knee was particularly susceptible to PHA injury from applied anterior tibial force. Because tensile forces developed in the PHA are also borne by meniscus tissue near the attachment site, loading mechanisms that produce high PHA forces could also produce complete or partial radial tears near the posterior horn, a relatively common clinical observation.

  15. The Relationship between Chondromalacia Patella, Medial Meniscal Tear and Medial Periarticular Bursitis in Patients with Osteoarthritis

    PubMed Central

    Doner, Davut; Karatag, Ozan; Toprak, Canan Akgun

    2017-01-01

    Abstract Background This study investigated the presence of bursitis in the medial compartment of the knee (pes anserine, semimembranosus-tibial collateral ligament, and medial collateral ligament bursa) in osteoarthritis, chondromalacia patella and medial meniscal tears. Patients and methods Radiological findings of 100 patients undergoing magnetic resonance imaging with a preliminary diagnosis of knee pain were retrospectively evaluated by two radiologists. The first radiologist assessed all patients in terms of osteoarthritis, chondromalacia patella and medial meniscal tear. The second radiologist was blinded to these results and assessed the presence of bursitis in all patients. Results Mild osteoarthritis (grade I and II) was determined in 55 patients and severe osteoarthritis (grade III and IV) in 45 cases. At retropatellar cartilage evaluation, 25 patients were assessed as normal, while 29 patients were diagnosed with mild chondromalacia patella (grade I and II) and 46 with severe chondromalacia patella (grade III and IV). Medial meniscus tear was determined in 51 patients. Severe osteoarthritis and chondromalacia patella were positively correlated with meniscal tear (p < 0.001 and p = 0.018, respectively). Significant correlation was observed between medial meniscal tear and bursitis in the medial compartment (p = 0.038). Presence of medial periarticular bursitis was positively correlated with severity of osteoarthritis but exhibited no correlation with chondromalacia patella (p = 0.023 and p = 0.479, respectively). Evaluation of lateral compartment bursae revealed lateral collateral ligament bursitis in 2 patients and iliotibial bursitis in 5 patients. Conclusions We observed a greater prevalence of bursitis in the medial compartment of the knee in patients with severe osteoarthritis and medial meniscus tear. PMID:29333118

  16. Physicians’ accuracy and interrator reliability for the diagnosis of unstable meniscal tears in patients having osteoarthritis of the knee

    PubMed Central

    Dervin, Geoffrey F.; Stiell, Ian G.; Wells, George A.; Rody, Kelly; Grabowski, Jenny

    2001-01-01

    Objective To determine clinicians’ accuracy and reliability for the clinical diagnosis of unstable meniscus tears in patients with symptomatic osteoarthritis of the knee. Design A prospective cohort study. Setting A single tertiary care centre. Patients One hundred and fifty-two patients with symptomatic osteoarthritis of the knee refractory to conservative medical treatment were selected for prospective evaluation of arthroscopic débridement. Intervention Arthroscopic débridement of the knee, including meniscal tear and chondral flap resection, without abrasion arthroplasty. Outcome measures A standardized assessment protocol was administered to each patient by 2 independent observers. Arthroscopic determination of unstable meniscal tears was recorded by 1 observer who reviewed a video recording and was blinded to preoperative data. Those variables that had the highest interobserver agreement and the strongest association with meniscal tear by univariate methods were entered into logistic regression to model the best prediction of resectable tears. Results There were 92 meniscal tears (77 medial, 15 lateral). Interobserver agreement between clinical fellows and treating surgeons was poor to fair (κ < 0.4) for all clinical variables except radiographic measures, which were good. Fellows and surgeons predicted unstable meniscal tear preoperatively with equivalent accuracy of 60%. Logistic regression modelling revealed that a history of swelling and a ballottable effusion were negative predictors. A positive McMurray test was the only positive predictor of unstable meniscal tear. “Mechanical” symptoms were not reliable predictors in this prospective study. The model was 69% accurate for all patients and 76% for those with advanced medial compartment osteoarthritis defined by a joint space height of 2 mm or less. Conclusions This study underscored the difficulty in using clinical variables to predict unstable medial meniscal tears in patients with pre

  17. Medial Meniscus Root Tear in the Middle Aged Patient: A Case Based Review

    PubMed Central

    Carreau, Joseph H.

    2017-01-01

    Abstract Biomechanical studies have shown that medial meniscal root tears result in meniscal extrusion and increased tibiofemoral joint contact pressures, which can accelerate the progression of arthritis. Repair is generally recommended for acute injuries in the young, active patient population. The far more common presentation however, is a subacute root tear with medial meniscal extrusion in a middle aged patient. Coexisting arthritis is common in this population and complicates decision making. Treatment should be based on the severity of the underlying arthritis. In cases of early or minimal arthritis, root repair is ideal to improve symptoms and restore meniscal function. In patients with moderate or severe medial compartment arthritis, medial unloader bracing or injections can be tried initially. When non-operative treatment fails, high tibial osteotomy or arthroplasty is recommended. Long term clinical studies are needed to determine the natural history of medial meniscal root tears in middle aged patients and the best surgical option. PMID:28852346

  18. Fatigue Life of Bovine Meniscus under Longitudinal and Transverse Tensile Loading

    PubMed Central

    Creechley, Jaremy J.; Krentz, Madison E.; Lujan, Trevor J.

    2017-01-01

    The knee meniscus is composed of a fibrous matrix that is subjected to large and repeated loads. Consequently, the meniscus is frequently torn, and a potential mechanism for failure is fatigue. The objective of this study was to measure the fatigue life of bovine meniscus when applying cyclic tensile loads either longitudinal or transverse to the principal fiber direction. Fatigue experiments consisted of cyclic loads to 60, 70, 80 or 90% of the predicted ultimate tensile strength until failure occurred or 20,000 cycles was reached. The fatigue data in each group was fit with a Weibull distribution to generate plots of stress level vs. cycles to failure (S-N curve). Results showed that loading transverse to the principal fiber direction gave a two-fold increase in failure strain, a three-fold increase in creep, and a nearly four-fold increase in cycles to failure (not significant), compared to loading longitudinal to the principal fiber direction. The S-N curves had strong negative correlations between the stress level and the mean cycles to failure for both loading directions, where the slope of the transverse S-N curve was 11% less than the longitudinal S-N curve (longitudinal: S=108–5.9ln(N); transverse: S=112–5.2ln(N)). Collectively, these results suggest that the non-fibrillar matrix is more resistant to fatigue failure than the collagen fibers. Results from this study are relevant to understanding the etiology of atraumatic radial and horizontal meniscal tears, and can be utilized by research groups that are working to develop meniscus implants with fatigue properties that mimic healthy tissue. PMID:28088070

  19. A Current Review of the Meniscus Imaging: Proposition of a Useful Tool for Its Radiologic Analysis

    PubMed Central

    Lefevre, Nicolas; Naouri, Jean Francois; Herman, Serge; Gerometta, Antoine; Klouche, Shahnaz; Bohu, Yoann

    2016-01-01

    The main objective of this review was to present a synthesis of the current literature in order to provide a useful tool to clinician in radiologic analysis of the meniscus. All anatomical descriptions were clearly illustrated by MRI, arthroscopy, and/or drawings. The value of standard radiography is extremely limited for the assessment of meniscal injuries but may be indicated to obtain a differential diagnosis such as osteoarthritis. Ultrasound is rarely used as a diagnostic tool for meniscal pathologies and its accuracy is operator-dependent. CT arthrography with multiplanar reconstructions can detect meniscus tears that are not visible on MRI. This technique is also useful in case of MRI contraindications, in postoperative assessment of meniscal sutures and the condition of cartilage covering the articular surfaces. MRI is the most accurate and less invasive method for diagnosing meniscal lesions. MRI allows confirming and characterizing the meniscal lesion, the type, the extension, its association with a cyst, the meniscal extrusion, and assessing cartilage and subchondral bone. New 3D-MRI in three dimensions with isotropic resolution allows the creation of multiplanar reformatted images to obtain from an acquisition in one sectional plane reconstructions in other spatial planes. 3D MRI should further improve the diagnosis of meniscal tears. PMID:27057352

  20. Longitudinal change in quantitative meniscus measurements in knee osteoarthritis--data from the Osteoarthritis Initiative.

    PubMed

    Bloecker, Katja; Wirth, W; Guermazi, A; Hitzl, W; Hunter, D J; Eckstein, F

    2015-10-01

    We aimed to apply 3D MRI-based measurement technology to studying 2-year change in quantitative measurements of meniscus size and position. Forty-seven knees from the Osteoarthritis Initiative with medial radiographic joint space narrowing had baseline and 2-year follow-up MRIs. Quantitative measures were obtained from manual segmentation of the menisci and tibia using coronal DESSwe images. The standardized response mean (SRM = mean/SD change) was used as measure of sensitivity to longitudinal change. Medial tibial plateau coverage decreased from 34.8% to 29.9% (SRM -0.82; p < 0.001). Change in medial meniscus extrusion in a central image (SRM 0.18) and in the central five slices (SRM 0.22) did not reach significance, but change in extrusion across the entire meniscus (SRM 0.32; p = 0.03) and in the relative area of meniscus extrusion (SRM 0.56; p < 0.001) did. There was a reduction in medial meniscus volume (10%; p < 0.001), width (7%; p < 0.001), and height (2%; p = 0.08); meniscus substance loss was strongest in the posterior (SRM -0.51; p = 0.001) and weakest in the anterior horn (SRM -0.15; p = 0.31). This pilot study reports, for the first time, longitudinal change in quantitative 3D meniscus measurements in knee osteoarthritis. It provides evidence of improved sensitivity to change of 3D measurements compared with single slice analysis. • First longitudinal MRI-based measurements of change of meniscus position and size. • Quantitative longitudinal evaluation of meniscus change in knee osteoarthritis. • Improved sensitivity to change of 3D measurements compared with single slice analysis.

  1. A Prospective, Randomized, Double-Blind, Parallel-Group, Placebo-Controlled Study Evaluating Meniscal Healing, Clinical Outcomes, and Safety in Patients Undergoing Meniscal Repair of Unstable, Complete Vertical Meniscal Tears (Bucket Handle) Augmented with Platelet-Rich Plasma.

    PubMed

    Kaminski, Rafal; Kulinski, Krzysztof; Kozar-Kaminska, Katarzyna; Wielgus, Monika; Langner, Maciej; Wasko, Marcin K; Kowalczewski, Jacek; Pomianowski, Stanislaw

    2018-01-01

    The present study aimed to investigate the effectiveness and safety of platelet-rich plasma (PRP) application in arthroscopic repair of complete vertical tear of meniscus located in the red-white zone. This single center, prospective, randomized, double-blind, placebo-controlled, parallel-arm study included 37 patients with complete vertical meniscus tears. Patients received an intrarepair site injection of either PRP or sterile 0.9% saline during an index arthroscopy. The primary endpoint was the rate of meniscus healing in the two groups. The secondary endpoints were changes in the International Knee Documentation Committee (IKDC) score, Knee Injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and analog scale (VAS) in the two groups at 42 months. After 18 weeks, the meniscus healing rate was significantly higher in the PRP-treated group than in the control group (85% versus 47%, P = 0.048). Functional outcomes were significantly better 42 months after treatment than at baseline in both groups. The IKDC score, WOMAC, and KOOS were significantly better in the PRP-treated group than in the control group. No adverse events were reported during the study period. The findings of this study indicate that PRP augmentation in meniscus repair results in improvements in both meniscus healing and functional outcome.

  2. Ultrasound Assessment of Human Meniscus.

    PubMed

    Viren, Tuomas; Honkanen, Juuso T; Danso, Elvis K; Rieppo, Lassi; Korhonen, Rami K; Töyräs, Juha

    2017-09-01

    The aim of the present study was to evaluate the applicability of ultrasound imaging to quantitative assessment of human meniscus in vitro. Meniscus samples (n = 26) were harvested from 13 knee joints of non-arthritic human cadavers. Subsequently, three locations (anterior, center and posterior) from each meniscus were imaged with two ultrasound transducers (frequencies 9 and 40 MHz), and quantitative ultrasound parameters were determined. Furthermore, partial-least-squares regression analysis was applied for ultrasound signal to determine the relations between ultrasound scattering and meniscus integrity. Significant correlations between measured and predicted meniscus compositions and mechanical properties were obtained (R 2  = 0.38-0.69, p < 0.05). The relationship between conventional ultrasound parameters and integrity of the meniscus was weaker. To conclude, ultrasound imaging exhibited a potential for evaluation of meniscus integrity. Higher ultrasound frequency combined with multivariate analysis of ultrasound backscattering was found to be the most sensitive for evaluation of meniscus integrity. Copyright © 2017 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

  3. Modeling meniscus rise in capillary tubes using fluid in rigid-body motion approach

    NASA Astrophysics Data System (ADS)

    Hamdan, Mohammad O.; Abu-Nabah, Bassam A.

    2018-04-01

    In this study, a new term representing net flux rate of linear momentum is introduced to Lucas-Washburn equation. Following a fluid in rigid-body motion in modeling the meniscus rise in vertical capillary tubes transforms the nonlinear Lucas-Washburn equation to a linear mass-spring-damper system. The linear nature of mass-spring-damper system with constant coefficients offers a nondimensional analytical solution where meniscus dynamics are dictated by two parameters, namely the system damping ratio and its natural frequency. This connects the numerous fluid-surface interaction physical and geometrical properties to rather two nondimensional parameters, which capture the underlying physics of meniscus dynamics in three distinct cases, namely overdamped, critically damped, and underdamped systems. Based on experimental data available in the literature and the understanding meniscus dynamics, the proposed model brings a new approach of understanding the system initial conditions. Accordingly, a closed form relation is produced for the imbibition velocity, which equals half of the Bosanquet velocity divided by the damping ratio. The proposed general analytical model is ideal for overdamped and critically damped systems. While for underdamped systems, the solution shows fair agreement with experimental measurements once the effective viscosity is determined. Moreover, the presented model shows meniscus oscillations around equilibrium height occur if the damping ratio is less than one.

  4. Oxidative Stress Measures of Lipid and DNA Damage in Human Tears.

    PubMed

    Haworth, Kristina M; Chandler, Heather L

    2017-05-01

    We evaluate feasibility and repeatability of measures for lipid peroxidation and DNA oxidation in human tears, as well as relationships between outcome variables, and compared our findings to previously reported methods of evaluation for ocular sun exposure. A total of 50 volunteers were seen for 2 visits 14 ± 2 days apart. Tear samples were collected from the inferior tear meniscus using a glass microcapillary tube. Oxidative stress biomarkers were quantified using enzyme-linked immunosorbent assay (ELISA): lipid peroxidation by measurement of hexanoyl-lysine (HEL) expression; DNA oxidation by measurement of 8-oxo-2'-deoxyguinosone (8OHdG) expression. Descriptive statistics were generated. Repeatability estimates were made using Bland-Altman plots with mean differences and 95% limits of agreement were calculated. Linear regression was conducted to evaluate relationships between measures. Mean (±SD) values for tear HEL and 8OHdG expression were 17368.02 (±9878.42) nmol/L and 66.13 (±19.99) ng/mL, respectively. Repeatability was found to be acceptable for both HEL and 8OHdG expression. Univariate linear regression supported tear 8OHdG expression and spring season of collection to be predictors of higher tear HEL expression; tear HEL expression was confirmed as a predictor of higher tear 8OHdG expression. We demonstrate feasibility and repeatability of estimating previously unreported tear 8OHdG expression. Seasonal temperature variation and other factors may influence tear lipid peroxidation. Support is demonstrated to suggest lipid damage and DNA damage occur concurrently on the human ocular surface.

  5. The Meniscus: Review of Basic Principles With Application to Surgery and Rehabilitation

    PubMed Central

    Brindle, Timothy; Johnson, Darren L.

    2001-01-01

    Objective: To review basic meniscal anatomy, histology, and biomechanical principles as they apply to surgery and rehabilitation. Data Sources: We searched MEDLINE and CINAHL for the years 1960–1999 using the terms meniscus, surgery, rehabilitation, meniscal repair, and arthroscopy. Data Synthesis: Injuries to a healthy meniscus are usually produced by a compressive force coupled with transverse-plane tibiofemoral rotation as the knee moves from flexion to extension during rapid cutting or pivoting. The goal of meniscal surgery is to restore a functional meniscus to prevent the development of degenerative osteoarthritis in the involved knee. The goal of rehabilitation is to restore patient function based on individual needs, considering the type of surgical procedure, which meniscus was repaired, the presence of coexisting knee pathology (particularly ligamentous laxity or articular cartilage degeneration), the type of meniscal tear, the patient's age, preoperative knee status (including time between injury and surgery), decreased range of motion or strength, and the patient's athletic expectations and motivations. Progressive weight bearing and joint stress are necessary to enhance the functionality of the meniscal repair; however, excessive shear forces may be disruptive. Prolonged knee immobilization after surgery can result in the rapid development of muscular atrophy and greater delays in functional recovery. Conclusions/Recommendations: Accelerated joint mobility and weight-bearing components of rehabilitation protocols represent the confidence placed in innovative surgical fixation methods. After wound healing, an aquatic therapy environment may be ideal during all phases of rehabilitation after meniscal surgery (regardless of the exact procedure), providing the advantages of controlled weight bearing and mobility progressions. Well-designed, controlled, longitudinal outcome studies for patients who have undergone meniscectomy, meniscal repair, or meniscal

  6. A novel hypothesis: The application of platelet-rich plasma can promote the clinical healing of white-white meniscal tears

    PubMed Central

    Wei, Li-Cheng; Gao, Shu-Guang; Xu, Mai; Jiang, Wei; Tian, Jian; Lei, Guang-Hua

    2012-01-01

    Summary The white-white tears (meniscus lesion completely in the avascular zone) are without blood supply and theoretically cannot heal. Basal research has demonstrated that menisci are unquestionably important in load bearing, load redistribution, shock absorption, joint lubrication and the stabilization of the knee joint. It has been proven that partial or all-meniscusectomy results in an accelerated degeneration of cartilage and an increased rate of early osteoarthritis. Knee surgeons must face the difficult decision of removing or, if possible, retaining the meniscus; if it is possible to retain the meniscus, surgeons must address the difficulties of meniscal healing. Some preliminary approaches have progressed to improve meniscal healing. However, the problem of promoting meniscal healing in the avascular area has not yet been resolved. The demanding nature of the approach as well as its low utility and efficacy has impeded the progress of these enhancement techniques. Platelet-rich plasma (PRP) is a platelet concentration derived from autologous blood. In recent years, PRP has been used widely in preclinical and clinical applications for bone regeneration and wound healing. Therefore, we hypothesize that the application of platelet-rich plasma for white-white meniscal tears will be a simple and novel technique of high utility in knee surgery. PMID:22847210

  7. Effect of partial and complete posterior cruciate ligament transection on medial meniscus: A biomechanical evaluation in a cadaveric model.

    PubMed

    Gao, Shu-Guang; Zhang, Can; Zhao, Rui-Bo; Liao, Zhan; Li, Yu-Sheng; Yu, Fang; Zeng, Chao; Luo, Wei; Li, Kang-Hua; Lei, Guang-Hua

    2013-09-01

    The relationship between medial meniscus tear and posterior cruciate ligament (PCL) injury has not been exactly explained. We studied to investigate the biomechanical effect of partial and complete PCL transection on different parts of medial meniscus at different flexion angles under static loading conditions. TWELVE FRESH HUMAN CADAVERIC KNEE SPECIMENS WERE DIVIDED INTO FOUR GROUPS: PCL intact (PCL-I), anterolateral bundle transection (ALB-T), posteromedial bundle transection (PMB-T) and PCL complete transection (PCL-T) group. Strain on the anterior horn, body part and posterior horn of medial meniscus were measured under different axial compressive tibial loads (200-800 N) at 0°, 30°, 60° and 90° knee flexion in each groups respectively. Compared with the PCL-I group, the PCL-T group had a higher strain on whole medial meniscus at 30°, 60° and 90° flexion in all loading conditions and at 0° flexion with 400, 600 and 800 N loads. In ALB-T group, strain on whole meniscus increased at 30°, 60° and 90° flexion under all loading conditions and at 0° flexion with 800 N only. PMB-T exihibited higher strain at 0° flexion with 400 N, 600 N and 800 N, while at 30° and 60° flexion with 800 N and at 90° flexion under all loading conditions. Partial PCL transection triggers strain concentration on medial meniscus and the effect is more pronounced with higher loading conditions at higher flexion angles.

  8. A Prospective, Randomized, Double-Blind, Parallel-Group, Placebo-Controlled Study Evaluating Meniscal Healing, Clinical Outcomes, and Safety in Patients Undergoing Meniscal Repair of Unstable, Complete Vertical Meniscal Tears (Bucket Handle) Augmented with Platelet-Rich Plasma

    PubMed Central

    Kulinski, Krzysztof; Kozar-Kaminska, Katarzyna; Wielgus, Monika; Langner, Maciej; Wasko, Marcin K.; Kowalczewski, Jacek; Pomianowski, Stanislaw

    2018-01-01

    Objective The present study aimed to investigate the effectiveness and safety of platelet-rich plasma (PRP) application in arthroscopic repair of complete vertical tear of meniscus located in the red-white zone. Methods This single center, prospective, randomized, double-blind, placebo-controlled, parallel-arm study included 37 patients with complete vertical meniscus tears. Patients received an intrarepair site injection of either PRP or sterile 0.9% saline during an index arthroscopy. The primary endpoint was the rate of meniscus healing in the two groups. The secondary endpoints were changes in the International Knee Documentation Committee (IKDC) score, Knee Injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and analog scale (VAS) in the two groups at 42 months. Results After 18 weeks, the meniscus healing rate was significantly higher in the PRP-treated group than in the control group (85% versus 47%, P = 0.048). Functional outcomes were significantly better 42 months after treatment than at baseline in both groups. The IKDC score, WOMAC, and KOOS were significantly better in the PRP-treated group than in the control group. No adverse events were reported during the study period. Conclusions The findings of this study indicate that PRP augmentation in meniscus repair results in improvements in both meniscus healing and functional outcome. PMID:29713647

  9. Suture versus FasT-Fix all-inside meniscus repair at time of anterior cruciate ligament reconstruction.

    PubMed

    Choi, Nam-Hong; Kim, Byeong-Yeon; Hwang Bo, Byung-Hun; Victoroff, Brian N

    2014-10-01

    To compare meniscal healing and functional outcomes after all-inside meniscal repair between sutures and meniscal fixation devices. Sixty patients with a tear within the red-red or red-white zones of the posterior horn of the medial or lateral meniscus in conjunction with an anterior cruciate ligament (ACL) tear were included in this study. Meniscal repairs were performed with sutures in 35 patients and the FasT-Fix device (Smith & Nephew Endoscopy, Andover, MA) in 25 patients concomitantly with hamstring ACL reconstruction. Postoperative evaluations included Lysholm knee score, Tegner activity scale, Lachman and pivot-shift tests, and KT-1000 arthrometer (MEDmetric, San Diego, CA) testing. Follow-up magnetic resonance imaging (MRI) scans were obtained postoperatively for all patients to evaluate meniscal healing. The mean follow-up period was 47.2 months. In the suture group, 31 patients (86.1%) were asymptomatic and 4 (13.9%) were symptomatic. In the FasT-Fix group, 20 patients (80%) were asymptomatic and 5 (20%) were symptomatic. Postoperative functional evaluation and knee stability showed no statistically significant difference between the 2 groups. Follow-up MRI showed that 26 menisci (74.3%) were healed, 3 menisci (8.6%) were partially healed, and 6 menisci (17.1%) were not healed in the suture group. In the FasT-Fix group, 15 menisci (64%) were healed, 7 menisci (24%) were partially healed, and 3 menisci (12%) were not healed. Follow-up MRI showed no statistically significant difference between the 2 groups. In the FasT-Fix group, follow-up MRI showed a newly developed cyst posterior to the medial meniscus in 2 patients. A new tear anterior to the previous tear was found in 1 patient. In the suture group, follow-up MRI showed no cysts or new tears. All-inside meniscal repairs using either sutures or the FasT-Fix device showed satisfactory results in patients with concomitant hamstring ACL reconstruction. There was no statistically significant difference in

  10. Mechanobiology of the Meniscus

    PubMed Central

    McNulty, Amy L.; Guilak, Farshid

    2015-01-01

    The meniscus plays a critical biomechanical role in the knee, providing load support, joint stability, and congruity. Importantly, growing evidence indicates that the mechanobiologic response of meniscal cells plays a critical role in the physiologic, pathologic, and repair responses of the meniscus. Here we review experimental and theoretical studies that have begun to directly measure the biomechanical effects of joint loading on the meniscus under physiologic and pathologic conditions, showing that the menisci are exposed to high contact stresses, resulting in a complex and nonuniform stress-strain environment within the tissue. By combining microscale measurements of the mechanical properties of meniscal cells and their pericellular and extracellular matrix regions, theoretical and experimental models indicate that the cells in the meniscus are exposed to a complex and inhomogeneous environment of stress, strain, fluid pressure, fluid flow, and a variety of physicochemical factors. Studies across a range of culture systems from isolated cells to tissues have revealed that the biological response of meniscal cells is directly influenced by physical factors, such as tension, compression, and hydrostatic pressure. In addition, these studies have provided new insights into the mechanotransduction mechanisms by which physical signals are converted into metabolic or pro/anti-inflammatory responses. Taken together, these in vivo and in vitro studies show that mechanical factors play an important role in the health, degeneration, and regeneration of the meniscus. A more thorough understanding of the mechanobiologic responses of the meniscus will hopefully lead to therapeutic approaches to prevent degeneration and enhance repair of the meniscus. PMID:25731738

  11. A novel technique of contrast-enhanced optical coherence tomography imaging in evaluation of clearance of lipids in human tears.

    PubMed

    Napoli, Pietro Emanuele; Coronella, Franco; Satta, Giovanni Maria; Fossarello, Maurizio

    2014-01-01

    The aim of this work was to gather preliminary data in different conditions of healthy eyes, aqueous tear deficient dry eyes, obstructive meibomian gland disease (MGD) and non-obvious obstructive MGD (NOMGD) individuals, using a new, contrast-enhanced optical coherence tomography (OCT) imaging method to evaluate the clearance of lipids in human tears. Eighty-two adult patients presenting with complaints of ocular irritation were studied for abnormalities of the ocular surface and classified as healthy (n = 21), aqueous tear deficient dry eyes (n = 20), obstructive MGD (n = 15) and NOMGD (n = 26) individuals. A lipid-based tracer, containing an oil-in-water emulsion, was used to obtain an enhanced OCT imaging of the lower tear meniscus. After instillation, a dramatic initial increase of reflectivity of the lower tear meniscus was detected by OCT, followed by a decay back to baseline values over time. Based on this finding, the clearance of lipids was measured in real-time by Fourier-domain anterior segment OCT. The differences in the clearance of lipids among the four groups as well as the correlations between symptom questionnaire score, standardized visual scale test, fluorescein break-up time, ocular surface fluorescein staining score, Schirmer I test scores were found to be statistically significant. The individual areas under the curve of the clearance of lipids calculated by the receiver operating characteristic curve technique ranged from 0.66 to 0.98, suggesting reliable sensitivity and specificity of lipid-enhanced OCT imaging. This new technique of contrast-enhanced OCT imaging of the tear film following lipid-based tracer instillation provides a measure of the clearance of lipids. The quantitative values found are in agreement with other methods of evaluation of the lacrimal system. An improvement of the clinician's ability in the diagnosis and understanding of abnormalities of the ocular surface may be achieved by this simple approach.

  12. Impact of environmental adaptation on tear film assessments.

    PubMed

    Fagehi, R

    2018-03-01

    The purpose of this study was to investigate the effect of ocular environmental adaptation on clinical tear film assessment. Thirty subjects (male, mean age 23±2.5) participated in this study. A number of clinical tear film tests were applied, including: fluorescein tear break-up time (FTBUT), Schirmer test and tear prism height test (TPH). The tear physiology of each subject was evaluated twice, once immediately when they arrived from the external environment, and then after 30minutes adaptation in the exam room environment. The mean values were: Schirmer test A (22.1±2.99), Schirmer test B (24.2±2.63), FTBUT A (8.00±1.94), FTBUT B (9.13±2.04), TPH A (0.179±0.026) and TPH B* (0.187±0.023). Statistical testing using Wilcoxon-signed rank test showed a significant difference between the Schirmer test results measured at the different times (P=0.008). Also, the FTBUT and tear prism height test results showed significant differences between the two evaluation times, (P=0.001, 0.011, respectively) (A: tear assessed when the subject comes from the outside environment, B: tear film assessed after 30min adaptation in the clinical environment). This study showed a significant difference between the tear film test results evaluated when the subjects were assessed immediately from the outside environment and after an adaptation time in the clinic environment. Practitioners must consider the effect of differences between external and clinical environment adaptation on clinical tear film physiology. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

  13. The Effect of Topical Diquafosol Tetrasodium 3% on Dry Eye After Cataract Surgery.

    PubMed

    Baek, Jiwon; Doh, Sang Hee; Chung, Sung Kun

    2016-10-01

    To evaluate the effectiveness of 3% diquafosol tetrasodium for treating dry eye after cataract surgery. Among patients who underwent bilateral cataract surgery, 34, who met the diagnostic criteria for dry eye syndrome 1 week postoperatively, were enrolled. Patients were randomly assigned to receive 3.0% diquafosol tetrasodium ophthalmic solution in one eye and 0.9% saline in the other eye four times daily for 8 weeks. Dry eye severity was measured at 1, 5, and 9 postoperative weeks using the Schirmer 1 test (SIT), tear film breakup time (TBUT), and fluorescein corneal staining. tear meniscus height (TMH), tear meniscus depth (TMD), and tear meniscus area (TMA) measured using Fourier-domain optical coherence tomography and symptom questionnaire scores. TBUT and corneal staining significantly improved 8 weeks postoperatively in eyes treated with 3.0% diquafosol tetrasodium (p < 0.01, p < 0.01) and were better than normal saline-treated eyes (p < 0.01, p < 0.01). SIT did not improve (p = 0.26). TMH, TMD, and TMA did not improve at 4 and 8 weeks. All symptom questionnaire scores improved in eyes treated with 3.0% diquafosol tetrasodium (all p < 0.01). The 3.0% diquafosol tetrasodium treatment improved tear film stability and subjective symptoms of dry eye after cataract surgery. Increased mucin production as a result of diquafosol treatment may have caused these results.

  14. Medial meniscus posterior horn avulsion.

    PubMed

    Marzo, John M

    2009-05-01

    Avulsion of the posterior horn of the medial meniscus can occur from acute trauma or chronic degeneration, leading to meniscus extrusion, articular cartilage loss, osteophyte formation, and medial joint space narrowing. With meniscus extrusion, the meniscus is unable to resist hoop stresses and cannot shield the adjacent articular cartilage from excessive axial load. Over time, this can lead to symptomatic knee osteoarthritis. Patients typically report pain, swelling, mechanical symptoms, and general functional loss. Although nonsurgical care may relieve symptoms, it is unlikely to alter either the natural history of meniscal loss or the fate of the medial compartment. Surgical repair of posterior horn meniscal avulsion is done in an attempt to restore the anatomy and biomechanical function of the meniscus, and to slow or prevent degenerative joint disease. Meniscal transplantation is reserved for salvage situations.

  15. Biomaterial-Mediated Delivery of Degradative Enzymes to Improve Meniscus Integration and Repair

    PubMed Central

    Qu, Feini; Lin, Jung-Ming G.; Esterhai, John L.; Fisher, Matthew B.; Mauck, Robert L.

    2013-01-01

    Endogenous repair of fibrous connective tissues is limited, and there exist few successful strategies to improve healing after injury. As such, new methods that advance repair by promoting cell growth, extracellular matrix (ECM) production, and tissue integration would represent a marked clinical advance. Using the meniscus as a test platform, we sought to develop an enzyme-releasing scaffold that enhances integrative repair. We hypothesized that the high ECM density and low cellularity present physical and biologic barriers to endogenous healing, and that localized collagenase treatment might expedite cell migration to the wound edge and tissue remodeling. To test this hypothesis, we fabricated a delivery system in which collagenase was stored inside electrospun poly(ethylene oxide) (PEO) nanofibers and released upon hydration. In vitro results showed that partial digestion of the wound interface improved repair by creating a microenvironment that facilitated cell migration, proliferation, and matrix deposition. Specifically, treatment with high-dose collagenase led to a 2-fold increase in cell density at the wound margin and a 2-fold increase in integrative tissue compared to untreated controls at 4 weeks (p≤0.05). Furthermore, when composite scaffolds containing both collagenase-releasing and structural fiber fractions were placed inside meniscal tears in vitro, enzyme release acted locally and resulted in a positive cellular response similar to that of global treatment with aqueous collagenase. This innovative approach of targeted enzyme delivery may aid the many patients that exhibit meniscal tears by promoting integration of the defect, thereby circumventing the pathologic consequences of partial meniscus removal, and may find widespread application in the treatment of injuries to a variety of dense connective tissues. PMID:23376132

  16. Cell-Based Strategies for Meniscus Tissue Engineering

    PubMed Central

    Niu, Wei; Guo, Weimin; Han, Shufeng; Zhu, Yun; Liu, Shuyun; Guo, Quanyi

    2016-01-01

    Meniscus injuries remain a significant challenge due to the poor healing potential of the inner avascular zone. Following a series of studies and clinical trials, tissue engineering is considered a promising prospect for meniscus repair and regeneration. As one of the key factors in tissue engineering, cells are believed to be highly beneficial in generating bionic meniscus structures to replace injured ones in patients. Therefore, cell-based strategies for meniscus tissue engineering play a fundamental role in meniscal regeneration. According to current studies, the main cell-based strategies for meniscus tissue engineering are single cell type strategies; cell coculture strategies also were applied to meniscus tissue engineering. Likewise, on the one side, the zonal recapitulation strategies based on mimicking meniscal differing cells and internal architectures have received wide attentions. On the other side, cell self-assembling strategies without any scaffolds may be a better way to build a bionic meniscus. In this review, we primarily discuss cell seeds for meniscus tissue engineering and their application strategies. We also discuss recent advances and achievements in meniscus repair experiments that further improve our understanding of meniscus tissue engineering. PMID:27274735

  17. Interleukin-1 and tumor necrosis factor alpha inhibit repair of the porcine meniscus in vitro

    PubMed Central

    Hennerbichler, Alfred; Moutos, Franklin T.; Hennerbichler, Diana; Weinberg, J. Brice; Guilak, Farshid

    2011-01-01

    OBJECTIVE Injury or removal of the knee meniscus leads to progressive joint degeneration, and current surgical therapies for meniscal tears seek to maximally preserve meniscal structure and function. However, the factors that influence intrinsic repair of the meniscus are not well understood. The goal of this study was to investigate the capacity of meniscus tissue to repair a simulated defect in vitro and to examine the effect of pro-inflammatory cytokines on this process. METHODS Cylindrical explants were harvested from the outer one-third of medial porcine menisci. To simulate a full-thickness defect, a central core was removed and reinserted immediately into the defect. Explants were cultured for 2, 4, or 6 weeks in serum-containing media in the presence or absence of interleukin-1 (IL-1) or tumor necrosis factor alpha (TNF-alpha), and meniscal repair was investigated using mechanical testing and fluorescence confocal microscopy. RESULTS Meniscal lesions in untreated samples showed a significant capacity for intrinsic repair in vitro, with increasing cell accumulation and repair strength over time in culture. In the presence of IL-1 or TNF-alpha, no repair was observed despite the presence of abundant viable cells. CONCLUSIONS This study demonstrates that the meniscus exhibits an intrinsic repair response in vitro. However, the presence of pro-inflammatory cytokines completely inhibited repair. These findings suggest that increased levels of pro-inflammatory cytokines post-injury or under arthritic conditions may inhibit meniscal repair. Therefore, inhibition of these cytokines may provide a means of accelerating repair of damaged or injured menisci in vivo. PMID:17448702

  18. Cell-Based Meniscus Repair and Regeneration: At the Brink of Clinical Translation?

    PubMed Central

    Korpershoek, Jasmijn V.; de Windt, Tommy S.; Hagmeijer, Michella H.; Vonk, Lucienne A.; Saris, Daniel B. F.

    2017-01-01

    Background: Meniscus damage can be caused by trauma or degeneration and is therefore common among patients of all ages. Repair or regeneration of the menisci could be of great importance not only for pain relief or regaining function but also to prevent degenerative disease and osteoarthritis. Current treatment does not offer consistent long-term improvement. Although preclinical research focusing on augmentation of meniscal tear repair and regeneration after meniscectomy is encouraging, clinical translation remains difficult. Purpose: To systematically evaluate the literature on in vivo meniscus regeneration and explore the optimal cell sources and conditions for clinical translation. We aimed at thorough evaluation of current evidence as well as clarifying the challenges for future preclinical and clinical studies. Study Design: Systematic review. Methods: A search was conducted using the electronic databases of MEDLINE, Embase, and the Cochrane Collaboration. Search terms included meniscus, regeneration, and cell-based. Results: After screening 81 articles based on title and abstract, 51 articles on in vivo meniscus regeneration could be included; 2 additional articles were identified from the references. Repair and regeneration of the meniscus has been described by intra-articular injection of multipotent mesenchymal stromal (stem) cells from adipose tissue, bone marrow, synovium, or meniscus or the use of these cell types in combination with implantable or injectable scaffolds. The use of fibrochondrocytes, chondrocytes, and transfected myoblasts for meniscus repair and regeneration is limited to the combination with different scaffolds. The comparative in vitro and in vivo studies mentioned in this review indicate that the use of allogeneic cells is as successful as the use of autologous cells. In addition, the implantation or injection of cell-seeded scaffolds increased tissue regeneration and led to better structural organization compared with scaffold

  19. [MITOCHONDRIA-TARGETED ANTIOXIDANTS IN THE PREVENTION OF THE CORNEA EROSION WHEN PERFORMING SURGERY UNDER GENERAL ANESTHESIA.

    PubMed

    Gusev, E A; Chemodanov, D V; Sungurov, V A; Neverovsky, E A; Grebenchikov, O A; Likhvantsev, V V

    2017-09-01

    Despite the use of modern methods of prevention, at least 10% of patients operated on for ophthalmic indications not develop corneal erosion as the indirect complication of general anesthesia. To reduce the number of ophthalmic complications of general anesthesia by prophylactic use of new mito- chondria-targeted antioxidants - Vizomitin (eye drops). 70 patients, which was supposed to perform the average duration of operations under general anesthesia were randomized into 3 groups depending on the method specific (pharmacological) prevention of corneal erosions: (1) control (specic (pharmacological) prevention was not carried out), (2), using preparation "natural tear, and (3) "Vizomitin" preparation. Postoperative biomicroscopy was performed to assess the condition of the cornea, tear film stability was measured and the height of the tear meniscus. When using eye drops "Vizomitin" value is an indicator of stability of the tear film on the 3rd day after the operation more than in the control group of patients by 51% (p = 0.012) and patients groups, natural tear by 57% (p = 0.013). Surgical interventions performed under general anesthesia, leading to an increase in the number ofpatients with decreased tear meniscus height index of the control group with 4 to 7 patients (p = 0.30) in the group of natural tear from 3 to 11 patients (p = 0.008) . In the group with drug "Vizomitin" the number of such patients is reduced from 7 to 1 (p = 0.018). In the surgical procedures under general anesthesia eye drops "Vizomitin" effectively prevents the devel- opment of corneal erosion.

  20. Loading of the medial meniscus in the ACL deficient knee: A multibody computational study.

    PubMed

    Guess, Trent M; Razu, Swithin

    2017-03-01

    The menisci of the knee reduce tibiofemoral contact pressures and aid in knee lubrication and nourishment. Meniscal injury occurs in half of knees sustaining anterior cruciate ligament injury and the vast majority of tears in the medial meniscus transpire in the posterior horn region. In this study, computational multibody models of the knee were derived from medical images and passive leg motion for two female subjects. The models were validated against experimental measures available in the literature and then used to evaluate medial meniscus contact force and internal hoop tension. The models predicted that the loss of anterior cruciate ligament (ACL) constraint increased contact and hoop forces in the medial menisci by a factor of 4 when a 100N anterior tibial force was applied. Contact forces were concentrated in the posterior horn and hoop forces were also greater in this region. No differences were found in contact or hoop tension between the intact and ACL deficient (ACLd) knees when only a 5Nm external tibial torque was applied about the long axis of the tibia. Combining a 100N anterior tibial force and a 5Nm external tibial torque increased posterior horn contact and hoop forces, even in the intact knee. The results of this study show that the posterior horn region of the medial meniscus experiences higher contact forces and hoop tension, making this region more susceptible to injury, especially with the loss of anterior tibia motion constraint provided by the ACL. The contribution of the dMCL in constraining posterior medial meniscus motion, at the cost of higher posterior horn hoop tension, is also demonstrated. Copyright © 2016 IPEM. Published by Elsevier Ltd. All rights reserved.

  1. Loading of the Medial Meniscus in the ACL deficient knee: a Multibody Computational Study

    PubMed Central

    Razu, Swithin

    2017-01-01

    The menisci of the knee reduce tibiofemoral contact pressures and aid in knee lubrication and nourishment. Meniscal injury occurs in half of knees sustaining anterior cruciate ligament injury and the vast majority of tears in the medial meniscus transpire in the posterior horn region. In this study, computational multibody models of the knee were derived from medical images and passive leg motion for two female subjects. The models were validated against experimental measures available in the literature and then used to evaluate medial meniscus contact force and internal hoop tension. The models predicted that the loss of anterior cruciate ligament (ACL) constraint increased contact and hoop forces in the medial menisci by a factor of 4 when a 100 N anterior tibial force was applied. Contact forces were concentrated in the posterior horn and hoop forces were also greater in this region. No differences were found in contact or hoop tension between the intact and ACL deficient (ACLd) knees when only a 5 Nm external tibial torque was applied about the long axis of the tibia. Combining a 100 N anterior tibial force and a 5 Nm external tibial torque increased posterior horn contact and hoop forces, even in the intact knee. The results of this study show that the posterior horn region of the medial meniscus experiences higher contact forces and hoop tension, making this region more susceptible to injury, especially with the loss of anterior tibia motion constraint provided by the ACL. The contribution of the dMCL in constraining posterior medial meniscus motion, at the cost of higher posterior horn hoop tension, is also demonstrated. PMID:28089224

  2. Reliability of magnetic resonance imaging in evaluating meniscal and cartilage injuries in anterior cruciate ligament-deficient knees.

    PubMed

    Wong, Kenneth Pak Leung; Han, Audrey XinYun; Wong, Jeannie Leh Ying; Lee, Dave Yee Han

    2017-02-01

    The accuracy of magnetic resonance (MR) imaging in assessing meniscal and cartilage injuries in anterior cruciate ligament (ACL)-deficient knees as compared to arthroscopy was evaluated in the present study. The results of all preoperative MR imaging performed within 3 months prior to the ACL reconstruction were compared against intraoperative arthroscopic findings. A total of 206 patients were identified. The location and type of meniscal injuries as well as the location and grade of the cartilage injuries were studied. The negative predictive value, positive predictive value, sensitivity, specificity and accuracy of MR imaging for these 206 cases were calculated and analysed. In patients with an ACL injury, the highest incidence of concomitant injury was that of medial meniscus tears, 124 (60.2 %), followed by lateral meniscus tears, 105 (51.0 %), and cartilage injuries, 66 (32.0 %). Twenty-three (11.2 %) patients sustained injuries to all of the previously named structures. MR imaging was most accurate in detecting medial meniscus tears (85.9 %). MR imaging for medial meniscus tears also had the highest sensitivity (88.0 %) and positive predictive value (88.7 %), while MR imaging for cartilage injuries had the largest specificity (84.1 %) and negative predictive value (87.1 %). It was least accurate in evaluating lateral meniscus tears (74.3 %). The diagnostic accuracy of medial meniscus imaging is significantly influenced by age and the presence of lateral meniscus tears, while the duration between MR imaging and surgery has greater impact on the likelihood of lateral meniscus and cartilage injuries actually being present during surgery. The majority of meniscus tears missed by MR imaging affected the posterior horn and were complex in nature. Cartilage injuries affecting the medial femoral condyle or medial patella facet were also often missed by MR imaging. MR imaging remains a reliable tool for assessing meniscus tears and cartilage defects

  3. Three percent diquafosol ophthalmic solution as an additional therapy to existing artificial tears with steroids for dry-eye patients with Sjögren's syndrome.

    PubMed

    Yokoi, N; Sonomura, Y; Kato, H; Komuro, A; Kinoshita, S

    2015-09-01

    To investigate the long-term results of 3% diquafosol ophthalmic solution as an alternative therapy to existing ophthalmic solutions, including topical immunosuppression, for the treatment of dry eye in patients with Sjögren's syndrome. This study involved 14 female dry-eye patients (mean age: 62.4 years) with Sjögren's syndrome who insufficiently responded to their current therapy. In all patients, 3% diquafosol ophthalmic solution was administered six times daily for 12 months in substitution for artificial tears and sodium hyaluronate ophthalmic solution. Their use of corticosteroid eye drops remained unchanged from that prior to the treatment with diquafosol sodium. The subjective symptoms assessed, and ocular signs including tear meniscus radius and the tear film breakup time, and ocular-surface epithelial damage score were examined at 1, 2, 3, 4, 5, 6, 9, and 12 months after initiating treatment. Among the subjective symptoms, significant improvement was obtained in dryness at 2 months post treatment, in eye fatigue at 1, 2, 3, 4, and 12 months post treatment, and in pain at 1, 2, 6, and 12 months post treatment. Difficulty in opening the eye, foreign body sensation, and redness were also significantly ameliorated at various time-points. The tear meniscus radius and the tear film breakup time were significantly improved throughout the observation period, and the corneal epithelial staining scores were significantly decreased at 3 months post treatment. In dry-eye patients with Sjögren's syndrome, treatment with 3% diquafosol ophthalmic solution improved both symptoms and signs, and that effectiveness was maintained for 12 months.

  4. Meniscus Membranes For Separation

    DOEpatents

    Dye, Robert C.; Jorgensen, Betty; Pesiri, David R.

    2005-09-20

    Gas separation membranes, especially meniscus-shaped membranes for gas separations are disclosed together with the use of such meniscus-shaped membranes for applications such as thermal gas valves, pre-concentration of a gas stream, and selective pre-screening of a gas stream. In addition, a rapid screening system for simultaneously screening polymer materials for effectiveness in gas separation is provided.

  5. Middle-aged patients with an MRI-verified medial meniscal tear report symptoms commonly associated with knee osteoarthritis.

    PubMed

    Hare, Kristoffer B; Stefan Lohmander, L; Kise, Nina Jullum; Risberg, May Arna; Roos, Ewa M

    2017-12-01

    Background and purpose - No consensus exists on when to perform arthroscopic partial meniscectomy in patients with a degenerative meniscal tear. Since MRI and clinical tests are not accurate in detecting a symptomatic meniscal lesion, the patient's symptoms often play a large role when deciding when to perform surgery. We determined the prevalence and severity of self-reported knee symptoms in patients eligible for arthroscopic partial meniscectomy due to a degenerative meniscal tear. We investigated whether symptoms commonly considered to be related to meniscus injury were associated with early radiographic signs of knee osteoarthritis. Patients and methods - We included individual baseline items from the Knee injury and Osteoarthritis Outcome Score collected in 2 randomized controlled trials evaluating treatment for an MRI-verified degenerative medial meniscal tears in 199 patients aged 35-65 years. Each item was scored as no, mild, moderate, severe, extreme, and at least "mild" considering the symptoms present. Early radiographic signs of osteoarthritis, defined as a Kellgren and Lawrence grade of at least 1, were seen in 70 patients. Results - At least monthly knee pain, pain during stair walking and when twisting on the knee, and lack of confidence in knee was present in at least 80% of the patients. Median severity was at least moderate for knee pain, pain when twisting on the knee, pain walking on stairs, lack of confidence in knee, and clicking. Mechanical symptoms such as catching were rare. Early radiographic signs of osteoarthritis were associated with an increased risk of self-reported swelling, catching, and stiffness later in the day; the odds ratio was 2.4 (95% CI 1.2-4.9), 2.3 (1.2-4.3), and 2.3 (1.1-5.0), respectively. Interpretation - Middle-aged patients with a degenerative medial meniscus tear reported symptoms commonly associated with knee osteoarthritis. Frequent knee pain, presence of lack of confidence in the knee, and clicking did not

  6. Meniscus delivery: a maneuver for easy arthroscopic access to the posterior horn of the medial meniscus.

    PubMed

    Said, Hatem Galal; Goyal, Saumitra; Fetih, Tarek Nabil

    2016-03-16

    Pathology of posterior horn of medial meniscus is common and often presents a difficult approach during arthroscopy for various reasons. We describe an easy maneuver to facilitate "delivery of the medial meniscus" during arthroscopy.

  7. Structure-function relationships of human meniscus.

    PubMed

    Danso, Elvis K; Oinas, Joonas M T; Saarakkala, Simo; Mikkonen, Santtu; Töyräs, Juha; Korhonen, Rami K

    2017-03-01

    Biomechanical properties of human meniscus have been shown to be site-specific. However, it is not known which meniscus constituents at different depths and locations contribute to biomechanical properties obtained from indentation testing. Therefore, we investigated the composition and structure of human meniscus in a site- and depth-dependent manner and their relationships with tissue site-specific biomechanical properties. Elastic and poroelastic properties were analyzed from experimental stress-relaxation and sinusoidal indentation measurements with fibril reinforced poroelastic finite element modeling. Proteoglycan (PG) and collagen contents, as well as the collagen orientation angle, were determined as a function of tissue depth using microscopic and spectroscopic methods, and they were compared with biomechanical properties. For all the measurement sites (anterior, middle and posterior) of lateral and medial menisci (n=26), PG content and collagen orientation angle increased as a function of tissue depth while the collagen content had an initial sharp increase followed by a decrease across tissue depth. The highest values (p<0.05) of elastic parameters (equilibrium and instantaneous moduli) and strain-dependent biomechanical parameters (strain-dependent fibril network modulus and permeability) were observed in the anterior horn of the medial meniscus. This location had also higher (p<0.05) PG content in the deep meniscus, higher (p<0.05) collagen content in the entire tissue depth, and lower (p<0.05) collagen orientation angle at the superficial tissue, as compared to many other locations. On the other hand, in certain comparisons (such as anterior vs. middle sites of the medial meniscus) significantly higher (p<0.05) collagen content and lower orientation angle, without any difference in the PG content, were consistent with increased meniscus modulus and/or nonlinear permeability. This study suggests that nonlinear biomechanical properties of meniscus

  8. Randomized Trial of Desktop Humidifier for Dry Eye Relief in Computer Users.

    PubMed

    Wang, Michael T M; Chan, Evon; Ea, Linda; Kam, Clifford; Lu, Yvonne; Misra, Stuti L; Craig, Jennifer P

    2017-11-01

    Dry eye is a frequently reported problem among computer users. Low relative humidity environments are recognized to exacerbate signs and symptoms of dry eye, yet are common in offices of computer operators. Desktop USB-powered humidifiers are available commercially, but their efficacy for dry eye relief has not been established. This study aims to evaluate the potential for a desktop USB-powered humidifier to improve tear-film parameters, ocular surface characteristics, and subjective comfort of computer users. Forty-four computer users were enrolled in a prospective, masked, randomized crossover study. On separate days, participants were randomized to 1 hour of continuous computer use, with and without exposure to a desktop humidifier. Lipid-layer grade, noninvasive tear-film breakup time, and tear meniscus height were measured before and after computer use. Following the 1-hour period, participants reported whether ocular comfort was greater, equal, or lesser than that at baseline. The desktop humidifier effected a relative difference in humidity between the two environments of +5.4 ± 5.0% (P < .001). Participants demonstrated no significant differences in lipid-layer grade and tear meniscus height between the two environments (all P > .05). However, a relative increase in the median noninvasive tear-film breakup time of +4.0 seconds was observed in the humidified environment (P < .001), which was associated with a higher proportion of subjects reporting greater comfort relative to baseline (36% vs. 5%, P < .001). Even with a modest increase in relative humidity locally, the desktop humidifier shows potential to improve tear-film stability and subjective comfort during computer use.Trial registration no: ACTRN12617000326392.

  9. Dynamic measurement of the corneal tear film with a Twyman-Green interferometer

    NASA Astrophysics Data System (ADS)

    Micali, Jason D.; Greivenkamp, John E.; Primeau, Brian C.

    2014-07-01

    An interferometer for measuring dynamic properties of the in vivo tear film on the human cornea has been developed. The system is a near-infrared instantaneous phase-shifting Twyman-Green interferometer. The laser source is a 785 nm solidstate laser; the system has been carefully designed and calibrated to ensure that the system operates at eye safe levels. Measurements are made over a 6 mm diameter on the cornea. Successive frames of interferometric height measurements are combined to produce movies showing both the quantitative and qualitative changes in the topography of the tear film surface and structure. To date, measurement periods of up to 120 seconds at 28.6 frames per second have been obtained. Several human subjects have been examined using this system, demonstrating a surface height resolution of 25 nm and spatial resolution of 6 μm. Examples of features that have been observed in these in preliminary studies of the tear film include: post-blink disruption, evolution, and stabilization of the tear film; tear film artifacts generated by blinking; tear film evaporation and break-up; and the propagation of foreign objects in the tear film. This paper discusses the interferometer design and presents results from in vivo measurements.

  10. Dynamic measurement of the corneal tear film with a Twyman-Green interferometer

    NASA Astrophysics Data System (ADS)

    Micali, Jason D.; Greivenkamp, John E.; Primeau, Brian C.

    2015-05-01

    An interferometer for measuring dynamic properties of the in vivo tear film on the human cornea has been developed. The system is a near-infrared instantaneous phase-shifting Twyman-Green interferometer. The laser source is a 785 nm solid-state laser, and the system has been carefully designed and calibrated to ensure that the system operates at eye-safe levels. Measurements are made over a 6 mm diameter on the cornea. Successive frames of interferometric height measurements are combined to produce movies showing both the quantitative and qualitative changes in the topography of the tear film surface and structure. To date, measurement periods of up to 120 s at 28.6 frames per second have been obtained. Several human subjects have been examined using this system, demonstrating a surface height resolution of 25 nm and spatial resolution of 6 μm. Examples of features that have been observed in these preliminary studies of the tear film include postblink disruption, evolution, and stabilization of the tear film; tear film artifacts generated by blinking; tear film evaporation and breakup; and the propagation of foreign objects in the tear film. This paper discusses the interferometer design and presents results from in vivo measurements.

  11. Oral omega-6 essential fatty acid treatment in contact lens associated dry eye.

    PubMed

    Kokke, Karolien H; Morris, Judith A; Lawrenson, John G

    2008-06-01

    Symptoms of dry eye are commonly reported in contact lens wearers and are a frequent cause of non-tolerance. The purpose of the present study is to evaluate the effects of oral treatment with particular omega-6 fatty acids in the form of evening primrose oil (EPO) on subjective symptoms, ocular surface signs and tear film characteristic in patients with contact lens associated dry eye. The study design was randomised, double-masked and placebo controlled. 76 female soft contact lens wearers were treated for 6 months with either EPO or placebo (olive oil). Subjects underwent three examinations (baseline, 3 and 6 months). At each examination subjects were given a questionnaire relating to lens comfort and dry eye symptoms and underwent a series of tests of tear film characteristics (tear meniscus height, break-up time), meibomian gland function (lipid layer thickness and quality) and ocular surface parameters (hyperaemia and staining). The EPO group showed a significant improvement in the specific symptom of 'dryness' at 3 and 6 months (p<0.01) and also a significant improvement in overall lens comfort at 6 months (p<0.01). Tear meniscus height was increased in the EPO group at 6 months relative to baseline (p<0.01), although all other objective signs were unchanged. This study provides evidence for a beneficial effect of particular orally administered omega-6 fatty acids in alleviating dry eye symptoms and improving overall lens comfort in patients suffering from contact lens associated dry eye.

  12. Region-Specific Effect of the Decellularized Meniscus Extracellular Matrix on Mesenchymal Stem Cell-Based Meniscus Tissue Engineering.

    PubMed

    Shimomura, Kazunori; Rothrauff, Benjamin B; Tuan, Rocky S

    2017-03-01

    The meniscus is the most commonly injured knee structure, and surgical repair is often ineffective. Tissue engineering-based repair or regeneration may provide a needed solution. Decellularized, tissue-derived extracellular matrices (ECMs) have received attention for their potential use as tissue-engineered scaffolds. In considering meniscus-derived ECMs (mECMs) for meniscus tissue engineering, it is noteworthy that the inner and outer regions of the meniscus have different structural and biochemical features, potentially directing the differentiation of cells toward region-specific phenotypes. To investigate the applicability of mECMs for meniscus tissue engineering by specifically comparing region-dependent effects of mECMs on 3-dimensional constructs seeded with human bone marrow mesenchymal stem cells (hBMSCs). Controlled laboratory study. Bovine menisci were divided into inner and outer halves and were minced, treated with Triton X-100 and DNase, and extracted with urea. Then, hBMSCs (1 × 10 6 cells/mL) were encapsulated in a photo-cross-linked 10% polyethylene glycol diacrylate scaffold containing mECMs (60 μg/mL) derived from either the inner or outer meniscus, with an ECM-free scaffold as a control. The cell-seeded constructs were cultured with chondrogenic medium containing recombinant human transforming growth factor β3 (TGF-β3) and were analyzed for expression of meniscus-associated genes as well as for the collagen (hydroxyproline) and glycosaminoglycan content as a function of time. Decellularization was verified by the absence of 4',6-diamidino-2-phenylindole (DAPI)-stained cell nuclei and a reduction in the DNA content. Quantitative real-time polymerase chain reaction showed that collagen type I expression was significantly higher in the outer mECM group than in the other groups, while collagen type II and aggrecan expression was highest in the inner mECM group. The collagen (hydroxyproline) content was highest in the outer mECM group, while the

  13. Shifting the IGF-axis: An age-related decline in human tear IGF-1 correlates with clinical signs of dry eye.

    PubMed

    Patel, Roshni; Zhu, Meifang; Robertson, Danielle M

    2018-06-01

    The human corneal epithelium expresses both the insulin-like growth factor type 1 receptor (IGF-1R) and the IGF-1R/insulin receptor (INSR) hybrid. Despite the previous identification of IGF-1 in human tear fluid, little is known regarding the regulation of IGF-1 in tear fluid and its role in corneal epithelial homeostasis. In the present study, we investigated the impact of biological parameters on the concentration of human tear levels of IGF-1. Tear levels of IGF-1 were measured in 41 healthy, human volunteers without any reported symptoms of dry eye. All volunteers underwent standard biomicroscopic examination of the cornea and tear film. In a subgroup of volunteers, corneal staining with sodium fluorescein, tear film break up time and tear production using a Schirmer's test strip were measured to assess clinical signs of dry eye. Tears were collected from the inferior tear meniscus using glass microcapillary tubes and IGF-1 levels were measured using a solid phase sandwich ELISA. Tear levels of IGF-1 were highest in young adults and significantly decreased in older adults (P = 0.003). There were no differences in tear IGF-1 between males and females (P = 0.628). Tear IGF-1 levels were correlated with tear film break up time (R = 0.738) and tear production (R = 0.826). These data indicate that there is a progressive decline in tear IGF-1 due to aging that is associated with clinical signs of dry eye. This effect is likely due to age-related changes in the lacrimal gland. Copyright © 2018 Elsevier Ltd. All rights reserved.

  14. Prognostic Factors in the Midterm Results of Pullout Fixation for Posterior Root Tears of the Medial Meniscus.

    PubMed

    Chung, Kyu Sung; Ha, Jeong Ku; Ra, Ho Jong; Kim, Jin Goo

    2016-07-01

    To identify predictors of unfavorable clinical and radiologic outcomes a minimum of 5 years after pullout fixation for medial meniscus posterior root tears (MMPRTs). In total, 40 patients who were followed for >5 years after pullout fixation in MMPRT were recruited. The mean follow-up duration was 71.1 months. Clinical outcomes, including Lysholm score and International Knee Documentation Committee (IKDC) score, and radiographic results, including Kellgren-Lawrence (K-L; 0/1/2/3/4) grade and medial joint space width, were evaluated preoperatively and at final follow-up. Preoperative prognostic factors, including age, sex, body mass index, degree of varus alignment, K-L grade, medial joint space width, meniscal extrusion, and cartilage status, by the modified Outerbridge classification (grades 1 or 2 v 3 or 4), for relatively unfavorable (fair or poor grade) Lysholm or IKDC score, and progression of K-L grade were investigated by multivariate logistic regression analysis. The mean Lysholm score (52.1 ± 8.8 to 83.8 ± 11.9) and IKDC score (40.1 ± 7.6 to 73.3 ± 10.9) were improved significantly (P < .001), although the loss of medial joint space width (4.8 ± 1.1 to 3.9 ± 1.1 mm) and K-L grade (6/25/9/0/0 to 0/11/20/9/0) progressed significantly (P < .001). Unfavorable prognostic factors of the Lysholm score were grade ≥3 chondral lesions (odds ratio [OR] = 5.993; P = .028) and varus mechanical alignment (OR = 1.644; P = .017), for IKDC score were grade ≥3 chondral lesions (OR = 11.146; P = .038) and older age (OR = 1.200; P = .017). Preoperative chondral lesion grade ≥3 increased the risk of K-L grade progression (OR = 11.000; P = .031). Clinically, modified Outerbridge classification grade ≥3 chondral lesions, varus alignment, and older age were found to predict a poor prognosis after MMPRT fixation. In terms of radiographic K-L grade progression, grade ≥3 chondral lesions were identified as a poor prognostic factor. Level IV, case series

  15. Investigating the relationship between internal tibial torsion and medial collateral ligament injury in patients undergoing knee arthroscopy due to tears in the posterior one third of the medial meniscus.

    PubMed

    Guler, Olcay; Isyar, Mehmet; Karataş, Dilek; Ormeci, Tugrul; Cerci, Halis; Mahirogulları, Mahir

    2016-08-01

    To evaluate the relationship between medial collateral ligament (MCL) injury and degree of internal tibial torsion in patients who had undergone arthroscopic resection due to tears in the posterior one third of the medial meniscus. Seventy-one patients were allocated into two groups with respect to foot femur angle (FFA) and transmalleolar angle (TMA) (Group 1 31 patients with FFA<8° and Group 2 40 patients with FFA≥8°). The groups were compared in terms of valgus instability, Lysholm score, magnetic resonance view, FFA, and TMA, both before and after the operation. Lysholm scores were higher in Group 2 at both postoperative week 1 (p<0.001) and month 1 (p=0.045) relative to Group 1. Preoperative cartilage injury was encountered more frequently in Group 1 (p=0.037) than in Group 2. MCL injury was detected more frequently in Group 1 compared to Group 2 postoperatively at week 1 (p=0.001). We conclude that FFA and TFA, indicators of internal tibial torsion, may serve as markers for foreseeing clinical improvement and complications following arthroscopic surgery. level III retrospective comparative study. Copyright © 2015 Elsevier B.V. All rights reserved.

  16. A meta-analysis of clinical and radiographic outcomes of posterior horn medial meniscus root repairs.

    PubMed

    Chung, Kyu Sung; Ha, Jeong Ku; Ra, Ho Jong; Kim, Jin Goo

    2016-05-01

    Although interest in medial meniscus posterior root tear (MMPRT) repair has increased, few case series have been reported. This meta-analysis aimed to examine the clinical and radiological effects of MMPRT repair by pooling pre- and post-operative data from case-series reports. A literature search was performed using MEDLINE/PubMed, the Cochrane Central Register of Controlled Trials, and EMBASE databases. Pre- and post-operative data were pooled to investigate the effects of MMPRT repair, including the Lysholm score improvement, meniscal extrusion (mm) reduction, progression of the Kellgren-Lawrence (K-L) grade, and cartilage status according to the Outerbridge classification. Treatment effects included paired standardized mean differences (difference in the pre- and post-operative mean outcomes divided by the standard deviation) for the Lysholm score and meniscal extrusion, as well as the pooled event rates of progression of K-L grade and cartilage status. As treatment effects, the Lysholm score increased by as much as 3.675 (P < 0.001), whereas meniscus extrusion was not reduced (n.s.). The overall pooled event rates of progression of K-L grade and cartilage status were 10.6 and 17.3 % (P < 0.001), respectively. According to the current literature, MMPRT repair resulted in significant improvements in the post-operative clinical subjective scores compared with the preoperative status. However, meniscus extrusion was not reduced. Considering the occurrence of progression of K-L grade and cartilage status, it did not prevent the progression of arthrosis completely. Based on these results, repair results in favourable outcomes for MMPRT. Meta-analysis, Level IV.

  17. Medial meniscus anatomy-from basic science to treatment.

    PubMed

    Śmigielski, Robert; Becker, Roland; Zdanowicz, Urszula; Ciszek, Bogdan

    2015-01-01

    This paper focuses on the anatomical attachment of the medial meniscus. Detailed anatomical dissections have been performed and illustrated. Five zones can be distinguished in regard to the meniscus attachments anatomy: zone 1 (of the anterior root), zone 2 (anteromedial zone), zone 3 (the medial zone), zone 4 (the posterior zone) and the zone 5 (of the posterior root). The understanding of the meniscal anatomy is especially crucial for meniscus repair but also for correct fixation of the anterior and posterior horn of the medial meniscus.

  18. An in vitro study of cartilage-meniscus tribology to understand the changes caused by a meniscus implant.

    PubMed

    Majd, Sara Ehsani; Rizqy, Aditya Iman; Kaper, Hans J; Schmidt, Tannin A; Kuijer, Roel; Sharma, Prashant K

    2017-07-01

    Active lifestyles increase the risk of meniscal injury. A permanent meniscus implant of polycarbonate urethane (PCU) is a promising treatment to postpone/prevent total knee arthroplasty. Study of the changes in articular cartilage tribology in the presence of PCU is essential in developing the optimum meniscus implant. Therefore, a cartilage-meniscus reciprocating, sliding model was developed in vitro, mimicking the stance and swing phases of the gait cycle. The meniscus was further replaced with PCU and surface-modified PCUs (with C18 chains, mono-functional polydimethylsiloxane groups and mono-functional polytetrafluoroethylene groups) to study the changes. The coefficient of friction (COF) was calculated, and cartilage wear was determined and quantified histologically. The cartilage-meniscus sliding resulted in low COF during both stance and swing (0.01< COF <0.12) and low wear of cartilage (scores <1). The cartilage-PCU sliding, during stance, revealed similar low COFs. But during swing, the COFs were high (average ∼1, maximum 1.6), indicating a breakdown in interstitial fluid pressurization lubrication and non-effective activation of the boundary lubrication. This may lead to wear of cartilage in long term. However, under the tested conditions the wear of cartilage against PCUs was not higher than its wear against meniscus, and the cartilage was occasionally damaged. The COF decreased with increasing the contact pressure (as-per a power equation) up to 1MPa. The changes in the surface modification of PCU did not affect PCU's tribological performance. Crown Copyright © 2017. Published by Elsevier B.V. All rights reserved.

  19. Analysis of Meniscus Fluctuation in a Continuous Casting Slab Mold

    NASA Astrophysics Data System (ADS)

    Zhang, Kaitian; Liu, Jianhua; Cui, Heng; Xiao, Chao

    2018-06-01

    A water model of slab mold was established to analyze the microscopic and macroscopic fluctuation of meniscus. The fast Fourier transform and wavelet entropy were adopted to analyze the wave amplitude, frequency, and components of fluctuation. The flow patterns under the meniscus were measured by using particle image velocimetry measurement and then the mechanisms of meniscus fluctuation were discussed. The results reflected that wavelet entropy had multi-scale and statistical properties, and it was suitable for the study of meniscus fluctuation details both in time and frequency domain. The basic wave, frequency of which exceeding 1 Hz in the condition of no mold oscillation, was demonstrated in this work. In fact, three basic waves were found: long-wave with low frequency, middle-wave with middle frequency, and short-wave with high frequency. In addition, the upper roll flow in mold had significant effect on meniscus fluctuation. When the position of flow impinged was far from the meniscus, long-wave dominated the fluctuation and the stability of meniscus was enhanced. However, when the velocity of flow was increased, the short-wave dominated the meniscus fluctuation and the meniscus stability was decreased.

  20. Case control study of dry eye and related ocular surface abnormalities in Ibadan, Nigeria.

    PubMed

    Bekibele, C O; Baiyeroju, A M; Ajaiyeoba, A; Akang, E E U; Ajayi, B G K

    2010-02-01

    Tear instability is associated with symptoms of ocular discomfort and irritation. Many patients with dry eyes remain untreated due to improper diagnoses. To identify symptoms and surface abnormalities associated with dry eyes. One hundred and fifty-six eyes of 78 subjects attending the Eye Clinic of the University College Hospital Ibadan were screened for dry eyes/tear instability using rose Bengal stain (graded 0-9), tear break-up time (TBUT), Schirmer's 1 tests, tear meniscus height and a standardised symptoms questionnaire. Grades 4-9 rose Bengal staining were considered as positive dry eye and were compared with grades 0-3 staining eyes as negative controls. Mean tear meniscus height, Schirmer's test and TBUT were lower among cases than their corresponding control eyes. The difference between the mean Schirmer's test values of cases and their controls were statistically significant (P = 0.00 for right eyes and P = 0.002 for left eyes). Rose Bengal grades were inversely correlated with the mean Schirmer's values (Pearson correlation -0.429, P = 0.05 for right eyes and -0.335, P = 0.03 for left eyes) and TBUT (Pearson correlation -0.316, P = 0.05 for right eyes and -0.212, P = 0.06 for left eyes). About 95.8% of the cases were symptomatic, as opposed to 70.4% of the controls (P = 0.01, Fisher's exact test) and 95.8% of dry right eyes compared to 61.1% of their controls had ocular surface abnormalities (P = 0.001), while 89.5% of dry left eyes compared to 62.7% of controls had surface abnormalities (P = 0.07). A close relationship exists between ocular irritation symptoms, surface abnormalities and functional evidence of tear instability. Such patients should be treated empirically or screened for dry eyes.

  1. Hydrogels for precision meniscus tissue engineering: a comprehensive review.

    PubMed

    Rey-Rico, Ana; Cucchiarini, Magali; Madry, Henning

    The meniscus plays a pivotal role to preserve the knee joint homeostasis. Lesions to the meniscus are frequent, have a reduced ability to heal, and may induce tibiofemoral osteoarthritis. Current reconstructive therapeutic options mainly focus on the treatment of lesions in the peripheral vascularized region. In contrast, few approaches are capable of stimulating repair of damaged meniscal tissue in the central, avascular portion. Tissue engineering approaches are of high interest to repair or replace damaged meniscus tissue in this area. Hydrogel-based biomaterials are of special interest for meniscus repair as its inner part contains relatively high proportions of proteoglycans which are responsible for the viscoelastic compressive properties and hydration grade. Hydrogels exhibiting high water content and providing a specific three-dimensional (3D) microenvironment may be engineered to precisely resemble this topographical composition of the meniscal tissue. Different polymers of both natural and synthetic origins have been manipulated to produce hydrogels hosting relevant cell populations for meniscus regeneration and provide platforms for meniscus tissue replacement. So far, these compounds have been employed to design controlled delivery systems of bioactive molecules involved in meniscal reparative processes or to host genetically modified cells as a means to enhance meniscus repair. This review describes the most recent advances on the use of hydrogels as platforms for precision meniscus tissue engineering.

  2. Knee Injuries

    MedlinePlus

    ... when bending, extending, or lifting a leg. Meniscus Tears Damage to the menisci is a really common ... side-to-side movements can cause them to tear. Meniscus injuries often occur together with severe sprains, ...

  3. Knee Osteoarthritis Is Associated With Previous Meniscus and Anterior Cruciate Ligament Surgery Among Elite College American Football Athletes.

    PubMed

    Smith, Matthew V; Nepple, Jeffrey J; Wright, Rick W; Matava, Matthew J; Brophy, Robert H

    Football puts athletes at risk for knee injuries such meniscus and anterior cruciate ligament (ACL) tears, which are associated with the development of osteoarthritis (OA). Previous knee surgery, player position, and body mass index (BMI) may be associated with knee OA. In elite football players undergoing knee magnetic resonance imaging at the National Football League's Invitational Combine, the prevalence of knee OA is associated with previous knee surgery and BMI. Retrospective cohort. Level 4. A retrospective review was performed of all participants of the National Football League Combine from 2005 to 2009 who underwent magnetic resonance imaging of the knee because of prior knee injury, surgery, or knee-related symptoms or concerning examination findings. Imaging studies were reviewed for evidence of OA. History of previous knee surgery-including ACL reconstruction, meniscal procedures, and articular cartilage surgery-and position were recorded for each athlete. BMI was calculated based on height and weight. There was a higher prevalence of OA in knees with a history of previous knee surgery (23% vs 4.0%, P < 0.001). The prevalence of knee OA was 4.0% in those without previous knee surgery, 11% in those with a history of meniscus repair, 24% of those with a history of ACL reconstruction, and 27% of those with a history of partial meniscectomy. Among knees with a previous ACL reconstruction, the rate of OA doubled in tibiofemoral compartments in which meniscal surgery was performed. BMI >30 kg/m 2 was also associated with a higher risk of OA ( P = 0.007) but player position was not associated with knee OA. Previous knee surgery, particularly ACL reconstruction and partial meniscectomy, and elevated BMI are associated with knee OA in elite football players. Future research should investigate ways to minimize the risk of OA after knee surgery in these athletes. Treatment of knee injuries in football athletes should consider chondroprotection, including meniscal

  4. Meniscus Repair in Children and Adolescents: A Systematic Review of Treatment Approaches, Meniscal Healing, and Outcomes.

    PubMed

    Ferrari, Márcio Balbinotti; Murphy, Colin P; Gomes, João Luiz Ellera

    2018-05-23

    Although the consequences of traumatic meniscus tears and the importance of meniscal repair are well-established in adults, the same cannot be said for the young population. Better evidence regarding the outcomes following traumatic meniscal tears in children would improve our understanding of this increasing pathology and help define important factors in deciding the best treatment option. A systematic review was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines using the Cochrane Database of Systematic Review, Cochrane Central Register of Controlled Trials, MEDLINE Ovid, and MEDLINE PubMed databases. Inclusion criteria were as follows: studies reporting the outcomes of meniscal repair in patients 18 years old or younger, with a minimum mean follow-up of 12 months, Portuguese, Spanish, or English languages, and human studies including 10 or more patients. Our search identified 2,534 individual titles. After application of the inclusion and exclusion criteria, 8 studies were included, evaluating 287 patients with repaired meniscal tears. All eight studies were classified as level of evidence IV. The mean methodological index for nonrandomized studies score was 8.6 ± 1.4. Meniscal repair included all meniscal zones and tear patterns. Anterior cruciate ligament tear was the most common associated injury. The all-inside and inside-out techniques were predominantly reported. The majority of the patients reported good to excellent outcomes and had clinical signals of meniscal healing; meniscectomies following meniscal repair were performed in just 44 cases. In conclusion, meniscal tears in pediatrics are not uncommon. Repairs of this injury were associated with good to excellent outcomes in most patients, regardless of the injury pattern, zone, or technique. Reported complications were minimal; however, higher quality studies are needed to confirm the findings of this systematic review. This is a systematic

  5. Cationic Contrast Agent Diffusion Differs Between Cartilage and Meniscus.

    PubMed

    Honkanen, Juuso T J; Turunen, Mikael J; Freedman, Jonathan D; Saarakkala, Simo; Grinstaff, Mark W; Ylärinne, Janne H; Jurvelin, Jukka S; Töyräs, Juha

    2016-10-01

    Contrast enhanced computed tomography (CECT) is a non-destructive imaging technique used for the assessment of composition and structure of articular cartilage and meniscus. Due to structural and compositional differences between these tissues, diffusion and distribution of contrast agents may differ in cartilage and meniscus. The aim of this study is to determine the diffusion kinematics of a novel iodine based cationic contrast agent (CA(2+)) in cartilage and meniscus. Cylindrical cartilage and meniscus samples (d = 6 mm, h ≈ 2 mm) were harvested from healthy bovine knee joints (n = 10), immersed in isotonic cationic contrast agent (20 mgI/mL), and imaged using a micro-CT scanner at 26 time points up to 48 h. Subsequently, normalized X-ray attenuation and contrast agent diffusion flux, as well as water, collagen and proteoglycan (PG) contents in the tissues were determined. The contrast agent distributions within cartilage and meniscus were different. In addition, the normalized attenuation and diffusion flux were higher (p < 0.05) in cartilage. Based on these results, diffusion kinematics vary between cartilage and meniscus. These tissue specific variations can affect the interpretation of CECT images and should be considered when cartilage and meniscus are assessed simultaneously.

  6. Regeneration of meniscus tissue using adipose mesenchymal stem cells-chondrocytes co-culture on a hybrid scaffold: In vivo study.

    PubMed

    Moradi, Lida; Vasei, Mohammad; Dehghan, Mohammad M; Majidi, Mohammad; Farzad Mohajeri, Saeed; Bonakdar, Shahin

    2017-05-01

    The meniscus has poor intrinsic regenerative capacity and its damage inevitably leads to articular cartilage degeneration. We focused on evaluating the effects of Polyvinyl alcohol/Chitosan (PVA/Ch) scaffold seeded by adipose-derived mesenchymal stem cell (ASC) and articular chondrocytes (AC) in meniscus regeneration. The PVA/Ch scaffolds with different molar contents of Ch (Ch1, Ch2, Ch4 and Ch8) were cross-linked by pre-polyurethane chains. By increasing amount of Ch tensile modulus was increased from 83.51 MPa for Ch1 to 110 MPa for Ch8 while toughness showed decrease from 0.33 mJ/mm 3 in Ch1 to 0.11 mJ/mm 3 in Ch8 constructs. Moreover, swelling ratio and degradation rate increased with an increase in Ch amount. Scanning electron microscopy imaging was performed for pore size measurement and cell attachment. At day 21, Ch4 construct seeded by AC showed the highest expression with 24.3 and 22.64 folds increase in collagen II and aggrecan (p ≤ 0.05), respectively. Since, the mechanical properties, water uptake and degradation rate of Ch4 and Ch8 compositions had no statistically significant differences, Ch4 was selected for in vivo study. New Zealand rabbits were underwent unilateral total medial meniscectomy and AC/scaffold, ASC/scaffold, AC-ASC (co-culture)/scaffold and cell-free scaffold were engrafted. At 7 months post-implantation, macroscopic, histologic, and immunofluorescent studies for regenerated meniscus revealed better results in AC/scaffold group followed by AC-ASC/scaffold and ASC/scaffold groups. In the cell-free scaffold group, there was no obvious meniscus regeneration. Articular cartilages were best preserved in AC/scaffold group. The best histological score was observed in AC/scaffold group. Our results support that Ch4 scaffold seeded by AC alone can successfully regenerate meniscus in tearing injury and ASC has no significant contribution in the healing process. Copyright © 2017 Elsevier Ltd. All rights reserved.

  7. Proteoglycan 4 (PRG4) synthesis and immunolocalization in bovine meniscus.

    PubMed

    Schumacher, Barbara L; Schmidt, Tannin A; Voegtline, Michael S; Chen, Albert C; Sah, Robert L

    2005-05-01

    Proteoglycan 4 (PRG4) is synthesized and secreted into the synovial fluid by articular chondrocytes and synovial cells, lining the cavity of joints. A thin layer of PRG4 is also present at the articular surface, where it appears to be involved in boundary lubrication. This study investigated if PRG4 is also synthesized and secreted by the cells within meniscus, and if PRG4 is also present in, and at the surface of, meniscus. PRG4 was visualized in sections of bovine calf menisci by immunohistochemistry. PRG4 was detected in two regions: (1) at the femoral and tibial surfaces of the meniscus, and within cells below these surfaces; and (2) within and near cells along the radial tie fibers and circumferential fibers. From meniscus tissue harvested from these surfaces, PRG4 was extracted with 4M GuHCl and quantified by ELISA. There was 0.20 +/- 0.01 and 0.25 +/- 0.04 microg PRG4/cm(2) area of lateral and medial meniscus surface, respectively. ELISA analysis of spent medium from other samples of meniscus surface tissue incubated in medium supplemented with serum and ascorbate showed that 8.1 +/- 1.1 microg PRG4/cm(2) area of meniscus surface was secreted over six days. These results demonstrate that PRG4 is synthesized and secreted by certain cell populations in the meniscus, and that PRG4 is present in the meniscus at surfaces and also internal fibers where it may contribute to boundary lubrication.

  8. Synovial Mesenchymal Stem Cells Promote Meniscus Regeneration Augmented by an Autologous Achilles Tendon Graft in a Rat Partial Meniscus Defect Model

    PubMed Central

    Ozeki, Nobutake; Muneta, Takeshi; Matsuta, Seiya; Koga, Hideyuki; Nakagawa, Yusuke; Mizuno, Mitsuru; Tsuji, Kunikazu; Mabuchi, Yo; Akazawa, Chihiro; Kobayashi, Eiji; Saito, Tomoyuki; Sekiya, Ichiro

    2015-01-01

    Although meniscus defects and degeneration are strongly correlated with the later development of osteoarthritis, the promise of regenerative medicine strategies is to prevent and/or delay the disease's progression. Meniscal reconstruction has been shown in animal models with tendon grafting and transplantation of mesenchymal stem cells (MSCs); however, these procedures have not shown the same efficacy in clinical studies. Here, our aim was to investigate the ability of tendon grafts pretreated with exogenous synovial-derived MSCs to prevent cartilage degeneration in a rat partial meniscus defect model. We removed the anterior half of the medial meniscus and grafted autologous Achilles tendons with or without a 10-minute pretreatment of the tendon with synovial MSCs. The meniscus and surrounding cartilage were evaluated at 2, 4, and 8 weeks (n = 5). Tendon grafts increased meniscus size irrespective of synovial MSCs. Histological scores for regenerated menisci were better in the tendon + MSC group than in the other two groups at 4 and 8 weeks. Both macroscopic and histological scores for articular cartilage were significantly better in the tendon + MSC group at 8 weeks. Implanted synovial MSCs survived around the grafted tendon and native meniscus integration site by cell tracking assays with luciferase+, LacZ+, DiI+, and/or GFP+ synovial MSCs and/or GFP+ tendons. Flow cytometric analysis showed that transplanted synovial MSCs retained their MSC properties at 7 days and host synovial tissue also contained cells with MSC characteristics. Synovial MSCs promoted meniscus regeneration augmented by autologous Achilles tendon grafts and prevented cartilage degeneration in rats. Stem Cells 2015;33:1927–1938 PMID:25993981

  9. Analysis of Factors Associated With the Tear Film Lipid Layer Thickness in Normal Eyes and Patients With Dry Eye Syndrome.

    PubMed

    Jung, Ji Won; Park, Si Yoon; Kim, Jin Sun; Kim, Eung Kweon; Seo, Kyoung Yul; Kim, Tae-Im

    2016-08-01

    To determine the effects of clinical variables, including age, sex, history of refractive or cataract surgery, contact lens use, and ocular surface and meibomian gland parameters on the lipid layer thickness (LLT) in normal subjects and patients with dry eye syndrome (DES). A total of 64 normal subjects and 326 patients with DES were enrolled, and they underwent measurements of LLT with a LipiView interferometer and tear meniscus height using optical coherence tomography, tear film break-up time (TBUT) determination, ocular surface staining, Schirmer's test, examination of the lid margins and meibomian glands, and assessment using the Ocular Surface Disease Index (OSDI). In normal subjects, the median (range) LLT was 67 (33-100) nm, and age was the only factor that was significantly associated with LLT (β = 0.678, P = 0.028). In patients with DES, the median (range) LLT was 84 (20-100) nm, and 79.0% of the participants fulfilled the diagnostic criteria for meibomian gland dysfunction (MGD). In a multivariate analysis, increased age and female sex were significantly related to increased LLT (β = 0.282, P = 0.005 and β = 11.493, P < 0.001), and hypersecretory MGD and lid margin inflammation were independently associated with increased LLT (β = 11.299, P = 0.001 and β = 12.747, P = 0.001). Lipid layer thickness measurements using a new interferometer are significantly affected by demographic factors such as age, sex, ocular surgical history, and MGD type. Therefore, all of these factors must be considered in the diagnosis of ocular surface diseases.

  10. Nociceptive and sympathetic innervations in the abaxial part of the cranial horn of the equine medial meniscus: an immunohistochemical approach.

    PubMed

    Nemery, Elodie; Gabriel, Annick; Piret, Joëlle; Antoine, Nadine

    2016-12-01

    In athletic horses, diseases leading to lameness are of great importance due to the loss of performance and the resultant economic concerns. Although stifle lesions are frequent in the hindlimb, due to the large size and complexity of the joint, and although meniscal tears have been identified as the most common soft tissue injuries in this joint, little is known about the mechanism that causes the painful sensation and thus the lameness. The aim of our study was to highlight any peripheral fibres involved in meniscal nociception in five macroscopically sound cranial horns of the equine medial meniscus, which has been one of the most common sites reported for equine meniscal injuries. Immunohistochemical stainings were performed using antibodies against Substance P in order to identify nociceptive fibres; against tyrosine hydroxylase for detecting postganglionic sympathetic fibres; and against glial fibrillary acidic proteins in order to identify Schwann cells. Our work highlights for the first time the presence of nociceptive and sympathetic fibres in equine menisci. They were found in the abaxial part of the cranial horn of the equine medial meniscus. This study suggests that when the abaxial part is injured, the meniscus itself could be the source of pain. These findings could provide a better understanding of the clinical presentation of horses with meniscal injury and contribute towards improving therapeutic strategies to alleviate pain in cases of equine meniscal injury. © 2016 Anatomical Society.

  11. Predicting success with silicone-hydrogel contact lenses in new wearers.

    PubMed

    Best, Nigel; Drury, Laura; Wolffsohn, James S

    2013-10-01

    to evaluate changes in tear metrics and ocular signs induced by six months of silicone-hydrogel contact lens wear and the difference in baseline characteristics between those who successfully continued in contact lens wear compared to those that did not. Non-invasive Keratograph, Tearscope and fluorescein tear break-up times (TBUTs), tear meniscus height, bulbar and limbal hyperaemia, lid-parallel conjunctival folds (LIPCOF), phenol red thread, fluorescein and lissamine-green staining, and lid wiper epitheliopathy were measured on 60 new contact lens wearers fitted with monthly silicone-hydrogels (average age 36±14 years, 40 females). Symptoms were evaluated by the Ocular Surface Disease Index (OSDI). After six months full time contact lens wear the above metrics were re-measured on those patients still in contact lens wear (n=33). The initial measurements were also compared between the group still wearing lenses after six months and those who had ceased lens wear (n=27). There were significant changes in tear meniscus height (p=0.031), bulbar hyperaemia (p=0.011), fluorescein TBUT (p=0.027), corneal (p=0.007) and conjunctival (p=0.009) staining, LIPCOF (p=0.011) and lid wiper epitheliopathy (p=0.002) after six months of silicone-hydrogel wear. Successful wearers had a higher non-invasive (17.0±8.2s vs 12.0±5.6s; p=0.001) and fluorescein (10.7±6.4s vs 7.5±4.7s; p=0.001) TBUT than drop-outs, although OSDI (cut-off 4.2) was also a strong predictor of success. Silicone-hydrogel lenses induced significant changes in the tear film and ocular surface as well as lid margin staining. Wettability of the ocular surface is the main factor affecting contact lens drop-out. Copyright © 2013 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.

  12. Digital-Micromirror-Device Projection Printing System for Meniscus Tissue Engineering

    PubMed Central

    Grogan, Shawn P; Chung, Peter H; Soman, Pranav; Chen, Peter; Lotz, Martin K; Chen, Shaochen; D’Lima, Darryl D

    2013-01-01

    Meniscus degeneration due to age or injury can lead to osteoarthritis. Though promising, current cell-based approaches show limited success. Here we present three-dimensional methacrylated gelatin (GelMA) scaffolds patterned via projection stereolithography to emulate the circumferential alignment of cells in native meniscus tissue. Cultured human avascular zone meniscus cells from normal meniscus were seeded on the scaffolds. Cell viability was monitored, and neo-tissue formation was assessed by gene expression analysis and histology after two weeks in serum free culture with TGFβ1 (10ng/ml). Light, confocal and scanning electron microscopy was used to observe cell/GelMA interactions. Tensile mechanical testing was performed on unseeded, fresh scaffolds and two-week old cell-seeded and unseeded scaffolds. Two-week old cell/GelMA constructs were implanted into surgically created meniscus defects in an explant organ culture model. No cytotoxic effects were observed three weeks after implantation, and cells grew and aligned to the patterned GelMA strands. Gene expression profiles and histology indicated promotion of a fibrocartilage-like meniscus phenotype, and scaffold integration with repair tissue was observed in the explant model. We show that micropatterned GelMA scaffolds are non-toxic, produce organized cellular alignment, and promote meniscus-like tissue formation. Prefabrication of GelMA scaffolds with architectures mimicking meniscus collagen bundle organization shows promise for meniscal repair. Furthermore, the technique presented may be scaled to repair larger defects. PMID:23523536

  13. Survivorship Analysis and Clinical Outcomes of Transtibial Pullout Repair for Medial Meniscus Posterior Root Tears: A 5- to 10-Year Follow-up Study.

    PubMed

    Chung, Kyu Sung; Noh, June Mo; Ha, Jeong Ku; Ra, Ho Jong; Park, Sung Bae; Kim, Hyung Kook; Kim, Jin Goo

    2018-02-01

    This study investigated the clinical outcomes and mid- to long-term survival rates in patients undergoing transtibial pullout repair of medial meniscus posterior root tears (MMPRTs) after a minimum follow-up of 5 years. Between 2005 and 2011, patients with MMPRTs who had been followed for at least 5 years after undergoing transtibial pullout repair were recruited. Participants were identified using medical records and information in a prospectively collected database. Clinical outcomes were assessed based on a comparison of patient preoperative Lysholm scores and their scores at the final follow-up. A Kaplan-Meier survival analysis was used to investigate the survival rates of repair procedures. Clinical failures were defined as cases requiring conversion to total knee arthroplasty (TKA) or having final Lysholm score <65 or less than their preoperative scores. Overall, 91 patients (mean age, 58.7 ± 9.7 years) were included: the mean follow-up duration was 84.8 ± 13.8 months. Among these patients, the mean Lysholm score improved significantly from 51.8 ± 7.9 preoperatively to 83.0 ± 11.1 at the final follow-up (P < .001). Overall, 4 patients failed due to conversion to TKA (n = 1) or having final Lysholm scores <65 or less than the preoperative scores (n = 3). The overall Kaplan-Meier probabilities of survival after repair were 99% at 5 years, 98% at 6 years, 95% at 7 years, and 92% at 8 years. Among patients with MMPRTs, transtibial pullout repair demonstrated a high clinical survival rate and the patients demonstrated clinical improvement, based on mid- and long-term follow-up examinations. Level IV, retrospective uncontrolled case series. Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  14. Digital micromirror device projection printing system for meniscus tissue engineering.

    PubMed

    Grogan, Shawn P; Chung, Peter H; Soman, Pranav; Chen, Peter; Lotz, Martin K; Chen, Shaochen; D'Lima, Darryl D

    2013-07-01

    Meniscus degeneration due to age or injury can lead to osteoarthritis. Although promising, current cell-based approaches show limited success. Here we present three-dimensional methacrylated gelatin (GelMA) scaffolds patterned via projection stereolithography to emulate the circumferential alignment of cells in native meniscus tissue. Cultured human avascular zone meniscus cells from normal meniscus were seeded on the scaffolds. Cell viability was monitored, and new tissue formation was assessed by gene expression analysis and histology after 2weeks in serum-free culture with transforming growth factor β1 (10ngml(-1)). Light, confocal and scanning electron microscopy were used to observe cell-GelMA interactions. Tensile mechanical testing was performed on unseeded, fresh scaffolds and 2-week-old cell-seeded and unseeded scaffolds. 2-week-old cell-GelMA constructs were implanted into surgically created meniscus defects in an explant organ culture model. No cytotoxic effects were observed 3weeks after implantation, and cells grew and aligned to the patterned GelMA strands. Gene expression profiles and histology indicated promotion of a fibrocartilage-like meniscus phenotype, and scaffold integration with repair tissue was observed in the explant model. We show that micropatterned GelMA scaffolds are non-toxic, produce organized cellular alignment, and promote meniscus-like tissue formation. Prefabrication of GelMA scaffolds with architectures mimicking the meniscus collagen bundle organization shows promise for meniscal repair. Furthermore, the technique presented may be scaled up to repair larger defects. Copyright © 2013 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

  15. Structure and microanalysis of tear film ferning of camel tears, human tears, and Refresh Plus.

    PubMed

    Am, Masmali; Ra, Fagehi; El-Naggar, Ahmad H; Tm, Almubrad

    2018-01-01

    This study aimed to investigate the tear ferning pattern and chemical elements of the tear film of camel tears compared with human tears and Refresh Plus eye lubricant. Refresh Plus was used as a control because it provides a healthy ferning pattern, due to the presence of an optimum ratio of carboxymethylcellulose (CMC) sodium and electrolytes. The main research focus is elucidating the viability of camel tear film in the dry, harsh environment of the desert. The tears were collected from five camels, five male desert workers (20-25 years old) at a small village located 100 km from Riyadh, Saudi Arabia, and five male subjects (20-25 years old) from Riyadh. A small drop (1 μl) of tears was dried on a glass slide and observed under a light (Olympus BX1) and scanning electron microscope (Inspect S50, Field Electron and Ion Company [FEI]). Energy-dispersive X-ray spectroscopy (EDS) of the tear film and Refresh Plus were investigated with a JEOL 1400 scanning transmission electron microscope. The camel tear film pattern was surrounded by thick, peripheral, homogenous layers containing small oily droplets, particles, and tiny branches in the tear ferning. The tear ferning of the camel was grade 0-1, whereas the tear ferning of human tears and Refresh Plus was grade 1-2. The mass percentage of chloride was highest in the camel tears. The mass percentage of potassium in the camel tears was greater than that in the human tears, but it was less than that in the Refresh Plus lubricant. Camel tears exhibit a better quality than human tears and Refresh Plus lubricant do. The presence of oily droplet-like structures at the periphery of tear ferning suggests that camel tear film may have a higher quality and quantity of minerals and lubricants, which may help the animal to avoid eye dryness. Future work is required to investigate the identification of the elements present in the peripheral and central part of the tear ferning.

  16. Healing potential of transplanted allogeneic chondrocytes of three different sources in lesions of the avascular zone of the meniscus: a pilot study.

    PubMed

    Weinand, Christian; Peretti, Giuseppe M; Adams, Samuel B; Randolph, Mark A; Savvidis, Estafios; Gill, Thomas J

    2006-11-01

    Successful treatment of tears to the avascular region of the meniscus remains a challenge. Current repair techniques, such as sutures and anchors, are effective in stabilizing the peripheral, vascularized regions of the meniscus, but are not adequate for promoting healing in the avascular region. The purpose of this study was to demonstrate the healing ability of a tissue-engineered repair technique using allogenic chondrocytes from three different sources for the avascular zone of the meniscus. Articular, auricular, and costal chondrocytes were harvested from 3-month-old Yorkshire swine. A 1-cm bucket-handle lesion was created in the avascular zone of each three swine. A cell-scaffold construct, composed of a single chondrocyte cell type and Vicryl mesh, was implanted into the lesion and secured with two vertical mattress sutures. Controls consisted of each three sutured unseeded mesh implants, suture only, and untreated lesions. The swine were allowed immediate post-operative full weight bearing. Menisci and controls were harvested after 12 weeks. In all experimental samples, lesion closure was observed. Gross mechanical testing with two Adson forceps demonstrated bonding of the lesion. Histological analysis showed formation of new tissue in all three experimental samples. None of the control samples demonstrated closure and formation of new matrix. We present preliminary data that demonstrates the potential of a tissue-engineered, allogenic cellular repair to provide successful healing of lesions in the avascular zone in a large animal model.

  17. Interferometer for measuring the dynamic surface topography of a human tear film

    NASA Astrophysics Data System (ADS)

    Primeau, Brian C.; Greivenkamp, John E.

    2012-03-01

    The anterior refracting surface of the eye is the thin tear film that forms on the surface of the cornea. Following a blink, the tear film quickly smoothes and starts to become irregular after 10 seconds. This irregularity can affect comfort and vision quality. An in vivo method of characterizing dynamic tear films has been designed based upon a near-infrared phase-shifting interferometer. This interferometer continuously measures light reflected from the tear film, allowing sub-micron analysis of the dynamic surface topography. Movies showing the tear film behavior can be generated along with quantitative metrics describing changes in the tear film surface. This tear film measurement allows analysis beyond capabilities of typical fluorescein visual inspection or corneal topography and provides better sensitivity and resolution than shearing interferometry methods. The interferometer design is capable of identifying features in the tear film much less than a micron in height with a spatial resolution of about ten microns over a 6 mm diameter. This paper presents the design of the tear film interferometer along with the considerations that must be taken when designing an interferometer for on-eye diagnostics. Discussions include eye movement, design of null optics for a range of ocular geometries, and laser emission limits for on-eye interferometry.

  18. Arthroscopic suture anchor repair versus pullout suture repair in posterior root tear of the medial meniscus: a prospective comparison study.

    PubMed

    Kim, Jae-Hwa; Chung, Ju-Hwan; Lee, Dong-Hoon; Lee, Yoon-Seok; Kim, Jung-Ryul; Ryu, Keun-Jung

    2011-12-01

    To evaluate functional and radiographic results of arthroscopic suture anchor repair for posterior root tear of the medial meniscus (PRTMM) and compare with pullout suture repair. From December 2006 to August 2008, 51 consecutive patients underwent arthroscopic repair of PRTMM at our hospital. The repair technique was switched over time from pullout suture repair (group 1) to suture anchor repair (group 2). Of the patients, 6 were lost to follow-up, leaving a study population of 45 patients, with 22 menisci (48.9%) in group 1 and 23 (51.1%) menisci in group 2. The mean follow-up duration was 25.9 months (range, 24 to 27 months) in group 1 and 26.8 months (range, 24 to 28 months) in group 2. Compared variables included International Knee Documentation Committee criteria, Kellgren-Lawrence grade, gap distance at PRTMM, structural healing, meniscal extrusion, and cartilage degeneration of the medial femoral condyle. At 2 years postoperatively, both groups showed significant improvements in function (P < .05) and did not show significant differences in Kellgren-Lawrence grade (P > .05) compared with preoperatively. On magnetic resonance imaging, the gap distance at PRTMM was 3.2 ± 1.1 mm in group 1 and 2.9 ± 0.9 mm in group 2 preoperatively (P > .05). Complete structural healing was seen in 11 cases in group 1 and 12 cases in group 2 (P > .05). Mean meniscal extrusion of 4.3 ± 0.9 mm (group 1) and 4.1 ± 1.0 mm (group 2) preoperatively was significantly decreased to 2.1 ± 1.0 mm (group 1) and 2.2 ± 0.8 mm (group 2) postoperatively (P < .05). Regardless of repair technique, incompletely healed cases showed progression of cartilage degeneration (4 cases in group 1 and 2 cases in group 2). For PRTMM, our results show significant functional improvement in both the suture anchor repair and pullout suture repair groups. Reduction of meniscal extrusion seems to be appropriate to preserve its protective role against progression of cartilage degeneration after complete

  19. Meniscus repair using mesenchymal stem cells - a comprehensive review.

    PubMed

    Yu, Hana; Adesida, Adetola B; Jomha, Nadr M

    2015-04-30

    The menisci are a pair of semilunar fibrocartilage structures that play an essential role in maintaining normal knee function. Injury to the menisci can disrupt joint stability and lead to debilitating results. Because natural meniscal healing is limited, an efficient method of repair is necessary. Tissue engineering (TE) combines the principles of life sciences and engineering to restore the unique architecture of the native meniscus. Mesenchymal stem cells (MSCs) have been investigated for their therapeutic potential both in vitro and in vivo. This comprehensive review examines the English literature identified through a database search using Medline, Embase, Engineering Village, and SPORTDiscus. The search results were classified based on MSC type, animal model, and method of MSC delivery/culture. A variety of MSC types, including bone marrow-derived, synovium-derived, adipose-derived, and meniscus-derived MSCs, has been examined. Research results were categorized into and discussed by the different animal models used; namely murine, leporine, porcine, caprine, bovine, ovine, canine, equine, and human models of meniscus defect/repair. Within each animal model, studies were categorized further according to MSC delivery/culture techniques. These techniques included direct application, fibrin glue/gel/clot, intra-articular injection, scaffold, tissue-engineered construct, meniscus tissue, pellets/aggregates, and hydrogel. The purpose of this review is to inform the reader about the current state and advances in meniscus TE using MSCs. Future directions of MSC-based meniscus TE are also suggested to help guide prospective research.

  20. [How good are clinical investigative procedures for diagnosing meniscus lesions?].

    PubMed

    Jerosch, J; Riemer, S

    2004-06-01

    The purpose of this study was to evaluate different clinical meniscus tests. During 13 months we evaluated 64 patients with a suspected meniscus lesion in a prospective study. The age ranged from 16 to 76 years (average: 38.5 years). 66 % were male patients. Between the clinical examination and the arthroscopy there was no additional trauma to the knee. All patients were clinically examined in a standard manner by two independent orthopaedic surgeons. Clinical findings of the menisci were documented according to 12 well-described and commonly used meniscus tests. The arthroscopy was performed by a single surgeon who was not aware of the results of the clinical examination. This surgeon documented the intraarticular findings in a standardized operating report. A meniscus lesion/degeneration was documented when this was evident either by inspection or by palpation. The results showed either clinical meniscus tests with a high specificity and a low sensitivity or tests with a high sensitivity, but only a low specificity. We were not able to identify meniscus tests which showed both a high sensitivity and a high specificity. Even with access to MRI the clinical findings in knee joint with injured menisci still have a high diagnostic value. However, it seems to be necessary to combine different tests.

  1. Changes of rabbit meniscus influenced by hyaline cartilage injury of osteoarthritis.

    PubMed

    Zhao, Jiajun; Huang, Suizhu; Zheng, Jia; Zhong, Chunan; Tang, Chao; Zheng, Lei; Zhang, Zhen; Xu, Jianzhong

    2014-01-01

    Osteoarthritis (OA) is a common disease in the elderly population. Most of the previous OA-related researches focused on articular cartilage degeneration, osteophyte formation and synovitis etc. However, the role of the meniscus in these pathological changes has not been given enough attention. The goal of our study was to find the pathological changes of the meniscus in OA knee and determine their relationship. 20 months old female Chinese rabbits received either knee damaging operations with articular cartilage scratch method or sham operation randomly on one of their knees. They were sacrificed after 1-6 weeks post-operation. Medial Displacement Index (MDI) for meniscus dislocation, hematoxylin and eosin (HE) for routine histological evaluation, Toluidine blue (TB) stains for evaluating proteoglycans were carried out. Immunohistochemical (IHC) staining was performed with a two-step detection kit. Histological analysis showed chondrocyte clusters around cartilage lesions and moderate loss of proteoglycans in the operation model, as well as MDI increase and all characteristics of OA. High expression of MMP-3 and TIMP-1 also were found in both hyaline cartilage and meniscus. Biomechanical and biochemistry environment around the meniscus is altered when OA occur. If meniscus showed degeneration, subluxation and dysfunction, OA would be more severe. Prompt repair or reconstruction of hyaline cartilage in weight bearing area when it injured could prevent meniscus degeneration and subluxation, then prevent the development of OA.

  2. [Meniscus transplantation as an option in case of painful arthrosis following meniscectomy].

    PubMed

    van Arkel, E R

    2004-01-17

    The menisci play a role as shock absorbers and distribute the pressure uniformly over the joint cartilage. Other functions are: the nutrition of the joint cartilage, secondary stability and proprioception. In case of a torn meniscus, one should first attempt to suture the meniscus, followed by arthroscopic partial meniscectomy if suturing is impossible. In a large proportion of patients, arthrosis with pain and loss of function of the knee develops several years after the meniscectomy. In order to alleviate the symptoms of such arthrosis, a trial of meniscus transplantation was undertaken. In two long-term studies without a control group, the results of meniscus transplantation were reasonable. The results of medial meniscus transplantation are dependent upon the presence of an intact anterior cruciate ligament. The accepted indication for meniscus transplantation after meniscectomy is: disabling pain following (sub)total meniscectomy in a patient younger than 45-50 years of age with a normal alignment and a stable knee joint.

  3. Biological augmentation and tissue engineering approaches in meniscus surgery.

    PubMed

    Moran, Cathal J; Busilacchi, Alberto; Lee, Cassandra A; Athanasiou, Kyriacos A; Verdonk, Peter C

    2015-05-01

    The purpose of this review was to evaluate the role of biological augmentation and tissue engineering strategies in meniscus surgery. Although clinical (human), preclinical (animal), and in vitro tissue engineering studies are included here, we have placed additional focus on addressing preclinical and clinical studies reported during the 5-year period used in this review in a systematic fashion while also providing a summary review of some important in vitro tissue engineering findings in the field over the past decade. A search was performed on PubMed for original works published from 2009 to March 31, 2014 using the term "meniscus" with all the following terms: "scaffolds," "constructs," "cells," "growth factors," "implant," "tissue engineering," and "regenerative medicine." Inclusion criteria were the following: English-language articles and original clinical, preclinical (in vivo), and in vitro studies of tissue engineering and regenerative medicine application in knee meniscus lesions published from 2009 to March 31, 2014. Three clinical studies and 18 preclinical studies were identified along with 68 tissue engineering in vitro studies. These reports show the increasing promise of biological augmentation and tissue engineering strategies in meniscus surgery. The role of stem cell and growth factor therapy appears to be particularly useful. A review of in vitro tissue engineering studies found a large number of scaffold types to be of promise for meniscus replacement. Limitations include a relatively low number of clinical or preclinical in vivo studies, in addition to the fact there is as yet no report in the literature of a tissue-engineered meniscus construct used clinically. Neither does the literature provide clarity on the optimal meniscus scaffold type or biological augmentation with which meniscus repair or replacement would be best addressed in the future. There is increasing focus on the role of mechanobiology and biomechanical and

  4. Both Posterior Root Lateral-Medial Meniscus Tears With Anterior Cruciate Ligament Rupture: The Step-by-Step Systematic Arthroscopic Repair Technique.

    PubMed

    Chernchujit, Bancha; Prasetia, Renaldi

    2017-10-01

    The occurrence of posterior root tear of both the lateral and medial menisci, combined with anterior cruciate ligament rupture, is rare. Problems may be encountered such as the difficulty to access the medial meniscal root tear, the confusing circumstances about which structure to repair first, and the possibility of the tunnel for each repair to become taut inside the tibial bone. We present the arthroscopy technique step by step to overcome the difficulties in an efficient and time-preserving manner.

  5. High-grade rotatory knee laxity may be predictable in ACL injuries.

    PubMed

    Musahl, Volker; Burnham, Jeremy; Lian, Jayson; Popchak, Adam; Svantesson, Eleonor; Kuroda, Ryosuke; Zaffagnini, Stefano; Samuelsson, Kristian

    2018-06-21

    Lateral compartment acceleration and translation have been used to quantify rotatory knee laxity in the setting of anterior cruciate ligament (ACL) injury; however, their relationship remains elusive. The purpose of this study was to examine the correlation between lateral compartment acceleration and translation during pivot shift testing. It was hypothesized that a correlation would exist in ACL-injured and uninjured knees, irrespective of sex, but would be greatest in knees with combined ACL and lateral meniscus tear. Seventy-seven patients (34 females, 25.2 ± 9.0 years) undergoing primary single-bundle ACL reconstruction were prospectively enrolled in a 2-year study across four international centers. Patients underwent preoperative examination under anesthesia of the injured and uninjured knee using Image Analysis software and surface mounted accelerometer. A moderate correlation between lateral compartment acceleration and translation was observed in ACL-injured knees [ρ = 0.36, p < 0.05), but not in uninjured knees (ρ = 0.17, not significant (n.s.)]. A moderate correlation between acceleration and translation was demonstrated in ACL-injured knees with lateral meniscus tears (ρ = 0.53, p < 0.05), but not in knees with isolated ACL-injury (ρ = 0.32, n.s.), ACL and medial meniscus tears (ρ = 0.14, n.s.), or ACL and combined medial and lateral meniscus tears (ρ = 0.40, n.s.). A moderate correlation between acceleration and translation was seen in males (ρ = 0.51, p < 0.05), but not in females (ρ = 0.21, n.s.). Largest correlations were observed in males with ACL and lateral meniscus tears (ρ = 0.75, p < 0.05). Lateral compartment acceleration and translation were moderately correlated in ACL-injured knees, but largely correlated in males with combined ACL and lateral meniscus tears. ACL and lateral meniscus injury in males might, therefore, be suspected when both lateral compartment acceleration

  6. Diagnosis of the "large medial meniscus" of the knee on MR imaging.

    PubMed

    Samoto, Nobuhiko; Kozuma, Masakazu; Tokuhisa, Toshio; Kobayashi, Kunio

    2006-11-01

    Although several quantitative magnetic resonance (MR) diagnostic criteria for discoid lateral meniscus (DLM) have been described, there are no criteria by which to estimate the size of the medial meniscus. We define a medial meniscus that exceeds the normal size as a "large medial meniscus" (LMM), and the purpose of this study is to establish the quantitative MR diagnostic criteria for LMM. The MR imaging findings of 96 knees with arthroscopically confirmed intact semilunar lateral meniscus (SLM), 18 knees with intact DLM, 105 knees with intact semilunar medial meniscus (SMM) and 4 knees with torn LMM were analyzed. The following three quantitative parameters were measured: (a) meniscal width (MW): the minimum MW on the coronal slice; (b) ratio of the meniscus to the tibia (RMT): the ratio of minimum MW to maximum tibial width on the coronal slice; (c) continuity of the anterior and posterior horns (CAPH): the number of consecutive 5-mm-thick sagittal slices showing continuity between the anterior horn and the posterior horn of the meniscus on sagittal slices. Using logistic discriminant analysis between intact SLM and DLM groups and using descriptive statistics of intact SLM and SMM groups, the cutoff values used to discriminate LMM from SMM were calculated by MW and RMT. Moreover, the efficacy of these cutoff values and three slices of the cutoff values for CAPH were estimated in the medial meniscus group. "MW> or =11 mm" and "RMT> or =15%" were determined to be effective diagnostic criteria for LMM, while three of four cases in the torn LMM group were true positives and specificity was 99% in both criteria. When "CAPH> or =3 slices" was used as a criterion, three of four torn LMM cases were true positives and specificity was 93%.

  7. Comparison of Clinical and Radiologic Results Between Partial Meniscectomy and Refixation of Medial Meniscus Posterior Root Tears: A Minimum 5-Year Follow-up.

    PubMed

    Chung, Kyu Sung; Ha, Jeong Ku; Yeom, Cheol Hyun; Ra, Ho Jong; Jang, Ho Su; Choi, Seung Hyuk; Kim, Jin Goo

    2015-10-01

    To compare the clinical and radiologic results of partial meniscectomy with those of refixation in patients with medial meniscus posterior root tears (MMPRTs) at a minimum 5-year follow-up. Between 2005 and 2009, patients with MMPRTs who had been followed up for at least 5 years after a partial meniscectomy (group M, n = 20) or pullout repair (group R, n = 37) were recruited. The mean follow-up duration was 67.5 months in group M and 72.0 months in group R. Clinical assessments, including the Lysholm score and International Knee Documentation Committee (IKDC) Subjective Knee Form score, and radiographic assessments, including the Kellgren-Lawrence (K-L) grade and medial joint space width, were evaluated preoperatively and at final follow-up. We compared the preoperative results with the final results in each group, and we compared the final results of groups M and R. Five-year survival rates were also evaluated. The mean Lysholm score (P = .039) and IKDC score (P = .037) improved significantly. However, the width of the medial joint space (P < .001) and K-L grade (P < .001) worsened significantly in both groups. When we compared the final results, group R had significantly better Lysholm scores (P = .002) and IKDC scores (P < .001) than group M. Group R showed less K-L grade progression (P = .005) and less medial joint space narrowing (P < .001) than group M. The rate of conversion to total knee arthroplasty was 35% in group M, whereas there was no conversion to total knee arthroplasty in group R. The 5-year survival rates in groups M and R were 75% and 100%, respectively (P < .001). For MMPRTs, refixation was more effective than partial meniscectomy in terms of the clinical and radiologic outcomes and survival for at least 5 years' follow-up. Refixation slowed the progression of arthritic changes compared with partial meniscectomy, although it did not prevent the progression of arthrosis completely. Level III, retrospective comparative study. Copyright

  8. Arthroscopic meniscal repair with use of the outside-in technique.

    PubMed

    Rodeo, S A

    2000-01-01

    The outside-in technique of arthroscopic repair is effective for repair of most meniscal tears. The overall indications for the use of this technique are similar to those for the commonly used inside-out technique. The outside-in technique is especially useful for suturing the anterior horn of the meniscus as well as for suturing meniscal replacement devices such as a collagen meniscal implant or a meniscal allograft. Other specific advantages of this technique include the ability to predictably avoid neurovascular injury without the need for a large posterior incision. A particular disadvantage is the difficulty of achieving perpendicular orientation of sutures when a tear is adjacent to the site of attachment of the posterior horn. Use of the inside-out technique or an all-inside implant is suggested for these tears. The use of this suturing technique is facilitated by attention to several technical points. The knee should be maintained in flexion for repair of tears of the lateral meniscus (to avoid injury to the peroneal nerve) and in nearly full extension for repair of the posterior aspect of the medial meniscus (to avoid injury to the saphenous nerve and its branches). Care must be taken to avoid tying the sutures around a branch of the saphenous nerve during repair of the medial meniscus. The sutures should be retrieved through a cannula in the anterior portal to avoid the entrapment of the sutures in soft tissue. A probe can be used to prevent displacement of the inner fragment of a bucket handle tear when the needles are placed across the tear, as the entering needles may push the torn fragment into the knee. A vertical suture orientation is preferred in order to evenly co-apt the meniscus to the capsule. If knot-end sutures (so-called Mulberry knots) are used, 2 sutures can be vertically stacked, with 1 on each surface of the meniscus. If a mattress suture is used, a vertical orientation is easily achieved with the outside-in technique. Use of an

  9. Transplantation of autologous synovial mesenchymal stem cells promotes meniscus regeneration in aged primates.

    PubMed

    Kondo, Shimpei; Muneta, Takeshi; Nakagawa, Yusuke; Koga, Hideyuki; Watanabe, Toshifumi; Tsuji, Kunikazu; Sotome, Shinichi; Okawa, Atsushi; Kiuchi, Shinji; Ono, Hideo; Mizuno, Mitsuru; Sekiya, Ichiro

    2017-06-01

    Transplantation of aggregates of synovial mesenchymal stem cells (MSCs) enhanced meniscus regeneration in rats. Anatomy and biological properties of the meniscus depend on animal species. To apply this technique clinically, it is valuable to investigate the use of animals genetically close to humans. We investigated whether transplantation of aggregates of autologous synovial MSCs promoted meniscal regeneration in aged primates. Chynomolgus primates between 12 and 13 years old were used. After the anterior halves of the medial menisci in both knees were removed, an average of 14 aggregates consisting of 250,000 synovial MSCs were transplanted onto the meniscus defect. No aggregates were transplanted to the opposite knee for the control. Meniscus and articular cartilage were analyzed macroscopically, histologically, and by MRI T1rho mapping at 8 (n = 3) and 16 weeks (n = 4). The medial meniscus was larger and the modified Pauli's histological score for the regenerated meniscus was better in the MSC group than in the control group in each primate at 8 and 16 weeks. Mankin's score for the medial femoral condyle cartilage was better in the MSC group than in the control group in all primates at 16 weeks. T1rho value for both the regenerated meniscus and adjacent articular cartilage in the MSC group was closer to the normal meniscus than in the control group in all primates at 16 weeks. Transplantation of aggregates of autologous synovial MSCs promoted meniscus regeneration and delayed progression of degeneration of articular cartilage in aged primates. This is the first report dealing with meniscus regeneration in primates. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1274-1282, 2017. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  10. Tendon and ligament as novel cell sources for engineering the knee meniscus.

    PubMed

    Hadidi, P; Paschos, N K; Huang, B J; Aryaei, A; Hu, J C; Athanasiou, K A

    2016-12-01

    The application of cell-based therapies in regenerative medicine is hindered by the difficulty of acquiring adequate numbers of competent cells. For the knee meniscus in particular, this may be solved by harvesting tissue from neighboring tendons and ligaments. In this study, we have investigated the potential of cells from tendon and ligament, as compared to meniscus cells, to engineer scaffold-free self-assembling fibrocartilage. Self-assembling meniscus-shaped constructs engineered from a co-culture of articular chondrocytes and either meniscus, tendon, or ligament cells were cultured for 4 weeks with TGF-β1 in serum-free media. After culture, constructs were assessed for their mechanical properties, histological staining, gross appearance, and biochemical composition including cross-link content. Correlations were performed to evaluate relationships between biochemical content and mechanical properties. In terms of mechanical properties as well as biochemical content, constructs engineered using tenocytes and ligament fibrocytes were found to be equivalent or superior to constructs engineered using meniscus cells. Furthermore, cross-link content was found to be correlated with engineered tissue tensile properties. Tenocytes and ligament fibrocytes represent viable cell sources for engineering meniscus fibrocartilage using the self-assembling process. Due to greater cross-link content, fibrocartilage engineered with tenocytes and ligament fibrocytes may maintain greater tensile properties than fibrocartilage engineered with meniscus cells. Copyright © 2016 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

  11. Tendon and ligament as novel cell sources for engineering the knee meniscus

    PubMed Central

    Hadidi, Pasha; Paschos, Nikolaos K.; Huang, Brian J.; Aryaei, Ashkan; Hu, Jerry C.; Athanasiou, Kyriacos A.

    2016-01-01

    Objective The application of cell-based therapies in regenerative medicine is hindered by the difficulty of acquiring adequate numbers of competent cells. For the knee meniscus in particular, this may be solved by harvesting tissue from neighboring tendons and ligaments. In this study, we have investigated the potential of cells from tendon and ligament, as compared to meniscus cells, to engineer scaffold-free self-assembling fibrocartilage. Method Self-assembling meniscus-shaped constructs engineered from a co-culture of articular chondrocytes and either meniscus, tendon, or ligament cells were cultured for 4 weeks with TGF-β1 in serum-free media. After culture, constructs were assessed for their mechanical properties, histological staining, gross appearance, and biochemical composition including cross-link content. Correlations were performed to evaluate relationships between biochemical content and mechanical properties. Results In terms of mechanical properties as well as biochemical content, constructs engineered using tenocytes and ligament fibrocytes were found to be equivalent or superior to constructs engineered using meniscus cells. Furthermore, cross-link content was found to be correlated with engineered tissue tensile properties. Conclusion Tenocytes and ligament fibrocytes represent viable cell sources for engineering meniscus fibrocartilage using the self-assembling process. Due to greater cross-link content, fibrocartilage engineered with tenocytes and ligament fibrocytes may maintain greater tensile properties than fibrocartilage engineered with meniscus cells. PMID:27473559

  12. Biomechanical Properties of Murine Meniscus Surface via AFM-based Nanoindentation

    PubMed Central

    Li, Qing; Doyran, Basak; Gamer, Laura W.; Lu, X. Lucas; Qin, Ling; Ortiz, Christine; Grodzinsky, Alan J.; Rosen, Vicki; Han, Lin

    2015-01-01

    This study aimed to quantify the biomechanical properties of murine meniscus surface. Atomic force microscopy (AFM)-based nanoindentation was performed on the central region, proximal side of menisci from 6- to 24-week old male C57BL/6 mice using microspherical tips (Rtip ≈ 5 μm) in PBS. A unique, linear correlation between indentation depth, D, and response force, F, was found on menisci from all age groups. This non-Hertzian behavior is likely due to the dominance of tensile resistance by the collagen fibril bundles on meniscus surface that are mostly aligned along the circumferential direction observed on 12-week old menisci. The indentation resistance was calculated as both the effective stiffness, Sind = dF/dD, and the effective modulus, Eind, via the isotropic Hertz model. Values of Sind and Eind were found to depend on indentation rate, suggesting the existence of poro-viscoelasticity. These values do not significantly vary with anatomical sites, lateral versus medial compartments, or mouse age. In addition, Eind of meniscus surface (e.g., 6.1 ± 0.8 MPa for 12 weeks of age, mean ± SEM, n = 13) was found to be significantly higher than those of meniscus surfaces in other species, and of murine articular cartilage surface (1.4 ± 0.1 MPa, n = 6). In summary, these results provided the first direct mechanical knowledge of murine knee meniscus tissues. We expect this understanding to serve as a mechanics-based benchmark for further probing the developmental biology and osteoarthritis symptoms of meniscus in various murine models. PMID:25817332

  13. The Influence of Articular Cartilage Thickness Reduction on Meniscus Biomechanics

    PubMed Central

    Łuczkiewicz, Piotr; Daszkiewicz, Karol; Chróścielewski, Jacek; Witkowski, Wojciech; Winklewski, Pawel J.

    2016-01-01

    Objective Evaluation of the biomechanical interaction between meniscus and cartilage in medial compartment knee osteoarthritis. Methods The finite element method was used to simulate knee joint contact mechanics. Three knee models were created on the basis of knee geometry from the Open Knee project. We reduced the thickness of medial cartilages in the intact knee model by approximately 50% to obtain a medial knee osteoarthritis (OA) model. Two variants of medial knee OA model with congruent and incongruent contact surfaces were analysed to investigate the influence of congruency. A nonlinear static analysis for one compressive load case was performed. The focus of the study was the influence of cartilage degeneration on meniscal extrusion and the values of the contact forces and contact areas. Results In the model with incongruent contact surfaces, we observed maximal compressive stress on the tibial plateau. In this model, the value of medial meniscus external shift was 95.3% greater, while the contact area between the tibial cartilage and medial meniscus was 50% lower than in the congruent contact surfaces model. After the non-uniform reduction of cartilage thickness, the medial meniscus carried only 48.4% of load in the medial compartment in comparison to 71.2% in the healthy knee model. Conclusions We have shown that the change in articular cartilage geometry may significantly reduce the role of meniscus in load transmission and the contact area between the meniscus and cartilage. Additionally, medial knee OA may increase the risk of meniscal extrusion in the medial compartment of the knee joint. PMID:27936066

  14. Evaporation from a meniscus within a capillary tube in microgravity

    NASA Technical Reports Server (NTRS)

    Hallinan, K. P.

    1993-01-01

    The following represents a summary of progress made on the project 'Evaporation from a Capillary Meniscus in Microgravity' being conducted at the University of Dayton during the period 1 Dec. 1992 to 30 Nov. 1993. The efforts during this first year of the grant focused upon the following specific tasks: (1) application of a 3-D scattering particle image velocimetry technique to thin film velocity field measurement; (2) modeling the thermo-fluid behavior of the evaporating meniscus in 0-g within large diameter capillaries; (3) conceptualization of the space flight test cell (loop) configuration; (4) construction of prototypes of the test loop configuration; (5) conduct of experiments in 0-g in the 2.2 second drop tower at NASA-LeRC to study evaporation from a capillary meniscus within a square cuvette; and (6) investigation of the effect of vibrations on the stability of the meniscus. An overview of the work completed within these six task areas is presented.

  15. Meniscus on a shaped fibre: singularities and hodograph formulation.

    PubMed

    Alimov, Mars M; Kornev, Konstantin G

    2014-08-08

    Using the method of matched asymptotic expansions, the problem of the capillary rise of a meniscus on the complex-shaped fibres was reduced to a nonlinear problem of determination of a minimal surface. This surface has to satisfy a special boundary condition at infinity. The proposed formulation allows one to interpret the meniscus problem as a problem of flow of a fictitious non-Newtonian fluid through a porous medium. As an example, the shape of a meniscus on a fibre of an oval cross section was analysed employing Chaplygin's hodograph transformation. It was discovered that the contact line may form singularities even if the fibre has a smooth profile: this statement was illustrated with an oval fibre profile having infinite curvature at two endpoints.

  16. Meniscus on a shaped fibre: singularities and hodograph formulation

    PubMed Central

    Alimov, Mars M.; Kornev, Konstantin G.

    2014-01-01

    Using the method of matched asymptotic expansions, the problem of the capillary rise of a meniscus on the complex-shaped fibres was reduced to a nonlinear problem of determination of a minimal surface. This surface has to satisfy a special boundary condition at infinity. The proposed formulation allows one to interpret the meniscus problem as a problem of flow of a fictitious non-Newtonian fluid through a porous medium. As an example, the shape of a meniscus on a fibre of an oval cross section was analysed employing Chaplygin's hodograph transformation. It was discovered that the contact line may form singularities even if the fibre has a smooth profile: this statement was illustrated with an oval fibre profile having infinite curvature at two endpoints. PMID:25104910

  17. [Clinical natural development in human meniscus injury].

    PubMed

    Hong-hai, X u; Zhang, Feng; Liu, Ning; Zheng, Jing-Jing; Zhang, Yin-Ping; Zhao, Quan-min; Guo, Xiong; Yu, Min; Liu, Zong-Zhi; Sun, Zheng-Ming; Zou, Qing-Yang; Liu, Cong

    2013-10-01

    To investigate the changes of clinic and wound edge of the meniscus without treatment in order to provide a theoretical basis for clinical treatment. From January 2001 to December 2011,68 patients with knee injury without diagnosis and treatment were selected in the study. According to clinical symptoms (pain,interlocking,instability, etc.) and knee MRI,32 patients were diagnosed as meniscus injury and underwent the arthroscopy. Total meniscectomy was performed in 32 cases on account of impossible repair of the meniscus. There were 21 males and 11 females,ranging in age from 15 to 49 years old with an average age of 25 years old,with an average time from diagnosis to arthroscopy for 46 weeks. Observation indexes included 1Preoperative and postoperative Lysholm scores of knee. 2Position,type and status of injury by arthroscopy. 3Observation of histology. With the procedure as follow: tissue samples were taken from different positions of the edge of the meniscus wound,and were divided into two parts. One part of sample was fixed with formalin, sliced with paraffin imbedding,and observed under an electron microscope after HE staining,and the other part of the sample was fixed with glutaraldehyde of 3%,sliced with ethoxyline imbedding ,and observed under an electron microscope after Lead Citrate staining. Thirty-two patients were followed up more than one year. There was significant differences in Lysholm scores bewteen preoperative and postoperative 3 months (t=15.6,P<0.01). Arthroscopy showed typical differences in 28 cases between the middle and the two ends of the wound edge and atypical differences in 4 cases. Light microscope showed typical manifestations in 26 cases, a few epithelioid cells could been seen fat the middle of the wound edge as well as cells tissue healing (such as fibroblasts) at the junction of each end,and atypical manifestations in 2 cases. Electron microscope showed typical manifestation in 25 cases and atypical manifestations in 3 cases

  18. Evaluation of posterior lateral femoral condylar hypoplasia using axial MRI images in patients with complete discoid meniscus.

    PubMed

    Xu, Zhihong; Chen, Dongyang; Shi, Dongquan; Dai, Jin; Yao, Yao; Jiang, Qing

    2016-03-01

    Hypoplasia of the lateral femoral condyle has been reported in discoid lateral meniscus patients, but associated imaging findings in the axial plane have not been characterized. In this study, we aimed to identify differences in the lateral femoral condyle between patients with discoid lateral meniscus and those with normal menisci using axial MRI images. Twenty-three patients (24 knees) with complete discoid lateral meniscus, 43 (45 knees) with incomplete discoid lateral meniscus, and 50 with normal menisci (50 knees) were enrolled and distributed into three groups. Two new angles, posterior lateral condylar angle (PLCA) and posterior medial condylar angle (PMCA), were measured on axial MRI images; the posterior condylar angle (PCA) was also measured. Differences between the three groups in the PLCA, PMCA, PCA, and PLCA/PMCA were analysed. The predictive value of PLCA and PLCA/PMCA for complete discoid lateral meniscus was assessed. In the complete discoid lateral meniscus group, PLCA and PLCA/PMCA were significantly smaller compared with the normal meniscus group and the incomplete discoid lateral meniscus group (P < 0.001). A significantly larger PCA was identified in the complete discoid lateral meniscus group compared with the incomplete discoid lateral meniscus group (P < 0.05) and normal meniscus group (P < 0.05). Both PLCA and PLCA/PMCA showed excellent predictive value for complete discoid lateral meniscus. Hypoplasia of the posterior lateral femoral condyle is typically seen in patients with complete discoid lateral meniscus. PLCA and PLCA/PMCA can be measured from axial MRI images and used as excellent predictive parameters for complete discoid lateral meniscus. Diagnostic study, Level III.

  19. Age-related modulation of angiogenesis-regulating factors in the swine meniscus.

    PubMed

    Di Giancamillo, Alessia; Deponti, Daniela; Modina, Silvia; Tessaro, Irene; Domeneghini, Cinzia; Peretti, Giuseppe Maria

    2017-11-01

    An in-depth knowledge of the native meniscus morphology and biomechanics in its different areas is essential to develop an engineered tissue. Meniscus is characterized by a great regional variation in extracellular matrix components and in vascularization. Then, the aim of this work was to characterize the expression of factors involved in angiogenesis in different areas during meniscus maturation in pigs. The menisci were removed from the knee joints of neonatal, young and adult pigs, and they were divided into the inner, intermediate and outer areas. Vascular characterization and meniscal maturation were evaluated by immunohistochemistry and Western blot analysis. In particular, expression of the angiogenic factor Vascular Endothelial Growth Factor (VEGF) and the anti-angiogenic marker Endostatin (ENDO) was analysed, as well as the vascular endothelial cadherin (Ve-CAD). In addition, expression of Collagen II (COLL II) and SOX9 was examined, as markers of the fibro-cartilaginous differentiation. Expression of VEGF and Ve-CAD had a similar pattern in all animals, with a significant increase from the inner to the outer part of the meniscus. Pooling the zones, expression of both proteins was significantly higher in the neonatal meniscus than in young and adult menisci. Conversely, the young meniscus revealed a significantly higher expression of ENDO compared to the neonatal and adult ones. Analysis of tissue maturation markers showed an increase in COLL II and a decrease in SOX9 expression with age. These preliminary data highlight some of the changes that occur in the swine meniscus during growth, in particular the ensemble of regulatory factors involved in angiogenesis. © 2017 The Authors. Journal of Cellular and Molecular Medicine published by John Wiley & Sons Ltd and Foundation for Cellular and Molecular Medicine.

  20. Evolution of Intrameniscal Signal-Intensity Alterations Detected on MRI Over 24 Months in Patients With Traumatic Anterior Cruciate Ligament Tear.

    PubMed

    Guimaraes, Julio Brandao; Facchetti, Luca; Schwaiger, Benedikt J; Gersing, Alexandra S; Majumdar, Sharmila; Ma, Benjamin C; Li, Xiaojuan; Link, Thomas M

    2017-02-01

    The objective of our study was to assess the prevalence and evolution of intrameniscal signal-intensity alteration in subjects with an anterior cruciate ligament (ACL) tear over 24 months and compare clinical outcome and changes of cartilage between subjects with and those without this meniscal abnormality. Fifty-seven subjects with an ACL tear were screened for intrameniscal signal-intensity alteration. Morphologic and compositional MRI was performed before ACL reconstruction and 12 and 24 months after ACL reconstruction. Twelve subjects with an intrameniscal signal-intensity alteration and 12 subjects without any meniscal abnormality on MRI were identified. Clinical outcome was measured using the Knee Injury and Osteoarthritis Outcome Score (KOOS), and T1ρ and T2 maps of the cartilage were obtained. In 10 of 12 subjects (83%) the meniscal signal-intensity abnormality identified on baseline MRI was located at the posterior horn of the medial meniscus. None of these subjects presented with a meniscal tear over 24 months of follow-up. At 12 months after the ACL tear, the intrameniscal signal-intensity alteration detected on baseline MRI had completely resolved in seven of 12 subjects (58%), showed a signal-intensity decrease in four (33%), and remained stable in one subject (8%). Of the 10 subjects who underwent MRI at 24 months, the meniscal signal-intensity alteration had completely resolved in eight (80%), and the signal intensity had decreased in the other two subjects. Changes in the KOOS and cartilage T1ρ and T2 values from baseline and 24 months did not differ significantly between subjects with and those without intrameniscal signal-intensity alteration (p > 0.05). High intrameniscal signal-intensity alterations are a common finding in subjects with an ACL tear and have a benign course over 24 months after surgical repair of the ACL tear.

  1. Videoreflective dacryomeniscometry in normal adults and in patients with functional or primary acquired nasolacrimal duct obstruction.

    PubMed

    Francis, Ian C; Chan, Derek G; Papalkar, Daya; Papas, Eric B; Stapleton, Fiona

    2005-03-01

    Videoreflective dacryomeniscometry (VRD) for evaluation of marginal tear film has not been performed in patients with watery eye or in a controlled study. We used VRD to evaluate the height of the central marginal lower lid tear film in normal adults and compared it with two watery-eye groups and a postoperative dacryocystorhinostomy (DCR) group. Case-controlled interventional case series. We evaluated with VRD 20 subjects with normal lacrimal drainage function, 21 patients with primary acquired nasolacrimal duct obstruction (PANDO), 28 patients with functional nasolacrimal duct obstruction (FNLDO), and a postoperative group of 14 patients derived from the previous two pathologic groups. Comparison between the four groups was performed to determine statistically significant differences between tear film height. PANDO and FNLDO groups were shown to have significantly greater median tear meniscus heights ([TMH] PANDO: 620 microm, interquartile range [IQR] 453 microm; FNLDO: 731 microm, IQR 529 microm) than normal subjects (296 microm, IQR 214 microm; P < .001) and postoperative PANDO patients (265 microm, IQR 159 microm). There was no significant difference in TMH between PANDO and FNLDO groups preoperatively (P = .275). There was a reduction in median TMH postoperatively of 355 microm (P = .008) in PANDO and 360 microm (P = .068) in FNLDO. PANDO and FNLDO patients have similar preoperative TMH. In both these groups, TMH is significantly greater than in normal control subjects. Lacrimal drainage surgery substantially reduces TMH as measured using VRD in PANDO.

  2. The association between body fat and rotator cuff tear: the influence on rotator cuff tear sizes.

    PubMed

    Gumina, Stefano; Candela, Vittorio; Passaretti, Daniele; Latino, Gianluca; Venditto, Teresa; Mariani, Laura; Santilli, Valter

    2014-11-01

    Rotator cuff tear (RCT) has a multifactorial etiology. We hypothesized that obesity may increase the risk of RCT and influence tear size. A case-control design study was used. We studied 381 consecutive patients (180 men, 201 women; mean age ± standard deviation, 65.5 ± 8.52 years; range, 43-78 years) who underwent arthroscopic rotator cuff repair. Tear size was determined intraoperatively. The control group included 220 subjects (103 men, 117 women; mean age ± standard deviation, 65.16 ± 7.24 years; range, 42-77 years) with no RCT. Body weight, height, and bicipital, tricipital, subscapularis, and suprailiac skinfolds of all participants were measured to obtain body mass index (BMI) and the percentage of body fat (%BF). For the purposes of the study, the 601 participants were divided into 2 groups by BMI (group A, BMI ≥ 25; group B, BMI < 25). The odds ratios (ORs) were calculated to investigate whether adiposity affects the risk of RCT. Data were stratified according to gender and age. Multiple linear regression analyses were applied to explore the association between obesity and tear size. The highest ORs for both men (OR, 2.49; 95% confidence interval, 1.41-3.90; P = .0037) and women (OR, 2.31; 95% confidence interval, 1.38-3.62; P = .0071) were for individuals with a BMI ≥ 30; 69% (N = 303) of group A and 48% (N = 78) of group B had RCTs. Patients with RCT had a BMI higher than that of subjects with no RCT in both groups (P = .031, group A; P = .02, group B). BMI and %BF significantly increased from patients with a small tear (BMI, 27.85; %BF, 37.63) to those with a massive RCT (BMI, 29.93; %BF, 39.43). Significant differences were found (P = .004; P = .031). Our results provide evidence that obesity, measured through BMI and %BF, is a significant risk factor for the occurrence and severity of RCT. Copyright © 2014. Published by Elsevier Inc.

  3. Mass spectrometric identification of phospholipids in human tears and tear lipocalin.

    PubMed

    Dean, Austin W; Glasgow, Ben J

    2012-04-02

    The purpose of this article was to identify by mass spectrometry phosphocholine lipids in stimulated human tears and determine the molecules bound to tear lipocalin or other proteins. Tear proteins were separated isocratically from pooled stimulated human tears by gel filtration fast performance liquid chromatography. Separation of tear lipocalin was confirmed by SDS tricine gradient PAGE. Protein fractions were extracted with chloroform/methanol and analyzed with electrospray ionization MS/MS triple quadrupole mass spectrometry in precursor ion scan mode for select leaving groups. For quantification, integrated ion counts were derived from standard curves of authentic compounds of phosphatidylcholine (PC) and phosphatidylserine. Linear approximation was possible from integration of the mass spectrometrically obtained ion peaks at 760 Da for the PC standard. Tears contained 194 ng/mL of the major intact PC (34:2), m/z 758.6. Ten other monoisotopic phosphocholines were found in tears. A peak at 703.3 Da was assigned as a sphingomyelin. Four lysophosphatidylcholines (m/z 490-540) accounted for about 80% of the total integrated ion count. The [M+H](+) compound, m/z 496.3, accounted for 60% of the signal intensity. Only the tear lipocalin-bearing fractions showed phosphocholines (104 ng/mL). Although the intact phospholipids bound to tear lipocalin corresponded precisely in mass and relative signal intensity to that found in tears, we did not identify phosphocholines between m/z 490 and 540 in any of the gel-filtration fractions. Phospholipids, predominantly lysophospholipids, are present in tears. The higher mass intact PCs in tears are native ligands of tear lipocalin.

  4. Epidemiology of isolated meniscal injury and its effect on performance in athletes from the National Basketball Association.

    PubMed

    Yeh, Peter C; Starkey, Chad; Lombardo, Stephen; Vitti, Gary; Kharrazi, F Daniel

    2012-03-01

    The current incidence and outcomes of meniscal injury have not been quantified in professional athletes. To describe the incidence, risk, amount of time lost, and effect on performance for isolated meniscal injury in athletes from the National Basketball Association (NBA). Demographic factors predicting the risk of meniscal tears and the effect of injury in return to play were also investigated. Descriptive epidemiology study. A centralized database was queried to identify meniscal injuries occurring in the NBA over 21 seasons. The frequency of injury, time lost, game exposures, and incidence, rate, and risk were calculated. The preinjury and postinjury player efficiency rating (PER) was used to identify changes in player performance. We identified 129 isolated meniscal tears in NBA athletes during a 21-season span. From this number, 77 (59.7%) involved the lateral meniscus and 52 (40.3%) the medial meniscus. Injuries occurred more frequently in games. The lateral meniscus had a statistically significant higher injury rate. Both left and right knees were equally affected. The number of days missed for lateral meniscal tears and medial meniscal tears was 43.8 ± 35.7 days and 40.9 ± 29.7 days, respectively, and was not statistically different. There was a significant inverse relationship between age and rate of lateral meniscal tears, with lateral meniscal tears more likely to occur up to age 30 years; beyond that medial meniscal tears were more common. Players with a body mass index (BMI) greater than 25 had a significantly increased risk of meniscal tears compared with players with a BMI less than 25, specifically with an increased risk of lateral meniscal tears. Twenty-five players (19.4%) did not return to play. For those who did, upon returning to competition, there was no statistical change in PER from their preinjury status, and the mean number of seasons completed was 4.1 ± 3.7 seasons. The lateral meniscus is more frequently torn than the medial meniscus

  5. [Application of pie-crusting the medial collateral ligament release in arthroscopic surgery for posterior horn of 
medial meniscus in knee joint].

    PubMed

    Zhu, Weihong; Tang, Qi; Liao, Lele; Li, Ding; Yang, Yang; Chen, You

    2017-09-28

    To explore the effectiveness and safety of pie-crusting the medial collateral ligament release (MCL) in treating posterior horn of medial meniscus (PHMM) tear in tight medial tibiofemoral compartment of knee joint.
 Methods: Thirty-two consecutive patients with PHMM tear in tight medial tibiofemoral compartment of knee joint were admitted to our department from January, 2013 to December, 2014. All patients were performed pie-crusting the MCL release at its tibial insertion with 18-gauge intravenous needle. All patients were evaluated by valgus stress test and bilateral valgus stress radiograph at postoperative 1st day, 4th week and 12th week. Visual Analogue Scales (VAS), Lysholm scores, Tegner scores and International Knee Documentation Committee (IKDC) scores were recorded at the 1st, 3th, 6th month follow-up, then follow-up every 6 months.
 Results: The mean follow-up was 28 (24-36) months. All cases were negative in valgus stress test. MCL rupture, femoral fracture, articular cartilage lesion and neurovascular injury were not found at the last follow-up. The median medial joint space width of affected side and unaffected side for valgus stress radiographs were 6.8 mm and 4.3 mm (P<0.05) at the 1st day, 5.5 mm and 4.2 mm 
(P<0.05) in the 4th week and 4.8 mm and 4.3 mm (P>0.05) at the 12th week, respectively. VAS scores was changed from 4.5±1.5 preoperatively to 1.7±1.0 at the final follow-up (t=16.561, P<0.05). Lysholm scores was changed from 52.3±5.8 preoperatively to 93.2±6.3 at the final follow-up (t=-41.353, P<0.05). Tegner scores was changed from 4.1±1.1 preoperatively to 5.5±0.6 at the final follow-up (t=-18.792, P<0.05). IKDC scores was changed from 54.5±6.2 preoperative to 93.8±4.5 at the final follow-up (t=-38.253, P<0.05).
 Conclusion: Pie-crusting the medial collateral ligament release is a safe, minimal invasive and effective surgical option for posterior horn of medial meniscus tear in tight medial tibiofemoral compartment of knee

  6. Mass Spectrometric Identification of Phospholipids in Human Tears and Tear Lipocalin

    PubMed Central

    Dean, Austin W.; Glasgow, Ben J.

    2012-01-01

    Purpose. The purpose of this article was to identify by mass spectrometry phosphocholine lipids in stimulated human tears and determine the molecules bound to tear lipocalin or other proteins. Methods. Tear proteins were separated isocratically from pooled stimulated human tears by gel filtration fast performance liquid chromatography. Separation of tear lipocalin was confirmed by SDS tricine gradient PAGE. Protein fractions were extracted with chloroform/methanol and analyzed with electrospray ionization MS/MS triple quadrupole mass spectrometry in precursor ion scan mode for select leaving groups. For quantification, integrated ion counts were derived from standard curves of authentic compounds of phosphatidylcholine (PC) and phosphatidylserine. Results. Linear approximation was possible from integration of the mass spectrometrically obtained ion peaks at 760 Da for the PC standard. Tears contained 194 ng/mL of the major intact PC (34:2), m/z 758.6. Ten other monoisotopic phosphocholines were found in tears. A peak at 703.3 Da was assigned as a sphingomyelin. Four lysophosphatidylcholines (m/z 490–540) accounted for about 80% of the total integrated ion count. The [M+H]+ compound, m/z 496.3, accounted for 60% of the signal intensity. Only the tear lipocalin–bearing fractions showed phosphocholines (104 ng/mL). Although the intact phospholipids bound to tear lipocalin corresponded precisely in mass and relative signal intensity to that found in tears, we did not identify phosphocholines between m/z 490 and 540 in any of the gel-filtration fractions. Conclusions. Phospholipids, predominantly lysophospholipids, are present in tears. The higher mass intact PCs in tears are native ligands of tear lipocalin. PMID:22395887

  7. Meniscal healing after meniscal repair: a CT arthrography assessment.

    PubMed

    Pujol, Nicolas; Panarella, Ludovico; Selmi, Tarik Ait Si; Neyret, Philippe; Fithian, Donald; Beaufils, Philippe

    2008-08-01

    Studies evaluating healing of repaired meniscus are rare and primarily retrospective. The aim of this study was to assess whether there were different healing rates for arthroscopic meniscal repair with respect to the different zones of the meniscus. This study was conducted to assess outcomes and to document anatomic characteristics of the repaired meniscus with postoperative arthrography combined with computed tomography (arthro-CT), particularly the dimensions and healing of the repaired meniscus. Case series; Level of evidence, 4. Fifty-three arthroscopic meniscal repairs were prospectively evaluated between 2002 and 2004 in 2 orthopaedic departments. There were 36 medial and 17 lateral torn menisci. All ACL tears (n = 31, 58.5%) underwent reconstruction. Patients were preoperatively evaluated by magnetic resonance imaging. Clinical evaluation included International Knee Documentation Committee (IKDC) scores before the operation and 6 and 12 months afterward. Healing criteria were evaluated at 6 months by arthro-CT scan. Three parameters were evaluated--healing in thickness (Henning criteria), overall healing rate, and reduction in the width of the remaining meniscus. According to the objective IKDC score, 26 patients were graded A, 20 B, and 4 C (92% good results). The mean subjective IKDC score was 78.9 (standard deviation [SD], 16.2). According to Henning's criteria, 58% of the menisci healed completely, 24% partially, and 18% failed. The overall healing rate was 73.1% (SD, 38.5). Twenty tears located in the posterior part had a healing rate of 59.8% (SD, 46.0). Nineteen tears extending from the posterior to the middle part had a healing rate of 79.2% (SD, 28.2). Isolated tears located in the posterior part had a lower healing rate (P < .05). There was a 9% +/- 1.2% reduction in the width of the remaining medial meniscus in the middle and posterior repaired portions (P < .02). There was a 15% +/- 14% reduction in the width of the remaining lateral meniscus

  8. The relation between chondromalacia patella and meniscal tear and the sulcus angle/ trochlear depth ratio as a powerful predictor.

    PubMed

    Resorlu, Hatice; Zateri, Coskun; Nusran, Gurdal; Goksel, Ferdi; Aylanc, Nilufer

    2017-01-01

    To investigate the relation between chondromalacia patella and the sulcus angle/trochlear depth ratio as a marker of trochlear morphology. In addition, we also planned to show the relationship between meniscus damage, subcutaneous adipose tissue thickness as a marker of obesity, patellar tilt angle and chondromalacia patella. Patients with trauma, rheumatologic disease, a history of knee surgery and patellar variations such as patella alba and patella baja were excluded. Magnetic resonance images of the knees of 200 patients were evaluated. Trochlear morphology from standardized levels, patellar tilt angle, lateral/medial facet ratio, subcutaneous adipose tissue thickness from 3 locations and meniscus injury were assessed by two specialist radiologists. Retropatellar cartilage was normal in 108 patients (54%) at radiological evaluation, while chondromalacia patella was determined in 92 (46%) cases. Trochlear sulcus angle and prepatellar subcutaneous adipose tissue thickness were significantly high in patients with chondromalacia patella, while trochlear depth and lateral patellar tilt angle were low. The trochlear sulcus angle/trochlear depth ratio was also high in chondromalacia patella and was identified as an independent risk factor at regression analysis. Additionally, medial meniscal tear was observed in 35 patients (38%) in the chondromalacia patella group and in 27 patients (25%) in the normal group, the difference being statistically significant (P = 0.033). An increased trochlear sulcus angle/trochlear depth ratio is a significant predictor of chondromalacia patella. Medial meniscus injury is more prevalent in patients with chondromalacia patella in association with impairment in knee biomechanics and the degenerative process.

  9. Meniscus Tears (For Teens)

    MedlinePlus

    ... quickly, as can happen in sports like soccer, baseball, basketball, tennis, and racquetball taking a direct hit ... back into play too quickly. Your body (and performance) will be stronger if you wait until your ...

  10. Tibial avulsion fracture of the posterior root of the medial meniscus in children.

    PubMed

    Iversen, Jonas Vestergård; Krogsgaard, Michael Rindom

    2014-01-01

    Few reports have described avulsion fractures of the posterior root of the medial meniscus in skeletally immature patients. This lesion should not be overlooked as it damages the load absorptive (distributive) function of the meniscus, increasing the risk of cartilage degeneration. Two cases of displaced avulsion fractures of the posterior root of the medial meniscus in children are presented along with a concise report of the literature regarding avulsion fractures of the posterior root of the medial meniscus. Both avulsions were reattached arthroscopically by trans-tibial pull-out sutures with a good clinical result at 2-years follow-up, and in one case, the avulsion was found at re-arthroscopy after 6 weeks to have healed.

  11. Dynamic "Scanning-Mode" Meniscus Confined Electrodepositing and Micropatterning of Individually Addressable Ultraconductive Copper Line Arrays.

    PubMed

    Lei, Yu; Zhang, Xianyun; Xu, Dingding; Yu, Minfeng; Yi, Zhiran; Li, Zhixiang; Sun, Aihua; Xu, Gaojie; Cui, Ping; Guo, Jianjun

    2018-05-03

    Micro- and nanopatterning of cost-effective addressable metallic nanostructures has been a long endeavor in terms of both scientific understanding and industrial needs. Herein, a simple and efficient dynamic meniscus-confined electrodeposition (MCED) technique for precisely positioned copper line micropatterns with superior electrical conductivity (greater than 1.57 × 10 4 S/cm) on glass, silicon, and gold substrates is reported. An unexpected higher printing speed in the evaporative regime is realized for precisely positioned copper lines patterns with uniform width and height under horizontal scanning-mode. The final line height and width depend on the typical behavior of traditional flow coating process, while the surface morphologies and roughness are mainly governed by evaporation-driven electrocrystallization dynamics near the receding moving contact line. Integrated 3D structures and a rapid prototyping of 3D hot-wire anemometer are further demonstrated, which is very important for the freedom integration applications in advanced conceptual devices, such as miniaturized electronics and biomedical sensors and actuators.

  12. Releasing the circumferential fixation of the medial meniscus does not affect its kinematics.

    PubMed

    Vrancken, A C T; van Tienen, T G; Hannink, G; Janssen, D; Verdonschot, N; Buma, P

    2014-12-01

    Meniscal functioning depends on the fixation between the meniscal horns and the surrounding tissues. It is unknown, however, whether the integration between the outer circumference of the medial meniscus and the knee capsule/medial collateral ligament also influences the biomechanical behavior of the meniscus. Therefore, we aimed to determine whether detaching and resuturing the circumferential fixation of the medial meniscus influence its kinematic pattern. Human cadaveric knee joints were flexed (0°-30°-60°-90°) in a knee loading rig, in neutral orientation and under internal and external tibial torques. Roentgen stereophotogrammetric analysis was used to determine the motion of the meniscus in anteroposterior (AP) and mediolateral (ML) directions. Three fixation conditions were evaluated: (I) intact, (II) detached and (III) resutured. Detaching and resuturing the circumferential fixation did not alter the meniscal motion pattern in either the AP or ML direction. Applying an additional internal tibial torque caused the medial meniscus to move slightly anteriorly, and an external torque caused a little posterior translation with respect to the neutral situation. These patterns did not change when the circumferential fixation condition was altered. This study demonstrated that the motion pattern of the medial meniscus is independent of its fixation to the knee capsule and medial collateral ligament. The outcomes of this study can be deployed to design the fixation strategy of a permanent meniscus prosthesis. As peripheral fixation is a complicated step during meniscal replacement, the surgical procedure is considerably simplified when non-resorbable implants do not require circumferential fixation. Copyright © 2014 Elsevier B.V. All rights reserved.

  13. Successful anterior cruciate ligament reconstruction and meniscal repair in osteogenesis imperfecta.

    PubMed

    Park, Jae-Young; Cho, Tae-Joon; Lee, Myung Chul; Han, Hyuk-Soo

    2018-03-20

    A case of anterior cruciate ligament (ACL) reconstruction with meniscal repair in an osteogenesis imperfecta patient is reported. A 24-year-old female with osteogenesis imperfecta type 1a suffered from a valgus extension injury resulting in tear of ACL and medial meniscus. She underwent an arthroscopic-assisted ACL reconstruction and medial meniscus repair. Meniscal tear at the menisco-capsular junction of the posterior horn of medial meniscus was repaired with three absorbable sutures via inside-out technique. ACL reconstruction was then performed with a bone-patellar tendon-bone allograft. The patient was followed up for 1 year with intact ACL grafts and healed medial meniscus. This case report showed that successful ACL reconstruction and meniscal repair is possible in an osteogenesis imperfecta patient.Level of evidence V.

  14. [Usefulness of arthrography of the knee in assessing the unfavorable outcome from a meniscectomy intervention].

    PubMed

    Corbetti, F; Camposampiero, A; Pellicano, A; Meneghello, A

    1983-03-01

    Knee arthrography was performed in 22 patients suffering from persistent articular symptoms after meniscectomy. In 3 cases a surgically proved tear of the opposite meniscus was assessed. In 4 cases no meniscal tear was found, but 3 out of these patients had a significant anatomic lesion. In 15 cases meniscectomy was found to be incomplete, and a residual posterior horn of the medial meniscus was observed, normal in shape in 7 cases, torn or detached in 8. It is suggested that the persistence of the posterior horn of the medial meniscus after meniscectomy may cause the persistent symptoms; the value of knee arthrography before surgery is emphasized.

  15. Finite element modeling predictions of region-specific cell-matrix mechanics in the meniscus.

    PubMed

    Upton, Maureen L; Guilak, Farshid; Laursen, Tod A; Setton, Lori A

    2006-06-01

    The knee meniscus exhibits significant spatial variations in biochemical composition and cell morphology that reflect distinct phenotypes of cells located in the radial inner and outer regions. Associated with these cell phenotypes is a spatially heterogeneous microstructure and mechanical environment with the innermost regions experiencing higher fluid pressures and lower tensile strains than the outer regions. It is presently unknown, however, how meniscus tissue mechanics correlate with the local micromechanical environment of cells. In this study, theoretical models were developed to study mechanics of inner and outer meniscus cells with varying geometries. The results for an applied biaxial strain predict significant regional differences in the cellular mechanical environment with evidence of tensile strains along the collagen fiber direction of approximately 0.07 for the rounded inner cells, as compared to levels of 0.02-0.04 for the elongated outer meniscus cells. The results demonstrate an important mechanical role of extracellular matrix anisotropy and cell morphology in regulating the region-specific micromechanics of meniscus cells, that may further play a role in modulating cellular responses to mechanical stimuli.

  16. Automated Measurement of Tear Film Dynamics and Lipid Layer Thickness for Assessment of Non-Sjögren Dry Eye Syndrome With Meibomian Gland Dysfunction.

    PubMed

    Ji, Yong Woo; Lee, Jeihoon; Lee, Hun; Seo, Kyoung Yul; Kim, Eung Kweon; Kim, Tae-Im

    2017-02-01

    To investigate automated values from an advanced corneal topographer with a built-in real keratometer, color camera, and ocular surface interferometer for the evaluation of non-Sjögren dry eye syndrome (NSDES) with meibomian gland dysfunction (MGD). Sixty-four patients (64 eyes) diagnosed with NSDES with MGD were enrolled. All eyes were evaluated using the Ocular Surface Disease Index (OSDI), fluorescence staining score, tear film breakup time (TBUT), Schirmer test, and MGD grade. Noninvasive Keratograph average tear film breakup time (NIKBUTav), tear meniscus height (TMHk), meibomian gland (MG) dropout grade, and lipid layer thickness (LLT) using interferometry were measured. Among automated indexes, NIKBUTav (mean 7.68 ± 4.07 s) and the MG dropout grade (mean 1.0 ± 0.5) significantly correlated with the OSDI (mean 40.6 ± 22.9) (r = -0.337, P = 0.006; and r = 0.201, P = 0.023, respectively), as did all conventional indicators, except the Schirmer score (mean 9.1 ± 5.9 mm). TMHk (mean 0.21 ± 0.18 mm) had significant correlation with the Schirmer score, the staining score (mean 1.2 ± 0.7), TBUT (mean 3.8 ± 1.8 s), and NIKBUTav (r = 0.298, P = 0.007; r = -0.268, P = 0.016; r = 0.459, P < 0.001; and r = 0.439, P < 0.001, respectively), but not any MGD indicator, even the MG dropout grade. NIKBUTav showed significant correlations with all clinical parameters and other automated values, except the Schirmer score and LLT (mean 83.94 ± 20.82 nm) (all (Equation is included in full-text article.)≥ 0.25 and P < 0.01). The MG dropout grade highly correlated with all indexes except TMHk (all (Equation is included in full-text article.)≥ 0.25 and P < 0.05). LLT was significantly associated with TBUT, MGD grade (mean 2.0 ± 0.7), and MG dropout grade (r = 0.219, P = 0.047; r = -0.221, P = 0.039; and r = 0.433, P < 0.001, respectively), although it was not related to patient symptoms. Automated noninvasive measurements using an advanced corneal topographer and LLT

  17. Ocular Surface and Tear Film Changes in Older Women Working with Computers.

    PubMed

    Ribelles, Alfredo; Galbis-Estrada, Carmen; Parras, Maria A; Vivar-Llopis, Bárbara; Marco-Ramírez, Carla; Diaz-Llopis, Manuel

    2015-01-01

    The aim of this work is to investigate changes in the ocular surface (OS) and tear film (TF) by means of questionnaire-based subjective symptoms, TF break-up time, Schirmer test, and TF analysis in women working with computers and to analyze the effects of the oral supplementation with antioxidants/omega 3 fatty acids (A/ω3) in the OS outcomes. Women aged 40-65 years (n = 148) were recruited at the Administrative Offices of Valencia (Spain) and distributed into two age groups, 40-52 years (AGE1; n = 87) and 53-65 years (AGE2; n = 61), and then subdivided according to being (or not) computer users (CUG; NCUG) during the workday. Homogeneous subgroups were randomly assigned (or not) to the daily intake of three pills of A/ω3 for three months. At baseline and at the end of follow-up, personalized interviews and ocular examination were done. Reflex tear samples were collected from the inferior meniscus and processed for a multiplexed particle-based flow cytometry assay to measure proinflammatory molecules. Statistics were performed using the SPSS 15.0 program. The OS pathology was clinically evident in the AGE1-CUG (33%) versus the AGE2-CUG (64%) of women. Significantly higher interleukins-1β and -6 tear levels were found in the AGE1 versus the AGE2 women employees (P = 0.006 and P = 0.001, resp.), as well as in the CUG versus the NCUG (P = 0.001 and P = 0.000, resp.). Supplementation with A/ω3 positively influenced the OS pathology as manifested by the amelioration of the clinical signs/symptoms related to computer uses. Strategies involving a safe environment and oral micronutrient supplements may be managed within eye-care standards in older women.

  18. Ocular Surface and Tear Film Changes in Older Women Working with Computers

    PubMed Central

    Ribelles, Alfredo; Parras, Maria A.; Vivar-Llopis, Bárbara; Marco-Ramírez, Carla; Diaz-Llopis, Manuel

    2015-01-01

    The aim of this work is to investigate changes in the ocular surface (OS) and tear film (TF) by means of questionnaire-based subjective symptoms, TF break-up time, Schirmer test, and TF analysis in women working with computers and to analyze the effects of the oral supplementation with antioxidants/omega 3 fatty acids (A/ω3) in the OS outcomes. Women aged 40–65 years (n = 148) were recruited at the Administrative Offices of Valencia (Spain) and distributed into two age groups, 40–52 years (AGE1; n = 87) and 53–65 years (AGE2; n = 61), and then subdivided according to being (or not) computer users (CUG; NCUG) during the workday. Homogeneous subgroups were randomly assigned (or not) to the daily intake of three pills of A/ω3 for three months. At baseline and at the end of follow-up, personalized interviews and ocular examination were done. Reflex tear samples were collected from the inferior meniscus and processed for a multiplexed particle-based flow cytometry assay to measure proinflammatory molecules. Statistics were performed using the SPSS 15.0 program. The OS pathology was clinically evident in the AGE1-CUG (33%) versus the AGE2-CUG (64%) of women. Significantly higher interleukins-1β and -6 tear levels were found in the AGE1 versus the AGE2 women employees (P = 0.006 and P = 0.001, resp.), as well as in the CUG versus the NCUG (P = 0.001 and P = 0.000, resp.). Supplementation with A/ω3 positively influenced the OS pathology as manifested by the amelioration of the clinical signs/symptoms related to computer uses. Strategies involving a safe environment and oral micronutrient supplements may be managed within eye-care standards in older women. PMID:26557673

  19. "Meniscus Sign" to Identify the Lenticule Edge in Small-Incision Lenticule Extraction.

    PubMed

    Titiyal, Jeewan S; Kaur, Manpreet; Brar, Anand S; Falera, Ruchita

    2018-06-01

    To describe our technique of lenticule edge identification in small-incision lenticule extraction using the "meniscus sign" to prevent lenticule misdissection. Femtosecond laser application for small-incision lenticule extraction was performed. A "double ring" was visible, signifying the edge of the cap cut (outer ring) and lenticule cut (inner ring). The anterior and posterior lamellar planes were delineated in 2 different directions. During creation of the posterior lamellar channel, the lenticule edge was slightly pushed away from the surgeon to create a gap between the inner ring (diameter of the lenticule cut) and the lenticule edge. The lenticule edge assumed a frilled wavy appearance, and the meniscus sign was observed as a gap between the lenticule edge and the inner ring. The meniscus-shaped gap served as a landmark to identify the lenticule edge, and the relationship between the frilled lenticule edge and surgical instruments further acted as a guide to identify the correct plane of dissection. This technique was successfully undertaken in 50 eyes of 25 patients. The meniscus sign was observed in all cases, and no case had cap lenticular adhesions. The meniscus sign helps to identify the lenticule edge and correct dissection planes and provides a visual landmark during the entire surgical procedure.

  20. Characterization of decellularized scaffold derived from porcine meniscus for tissue engineering applications

    NASA Astrophysics Data System (ADS)

    Gao, Shuang; Yuan, Zhiguo; Xi, Tingfei; Wei, Xiaojuan; Guo, Quanyi

    2016-06-01

    Menisci are fundamental fibrocartilaginous organs in knee joints. The injury in meniscus can impair normal knee function and predisposes patients to osteoarthritis. This study prepared decellularized meniscus scaffolds using a 1% (w/w) sodium dodecyl sulfate solution and sufficient rinsing steps. Complete cell removal was verified by hematoxylin and eosin staining and DNA content assay. Decellularized menisci had accordant tension properties to intact ones, but with declined compression properties. This occurred because the collagen fiber was not damaged but glycosaminoglycans was significantly lost during the decellularization process, which was confirmed by biochemical assay and histology staining. In vitro cytotoxicity assay demonstrated that decellularized meniscus scaffolds have no toxicity on L929 murine fibroblasts and porcine chondrocytes. Further experiment showed that porcine chondrocytes could adhere and proliferate on the scaffold surface, and some cells even could infiltrate into the scaffold. All results showed the potential of this decellularized meniscus to be the scaffolds in tissue engineering.

  1. Meniscus formation in a capillary and the role of contact line friction.

    PubMed

    Andrukh, Taras; Monaenkova, Daria; Rubin, Binyamin; Lee, Wah-Keat; Kornev, Konstantin G

    2014-01-28

    We studied spontaneous formation of an internal meniscus by dipping glass capillaries of 25 μm to 350 μm radii into low volatile hexadecane and tributyl phosphate. X-ray phase contrast and high speed optical microscopy imaging were employed. We showed that the meniscus completes its formation when the liquid column is still shorter than the capillary radius. After that, the meniscus travels about ten capillary radii at a constant velocity. We demonstrated that the experimental observations can be explained by introducing a friction force linearly proportional to the meniscus velocity with a friction coefficient depending on the air/liquid/solid triplet. It was demonstrated that the friction coefficient does not depend on the capillary radius. Numerical solution of the force balance equation revealed four different uptake regimes that can be specified in a phase portrait. This phase portrait was found to be in good agreement with the experimental results and can be used as a guide for the design of thin porous absorbers.

  2. A comparison of basal and eye-flush tears for the analysis of cat tear proteins.

    PubMed

    Petznick, Andrea; Evans, Margaret D M; Madigan, Michele C; Markoulli, Maria; Garrett, Qian; Sweeney, Deborah F

    2011-02-01

    To identify a rapid and effective tear collection method providing sufficient tear volume and total protein content (TPC) for analysis of individual proteins in cats. Domestic adult short-haired cats (12-37 months; 2.7-6.6 kg) were used in the study. Basal tears without stimulation and eye-flush tears after instillation of saline (10 μl) were collected using microcapillary tubes from animal eyes either unwounded control or wounded with 9-mm central epithelial debridement giving four groups with n = 3. Tear comparisons were based on total time and rate for tear collection, TPC using micro bicinchoninic acid (BCA), tear immunoglobulin A (IgA), total matrix-metalloproteinase (MMP)-9 concentration using sandwich enzyme-linked immunosorbent assay (ELISA) and MMP-9 activity. Eye-flush tears were collected significantly faster than basal tears in wounded eyes with higher rates for tear collection in unwounded control and wounded eyes. TPC was significantly lower in eye-flush tears compared to basal tears. The relative proportion of tear IgA normalized to TPC (% IgA of TPC) was not significantly different between basal and eye-flush tears. In unwounded control eyes, MMP-9 was slightly higher in eye-flush than in basal tears; activity of MMP-9 in both tear types was similar. In wounded eyes, eye-flush tears showed highest MMP-9 levels and activity on Day 1, which subsequently decreased to Day 7. MMP-9 activity in basal tears from wounded eyes did not display changes in expression. Eye-flush tears can be collected rapidly providing sufficient tear volume and TPC. This study also indicates that eye-flush tears may be more suitable than basal tears for the analysis of MMPs following corneal wounding. © 2011 The Authors. Acta Ophthalmologica © 2011 Acta Ophthalmologica Scandinavica Foundation.

  3. Adipokines induce catabolism of newly synthesized matrix in cartilage and meniscus tissues.

    PubMed

    Nishimuta, James F; Levenston, Marc E

    Altered synovial levels of various adipokines (factors secreted by fat as well as other tissues) have been associated with osteoarthritis (OA) onset and progression. However, the metabolic effects of adipokines on joint tissues, in particular the fibrocartilaginous menisci, are not well understood. This study investigated effects of several adipokines on release of recently synthesized extracellular matrix in bovine cartilage and meniscus tissue explants. After labeling newly synthesized proteins and sulfated glycosaminoglycans (sGAGs) with 3 H-proline and 35 S-sulfate, respectively; bovine cartilage and meniscus tissue explants were cultured for 6 days in basal medium (control) or media supplemented with adipokines (1 µg/ml of leptin, visfatin, adiponectin, or resistin) or 20 ng/ml interleukin-1 (IL-1). Release of radiolabel and sGAG to the media during culture and the final explant water, DNA, sGAG, and retained radiolabel were measured. Matrix metalloproteinase (MMP-2) and MMP-3 activities were assessed using gelatin and casein zymography, respectively. Water and DNA contents were not significantly altered by any treatment. Visfatin, adiponectin, resistin, and IL-1 stimulated sGAG release from meniscus, whereas only IL-1 stimulated sGAG release from cartilage. Release of 3 H and 35 S was stimulated not only by resistin and IL-1 in meniscus but also by IL-1 in cartilage. Retained 3 H was unaltered by any treatment, while retained 35 S was reduced by visfatin, resistin, and IL-1 in meniscus and by only IL-1 in cartilage. Resistin and IL-1 elevated active MMP-2 and total MMP-3 in meniscus, whereas cartilage MMP-3 activity was elevated by only IL-1. Resistin stimulated rapid and extensive catabolism of meniscus tissue, similar to IL-1, whereas adipokines minimally affected cartilage. Release of newly synthesized matrix was similar to overall release in both tissues. These observations provide further indications that meniscal tissue is more sensitive to pro

  4. Blocked Tear Duct

    MedlinePlus

    ... of the nose (lacrimal sac). From there tears travel down a duct (the nasolacrimal duct) draining into your nose. Once in the nose, tears are reabsorbed. A blockage can occur at any point in the tear drainage system, from the puncta ...

  5. Post-lens tear turbidity and visual quality after scleral lens wear.

    PubMed

    Carracedo, Gonzalo; Serramito-Blanco, Maria; Martin-Gil, Alba; Wang, Zicheng; Rodriguez-Pomar, Candela; Pintor, Jesús

    2017-11-01

    The aim was to evaluate the turbidity and thickness of the post-lens tear layer and its effect on visual quality in patients with keratoconus after the beginning of lens wear and before lens removal at the end of eight hours. Twenty-six patients with keratoconus (aged 36.95 ± 8.95 years) participated voluntarily in the study. The sample was divided into two groups: patients with intrastromal corneal ring (ICRS group) and patients without ICRS (KC group). Distance visual acuity (VA), contrast sensitivity, pachymetry, post-lens tear layer height and post-lens tear layer turbidity (percentage area occupied and number of particles per mm 2 ) were evaluated with optical coherence tomography before and after wearing a scleral lens. A significant increase of turbidity was found in all groups assessed (p < 0.05). The number of particles per square millimetre was eight times higher after scleral lens wear than at the beginning of wearing the lens for all groups. VA decreases in all groups after scleral lens wear (p < 0.001). All patients showed a statistical diminishing of contrast sensitivity after scleral lens wear (p < 0.05). A significant correlation was found for both turbidity parameters with distance VA but no correlation between turbidity and post-lens tear layer thickness at the beginning was found (p > 0.05). A strong correlation in all groups between the post-lens tear layer at the beginning and differences of tear layer thickness between two measures was also found (p < 0.05). The VA decrease during the scleral lens wearing, filled with preserved saline solution, was due to the increasing post-lens tear layer turbidity. © 2017 Optometry Australia.

  6. Tear-Film Evaporation Rate from Simultaneous Ocular-Surface Temperature and Tear-Breakup Area.

    PubMed

    Dursch, Thomas J; Li, Wing; Taraz, Baseem; Lin, Meng C; Radke, Clayton J

    2018-01-01

    A corneal heat-transfer model is presented to quantify simultaneous measurements of fluorescein tear-breakup area (TBA) and ocular-surface temperature (OST). By accounting for disruption of the tear-film lipid layer (TFLL), we report evaporation rates through lipid-covered tear. The modified heat-transfer model provides new insights into evaporative dry eye. A quantitative analysis is presented to assess human aqueous tear evaporation rate (TER) through intact TFLLs from simultaneous in vivo measurement of time-dependent infrared OST and fluorescein TBA. We interpret simultaneous OST and TBA measurements using an extended heat-transfer model. We hypothesize that TBAs are ineffectively insulated by the TFLL and therefore exhibit higher TER than does that for a well-insulting TFLL-covered tear. As time proceeds, TBAs increase in number and size, thereby increasing the cornea area-averaged TER and decreasing OST. Tear-breakup areas were assessed from image analysis of fluorescein tear-film-breakup video recordings and are included in the heat-transfer description of OST. Model-predicted OSTs agree well with clinical experiments. Percent reductions in TER of lipid-covered tear range from 50 to 95% of that for pure water, in good agreement with literature. The physical picture of noninsulating or ruptured TFLL spots followed by enhanced evaporation from underlying cooler tear-film ruptures is consistent with the evaporative-driven mechanism for local tear rupture. A quantitative analysis is presented of in vivo TER from simultaneous clinical measurement of transient OST and TBA. The new heat-transfer model accounts for increased TER through expanding TBAs. Tear evaporation rate varies strongly across the cornea because lipid is effectively missing over tear-rupture troughs. The result is local faster evaporation compared with nonruptured, thick lipid-covered tear. Evaporative-driven tear-film ruptures deepen to a thickness where fluorescein quenching commences and local

  7. [Relevance of proton spin tomographic meniscus diagnosis in correlation with arthroscopy].

    PubMed

    Imhoff, A; Buess, E; Hodler, J; Schreiber, A

    1994-04-01

    Arthroscopy of the menisci is considered the gold standard by which all noninvasive imaging procedures of the knee are measured. In a prospective study we evaluated the use of MRI in 50 patients in whom a disorder of the meniscus was suspected clinically; this was followed by an arthroscopic examination by an experienced arthroscopist. The MR studies were performed after clinical evaluation and were interpreted by an experienced radiologist, who had no knowledge of the clinical findings. The accuracy of the diagnosis from MRI was 78% for the medial meniscus (sensitivity 79% and specificity 78%) and 94% for the lateral meniscus (sensitivity 50% and specificity 98%). The average age of the patients was 34 years, with a range of 3-73 years. The imaging studies revealed 9 false-positive tests and suggested that the meniscus was either degenerated or torn in the horizontal plane. In all 9 menisci the abnormal MR imaging signal was limited to the posterior horns. The positive predictive value was 59% and the negative predictive value was 94%, representing a moderate level of diagnostic certainty both in patients who had a positive result and in those who had a negative result. The high predictive negative value of MRI indicates that a negative MRI is quite reliable for meniscal lesions. The problem areas in MR imaging are the popliteal tendon sheath and the transverse ligament. This ligament is seen in association with a large branch of the lateral inferior geniculate artery and may be mistaken for a grade 3 signal intensity in the anterior horn of the lateral meniscus.

  8. Clinical study on the arthroscopic refreshing treatment of anterior cruciate ligament injury combined with stable medial meniscus ramp injury

    PubMed Central

    Yang, J.; Guan, K.; Wang, J.Z.

    2017-01-01

    This study sought to investigate the clinical efficacy of arthroscopic refreshing treatment of anterior cruciate ligament (ACL) injury combined with stable medial meniscus ramp injury. Sixty-eight patients treated between January 2010 and January 2014 were included, and their clinical data were retrospectively analyzed. All patients, after being treated using ACL reconstruction, were divided into 2 groups according to meniscus injury treatment method. The observation group (31 cases) was treated by arthroscopic refreshing, which removed the tissue on both sides of the tear edge using a cutting knife, while the control group (37 cases) was treated using Fast-fix sutures. All patients were followed up for at least 24 months. Surgical duration, postoperative function recovery time, and hospital stay for patients in the observation group were significantly shorter than for those of the control group (P<0.05). Both groups showed significant post-operative improvement for Lysholm scores, IKDC scores, and average knee range of motion at 12 and 24 months post-operation (P<0.05), but no significant differences between groups were observed (P>0.05). Regarding the difference in movement range between the healthy and injured sides, both groups showed significant decrease post-operation (P<0.05). Ultimately, there was no significant difference in the recovery of ramp damage and objective symptoms between the two groups (P>0.05). Arthroscopic refreshing treatment of patients with anterior cruciate ligament injury combined with stable ramp lesion can achieve similar clinical curative effects as the Fast-fix suture, thereby providing a simple alternative for patient treatment worth popularizing. PMID:28574418

  9. Improvement in the medial meniscus posterior shift following anterior cruciate ligament reconstruction.

    PubMed

    Inoue, Hiroto; Furumatsu, Takayuki; Miyazawa, Shinichi; Fujii, Masataka; Kodama, Yuya; Ozaki, Toshifumi

    2018-02-01

    Anterior cruciate ligament (ACL) reconstruction can reduce the risk of developing osteoarthritic knees. The goals of ACL reconstruction are to restore knee stability and reduce post-traumatic meniscal tears and cartilage degradation. A chronic ACL insufficiency frequently results in medial meniscus (MM) injury at the posterior segment. How ACL reconstruction can reduce the deformation of the MM posterior segment remains unclear. In this study, we evaluated the form of the MM posterior segment and anterior tibial translation before and after ACL reconstruction using open magnetic resonance imaging (MRI). Seventeen patients who underwent ACL reconstructions without MM injuries were included in this study. MM deformation was evaluated using open MRI before surgery and 3 months after surgery. We measured medial meniscal length (MML), medial meniscal height (MMH), medial meniscal posterior body width (MPBW), MM-femoral condyle contact width (M-FCW) and posterior tibiofemoral distance (PTFD) at knee flexion angles of 10° and 90°. There were no significant pre- and postoperative differences during a flexion angle of 10°. At a flexion angle of 90°, MML decreased from 43.7 ± 4.5 to 41.4 ± 4.5 mm (P < 0.001), MMH from 7.5 ± 1.4 to 6.9 ± 1.4 mm (P = 0.006), MPBW from 13.1 ± 2.0 to 12.2 ± 1.9 mm (P < 0.001) and M-FCW from 10.0 ± 1.5 to 8.5 ± 1.5 mm (P < 0.001) after ACL reconstruction. The PTFD increased from 2.1 ± 2.8 to 2.7 ± 2.4 mm after ACL reconstruction (P = 0.015). ACL reconstruction affects the contact pattern between the MM posterior segment and medial femoral condyle and can reduce the deformation of the MM posterior segment in the knee-flexed position by reducing abnormal anterior tibial translation. It possibly prevents secondary injury to the MM posterior segment and cartilage that progresses to knee osteoarthritis. IV.

  10. Function of the medial meniscus in force transmission and stability.

    PubMed

    Walker, Peter S; Arno, Sally; Bell, Christopher; Salvadore, Gaia; Borukhov, Ilya; Oh, Cheongeun

    2015-06-01

    We studied the combined role of the medial meniscus in distributing load and providing stability. Ten normal knees were loaded in combinations of compressive and shear loading as the knee was flexed over a full range. A digital camera tracked the motion, from which femoral-tibial contacts were determined by computer modelling. Load transmission was determined from the Tekscan for the anterior horn, central body, posterior horn, and the uncovered cartilage in the centre of the meniscus. For the three types of loading; compression only, compression and anterior shear, compression and posterior shear; between 40% and 80% of the total load was transmitted through the meniscus. The overall average was 58%, the remaining 42% being transmitted through the uncovered cartilage. The anterior horn was loaded only up to 30 degrees flexion, but played a role in controlling anterior femoral displacement. The central body was loaded 10-20% which would provide some restraint to medial femoral subluxation. Overall the posterior horn carried the highest percentage of the shear load, especially after 30 degrees flexion when a posterior shear force was applied, where the meniscus was estimated to carry 50% of the shear force. This study added new insights into meniscal function during weight bearing conditions, particularly its role in early flexion, and in transmitting shear forces. Copyright © 2015 Elsevier Ltd. All rights reserved.

  11. Meniscal tears

    PubMed Central

    Maffulli, Nicola; Longo, Umile Giuseppe; Campi, Stefano; Denaro, Vincenzo

    2010-01-01

    The menisci are two semilunar-shaped fibrocartilagenous structures, which are interposed between the femoral condyles and tibial plateaux. They have an important role in knee function. Long-term follow-up studies showed that virtually all meniscectomized knees develop arthritic changes with time. The meniscus has functions in load bearing, load transmission, shock absorption, joint stability, joint lubrication, and joint congruity. Because of these functions, meniscal tissue should be preserved whenever possible. A well-trained surgeon can safely rely on clinical examination for diagnosing meniscal injuries. History and clinical examination are at least as accurate as magnetic resonance imaging in the skilled orthopedic surgeon’s hand. When meniscal repair is not possible, partial resection of the meniscus is indicated. Meniscal repair has evolved from open to arthroscopic techniques, which include the inside-out and outside-in suture repairs and the all-inside techniques. Meniscal transplantation is generally accepted as a management alternative option for selected symptomatic patients with previous complete or near-complete meniscectomy. PMID:24198542

  12. PLDLA/PCL-T Scaffold for Meniscus Tissue Engineering

    PubMed Central

    Moda, Marlon; Cattani, Silvia Mara de Melo; de Santana, Gracy Mara; Barbieri, Juliana Abreu; Munhoz, Monique Moron; Cardoso, Túlio Pereira; Barbo, Maria Lourdes Peris; Russo, Teresa; D'Amora, Ugo; Gloria, Antonio; Ambrosio, Luigi; Duek, Eliana Aparecida de Rezende

    2013-01-01

    Abstract The inability of the avascular region of the meniscus to regenerate has led to the use of tissue engineering to treat meniscal injuries. The aim of this study was to evaluate the ability of fibrochondrocytes preseeded on PLDLA/PCL-T [poly(L-co-D,L-lactic acid)/poly(caprolactone-triol)] scaffolds to stimulate regeneration of the whole meniscus. Porous PLDLA/PCL-T (90/10) scaffolds were obtained by solvent casting and particulate leaching. Compressive modulus of 9.5±1.0 MPa and maximum stress of 4.7±0.9 MPa were evaluated. Fibrochondrocytes from rabbit menisci were isolated, seeded directly on the scaffolds, and cultured for 21 days. New Zealand rabbits underwent total meniscectomy, after which implants consisting of cell-free scaffolds or cell-seeded scaffolds were introduced into the medial knee meniscus; the negative control group consisted of rabbits that received no implant. Macroscopic and histological evaluations of the neomeniscus were performed 12 and 24 weeks after implantation. The polymer scaffold implants adapted well to surrounding tissues, without apparent rejection, infection, or chronic inflammatory response. Fibrocartilaginous tissue with mature collagen fibers was observed predominantly in implants with seeded scaffolds compared to cell-free implants after 24 weeks. Similar results were not observed in the control group. Articular cartilage was preserved in the polymeric implants and showed higher chondrocyte cell number than the control group. These findings show that the PLDLA/PCL-T 90/10 scaffold has potential for orthopedic applications since this material allowed the formation of fibrocartilaginous tissue, a structure of crucial importance for repairing injuries to joints, including replacement of the meniscus and the protection of articular cartilage from degeneration. PMID:23593566

  13. Meniscus and beam halo formation in a tandem-type negative ion source with surface production

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Miyamoto, K.; Okuda, S.; Hatayama, A.

    2012-06-04

    A meniscus of plasma-beam boundary in H{sup -} ion sources largely affects the extracted H{sup -} ion beam optics. Although it is hypothesized that the shape of the meniscus is one of the main reasons for the beam halo observed in experiments, a physical mechanism of the beam halo formation is not yet fully understood. In this letter, it is first shown by the 2D particle in cell simulation that the H{sup -} ions extracted from the periphery of the meniscus cause a beam halo since the surface produced H{sup -} ions penetrate into the bulk plasma, and, thus, themore » resultant meniscus has a relatively large curvature.« less

  14. Abnormal Mechanical Loading Induces Cartilage Degeneration by Accelerating Meniscus Hypertrophy and Mineralization After ACL Injuries In Vivo.

    PubMed

    Du, Guoqing; Zhan, Hongsheng; Ding, Daofang; Wang, Shaowei; Wei, Xiaochun; Wei, Fangyuan; Zhang, Jianzhong; Bilgen, Bahar; Reginato, Anthony M; Fleming, Braden C; Deng, Jin; Wei, Lei

    2016-03-01

    Although patients with an anterior cruciate ligament (ACL) injury have a high risk of developing posttraumatic osteoarthritis (PTOA), the role of meniscus hypertrophy and mineralization in PTOA after an ACL injury remains unknown. The purpose of this study was to determine if menisci respond to abnormal loading and if an ACL injury results in meniscus hypertrophy and calcification. The hypotheses were that (1) abnormal mechanical loading after an ACL injury induces meniscus hypertrophy and mineralization, which correlates to articular cartilage damage in vivo, and (2) abnormal mechanical loading on bovine meniscus explants induces the overexpression of hypertrophic and mineralization markers in vitro. Controlled laboratory study. In vivo guinea pig study (hypothesis 1): Three-month-old male Hartley guinea pigs (n = 9) underwent ACL transection (ACLT) on the right knee; the left knee served as the control. Calcification in the menisci was evaluated by calcein labeling 1 and 5 days before knee harvesting at 5.5 months. Cartilage and meniscus damage and mineralization were quantified by the Osteoarthritis Research Society International score and meniscus grade, respectively. Indian hedgehog (Ihh), matrix metalloproteinase-13 (MMP-13), collagen type X (Col X), progressive ankylosis homolog (ANKH), ectonucleotide pyrophosphatase/phosphodiesterase-1 (ENPP1), alkaline phosphatase (ALP), inorganic pyrophosphate (PPi), and inorganic phosphate (Pi) concentrations were evaluated by immunohistochemistry and enzyme-linked immunosorbent assay. In vitro bovine meniscus explant study (hypothesis 2): Bovine meniscus explants were subjected to 25% strain at 0.3 Hz for 1, 2, and 3 hours. Cell viability was determined using live/dead staining. The levels of mRNA expression and protein levels were measured using real-time quantitative reverse transcription polymerase chain reaction and Western blot after 24, 48, and 72 hours in culture. The conditioned medium was collected for sulfated

  15. Abnormal Mechanical Loading Induces Cartilage Degeneration by Accelerating Meniscus Hypertrophy and Mineralization After ACL Injuries In Vivo

    PubMed Central

    Du, Guoqing; Zhan, Hongsheng; Ding, Daofang; Wang, Shaowei; Wei, Xiaochun; Wei, Fangyuan; Zhang, Jianzhong; Bilgen, Bahar; Reginato, Anthony M.; Fleming, Braden C.; Deng, Jin; Wei, Lei

    2016-01-01

    Background Although patients with an anterior cruciate ligament (ACL) injury have a high risk of developing posttraumatic osteoarthritis (PTOA), the role of meniscus hypertrophy and mineralization in PTOA after an ACL injury remains unknown. Purpose/Hypothesis The purpose of this study was to determine if menisci respond to abnormal loading and if an ACL injury results in meniscus hypertrophy and calcification. The hypotheses were that (1) abnormal mechanical loading after an ACL injury induces meniscus hypertrophy and mineralization, which correlates to articular cartilage damage in vivo, and (2) abnormal mechanical loading on bovine meniscus explants induces the overexpression of hypertrophic and mineralization markers in vitro. Study Design Controlled laboratory study. Methods In vivo guinea pig study (hypothesis 1): Three-month-old male Hartley guinea pigs (n = 9) underwent ACL transection (ACLT) on the right knee; the left knee served as the control. Calcification in the menisci was evaluated by calcein labeling 1 and 5 days before knee harvesting at 5.5 months. Cartilage and meniscus damage and mineralization were quantified by the Osteoarthritis Research Society International score and meniscus grade, respectively. Indian hedgehog (Ihh), matrix metalloproteinase–13 (MMP-13), collagen type X (Col X), progressive ankylosis homolog (ANKH), ectonucleotide pyrophosphatase/phosphodiesterase–1 (ENPP1), alkaline phosphatase (ALP), inorganic pyrophosphate (PPi), and inorganic phosphate (Pi) concentrations were evaluated by immunohistochemistry and enzyme-linked immunosorbent assay. In vitro bovine meniscus explant study (hypothesis 2): Bovine meniscus explants were subjected to 25% strain at 0.3 Hz for 1, 2, and 3 hours. Cell viability was determined using live/dead staining. The levels of mRNA expression and protein levels were measured using real-time quantitative reverse transcription polymerase chain reaction and Western blot after 24, 48, and 72 hours in

  16. Cruciate ligament replacement using a meniscus. An experimental study.

    PubMed

    Mitsou, A; Vallianatos, P; Piskopakis, N; Nicolaou, P

    1988-11-01

    In 30 rabbits, the medial meniscus was used to replace the anterior or posterior cruciate ligament. The changes that took place were followed in histological sections, obtained both from the area of insertion into bone and from the intra-articular part of the graft. There was a gradual differentiation to chondroid tissue, with subsequent calcific deposition and no appearance of normal ligamentous tissue. The strength of the graft after 52 weeks was only one-quarter of that of the normal ligament. Our results do not justify the use of the meniscus to replace a torn cruciate ligament.

  17. Co-culture with infrapatellar fat pad differentially stimulates proteoglycan synthesis and accumulation in cartilage and meniscus tissues.

    PubMed

    Nishimuta, James F; Bendernagel, Monica F; Levenston, Marc E

    2017-09-01

    Although osteoarthritis is widely viewed as a disease of the whole joint, relatively few studies have focused on interactions among joint tissues in joint homeostasis and degeneration. In particular, few studies have examined the effects of the infrapatellar fat pad (IFP) on cartilaginous tissues. The aim of this study was to test the hypothesis that co-culture with healthy IFP would induce degradation of cartilage and meniscus tissues. Bovine articular cartilage, meniscus, and IFP were cultured isolated or as cartilage-fat or meniscus-fat co-cultures for up to 14 days. Conditioned media were assayed for sulfated glycosaminoglycan (sGAG) content, nitrite content, and matrix metalloproteinase (MMP) activity, and explants were assayed for sGAG and DNA contents. Co-cultures exhibited increased cumulative sGAG release and sGAG release rates for both cartilage and meniscus, and the cartilage (but not meniscus) exhibited a substantial synergistic effect of co-culture (sGAG release in co-culture was significantly greater than the summed release from isolated cartilage and fat). Fat co-culture did not significantly alter the sGAG content of either cartilage or meniscus explants, indicating that IFP co-culture stimulated net sGAG production by cartilage. Nitrite release was increased relative to isolated tissue controls in co-cultured meniscus, but not the cartilage, with no synergistic effect of co-culture. Interestingly, MMP-2 production was decreased by co-culture for both cartilage and meniscus. This study demonstrates that healthy IFP may modulate joint homeostasis by stimulating sGAG production in cartilage. Counter to our hypothesis, healthy IFP did not promote degradation of either cartilage or meniscus tissues.

  18. Divalent cations in tears, and their influence on tear film stability in humans and rabbits.

    PubMed

    Wei, Xiaojia Eric; Markoulli, Maria; Millar, Thomas J; Willcox, Mark D P; Zhao, Zhenjun

    2012-06-05

    Reduced tear film stability is reported to contribute to dry eye. Rabbits are known to have a more stable tear film than humans. Thus, we sought to examine the tears of rabbits and humans for metal cations, and to test how they influence tear film stability. Tears were collected from 10 healthy humans and 6 rabbits. Tear osmolality was measured by vapor pressure osmometer, and metals analyzed using inductively coupled plasma (ICP) mass spectrometry or ICP atomic emission spectroscopy. The influence of divalent cations on tears was analyzed by measuring surface tension using the Langmuir trough in vitro, using different concentrations of cations in the subphase, and grading the tear break-up in rabbits in vivo after instillation of chelating agents. Rabbit tears had a higher osmolality compared to humans. Major metals did not differ between species; however, rabbits had higher levels of Mg(2+) (1.13 vs. 0.39 mM) and Ca(2+) (0.75 vs. 0.36 mM). In rabbit tears in vitro, diminishing divalent cations resulted in a decrease in the maximum surface pressure from 37 to 30 mN/m. In vivo, an increase in the amount of tear film that was broken-up was found. In contrast, when changing divalent cation concentrations in human tears, the maximum surface pressure remained at 26 mN/m. The normal osmolality of rabbit tears is significantly higher than that in humans. While divalent cations had little influence on human tears, they appear to have an important role in maintaining tear film stability in rabbits.

  19. Symptomatic rotator cuff tears show higher radioisotope uptake on bone scintigraphy compared with asymptomatic tears.

    PubMed

    Koike, Yoichi; Sano, Hirotaka; Kita, Atushi; Itoi, Eiji

    2013-09-01

    Some patients with rotator cuff tears complain of pain, whereas others are asymptomatic. Previous studies have pointed out the presence of active bone metabolism in the painful shoulder, identified with increased radioisotope uptake during bone scintigraphy. Shoulders with symptomatic rotator cuff tears will demonstrate higher radioisotope uptake than shoulders with asymptomatic tears with bone scintigraphy, reflecting active bone metabolism in symptomatic tears. Cross-sectional study; Level of evidence, 3. The study consisted of 3 groups: patients with symptomatic tears (symptomatic group), patients with asymptomatic tears (asymptomatic group), and controls (no tear group). The symptomatic group consisted of 28 shoulders from 28 patients with symptomatic rotator cuff tears (pain score ≤4 on the University of California, Los Angeles [UCLA] shoulder evaluation form) who underwent bone scintigraphy followed by rotator cuff repair. Of 70 volunteers who had previously undergone bone scintigraphy for diseases unrelated to their shoulder, 34 were selected for the asymptomatic group (pain score ≥8 on the UCLA shoulder form), and 32 were selected for the no tear group. The mean radioisotope uptake in the symptomatic group was significantly higher than that in the asymptomatic group (P = .02) and the no tear group (P = .02). Ten of 28 shoulders (36%) in the symptomatic group showed increased radioisotope uptake exceeding 2 standard deviations from the mean of the no tear group. This percentage was significantly higher when compared with the asymptomatic group (0%) (P < .01). Shoulders with a symptomatic rotator cuff tear showed higher radioisotope uptake on bone scintigraphy than those with an asymptomatic tear. The radioisotope uptake in shoulders with an asymptomatic tear was comparable with that in shoulders without a tear. Positive radioisotope uptake may be associated with pain in a subgroup of patients with rotator cuff tears.

  20. Risk Factors for Tear Progression in Symptomatic Rotator Cuff Tears: A Prospective Study of 174 Shoulders.

    PubMed

    Yamamoto, Nobuyuki; Mineta, Mitsuyoshi; Kawakami, Jun; Sano, Hirotaka; Itoi, Eiji

    2017-09-01

    The risk factors for tear progression in symptomatic rotator cuff tears have not been clarified yet. It is important for orthopaedic surgeons to know the natural course of tear progression when nonoperative management is to be chosen. Tears in younger patients, high-activity patients, or heavy laborers would progress in size more than those in older patients, low-activity patients, or light laborers. Case-control study; Level of evidence, 3. Two hundred twenty-five consecutive patients with symptomatic rotator cuff tears visited our institute between 2009 and 2015. Of these, 174 shoulders of 171 patients (mean age, 66.9 years) who underwent at least 2 magnetic resonance imaging (MRI) examinations were prospectively enrolled. The mean follow-up was 19 months. Tear progression was defined as positive when the tear size increased by ≥2 mm. The demographic factors that were analyzed by multivariate analysis included age, sex, hand dominance, smoking, alcohol drinking, hypercholesterolemia, sports participation, job type, tear size, and tear type (full or partial thickness). Of the 174 shoulders, 82 shoulders (47%) showed tear progression. The mean (±SD) tear length and width in the progression group on final MRI were 23.1 ± 12.5 mm and 17.3 ± 9.6 mm, respectively; the tear size progressed by a mean 5.8 ± 5.6 mm in length and 3.1 ± 5.2 mm in width. The mean propagation speed was 3.8 mm/y in length and 2.0 mm/y in width. The size of full-thickness tears significantly increased compared with that of articular-sided partial-thickness tears ( P = .0215). The size of medium tears significantly increased compared with that of other tears ( P < .0001). According to the logistic regression analysis, smoking was significantly correlated with tear progression ( P = .026). Subgroup analyses showed that male sex, hand dominance, and trauma were correlated with tear progression. Age, alcohol drinking, hypercholesterolemia, sports participation, and job type did not show any

  1. Apparent dynamic contact angle of an advancing gas--liquid meniscus

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Kalliadasis, S.; Chang, H.

    1994-01-01

    The steady motion of an advancing meniscus in a gas-filled capillary tube involves a delicate balance of capillary, viscous, and intermolecular forces. The limit of small capillary numbers Ca (dimensionless speeds) is analyzed here with a matched asymptotic analysis that links the outer capillary region to the precursor film in front of the meniscus through a lubricating film. The meniscus shape in the outer region is constructed and the apparent dynamic contact angle [Theta] that the meniscus forms with the solid surface is derived as a function of the capillary number, the capillary radius, and the Hamaker's constant for intermolecularmore » forces, under conditions of weak gas--solid interaction, which lead to fast spreading of the precursor film and weak intermolecular forces relative to viscous forces within the lubricating film. The dependence on intermolecular forces is very weak and the contact angle expression has a tight upper bound tan [Theta]=7.48 Ca[sup 1/3] for thick films, which is independent of the Hamaker constant. This upper bound is in very good agreement with existing experimental data for wetting fluids in any capillary and for partially wetting fluids in a prewetted capillary. Significant correction to the Ca[sup 1/3] dependence occurs only at very low Ca, where the intermolecular forces become more important and tan [Theta] diverges slightly from the above asymptotic behavior toward lower values.« less

  2. Does high knee flexion cause separation of meniscal repairs?

    PubMed

    Lin, David L; Ruh, Sarah S; Jones, Hugh L; Karim, Azim; Noble, Philip C; McCulloch, Patrick C

    2013-09-01

    Previous clinical studies comparing nonrestrictive and restrictive protocols after meniscal repair have shown no difference in outcomes; however, some surgeons still limit range of motion out of concern that it will place undue stress on the repair. Large acute medial meniscal tears will gap during simulated open chain exercises at high flexion angles, and a repaired construct with vertical mattress sutures will not gap. Controlled laboratory study. Tantalum beads were implanted in the medial menisci of 6 fresh-frozen cadaveric knees via an open posteromedial approach. Each knee underwent 10 simulated open chain flexion cycles with loading of the quadriceps and hamstrings. Testing was performed on 3 different states of the meniscus: intact, torn, and repaired. Biplanar radiographs were taken of the loaded knee in 90°, 110°, and 135° of flexion for each state. A 2.5-cm tear was created in the posteromedial meniscus and repaired with inside-out vertical mattress sutures. Displacement of pairs of beads spanning the tear was measured in all planes by use of radiostereometric analysis (RSA) with an accuracy of better than 80 μm. With a longitudinal tear, compression rather than gapping occurred in all 3 regions of the posterior horn of the meniscus (mean ± standard deviation for medial collateral ligament [MCL], -321 ± 320 μm; midposterior, -487 ± 256 μm; root, -318 ± 150 μm) with knee flexion. After repair, meniscal displacement returned part way to intact values in both the MCL (+55 ± 250 μm) and root region (-170 ± 123 μm) but not the midposterior region, where further compression was seen (-661 ± 278 μm). Acute posteromedial meniscal tears and repairs with vertical mattress sutures do not gap, but rather compress in the transverse plane at higher flexion angles when subjected to physiologic loads consistent with active, open kinetic chain range of motion rehabilitation exercises. The kinematics of the repaired meniscus more closely resemble that of

  3. Functional characterization of normal and degraded bovine meniscus: Rate-dependent indentation and friction studies

    PubMed Central

    Baro, Vincent J.; Bonnevie, Edward D.; Lai, Xiaohan; Price, Christopher; Burris, David L.; Wang, Liyun

    2013-01-01

    The menisci are known to play important roles in normal joint function and the development of diseases such as osteoarthritis. However, our understanding of meniscus’ load bearing and lubrication properties at the tissue level remains limited. The objective of this investigation was to characterize the site- and rate-dependency of the compressive and frictional responses of the meniscus under a spherical contact load. Using a custom testing device, indentation tests with rates of 1, 10, 25, 50, and 100 μm/s were performed on bovine medial meniscus explants, which were harvested from five locations including the femoral apposing surface at the anterior, central, and posterior locations and the central portion at the deep layer and at the tibial apposing surface (n=5 per location). Sliding tests with rates of 0.05, 0.25, 1, and 5 mm/s were performed on the central femoral aspect and central tibial aspect superficial samples (n=6 per location). A separate set of superficial samples were subjected to papain digestion and tested prior to and post treatment. Our findings are: i) the Hertz contact model can be used to fit the force responses of meniscus under the conditions tested; ii) the anterior region is significantly stiffer than the posterior region and tissue modulus does not vary with tissue depth at the central region; iii) the friction coefficient of the meniscus is on the order of 0.02 under migratory contacts and the femoral apposing surface tends to show lower friction than the tibial apposing surface; iv) the meniscus exhibits increased modulus and lubrication with increased indentation and sliding rates; v) matrix degradation impedes the functional load support and lubrication properties of the tissue. The site- and rate-dependent properties of the meniscus may be attributed to spatial variations of the tissue’s biphasic structure. These properties substantiate the role of the meniscus as one of the important bearing surfaces of the knee. These data

  4. The Pathobiology of the Meniscus: A Comparison Between the Human and Dog

    PubMed Central

    Krupkova, Olga; Smolders, Lucas; Wuertz-Kozak, Karin; Cook, James; Pozzi, Antonio

    2018-01-01

    Serious knee pain and related disability have an annual prevalence of approximately 25% on those over the age of 55 years. As curative treatments for the common knee problems are not available to date, knee pathologies typically progress and often lead to osteoarthritis (OA). While the roles that the meniscus plays in knee biomechanics are well characterized, biological mechanisms underlying meniscus pathophysiology and roles in knee pain and OA progression are not fully clear. Experimental treatments for knee disorders that are successful in animal models often produce unsatisfactory results in humans due to species differences or the inability to fully replicate disease progression in experimental animals. The use of animals with spontaneous knee pathologies, such as dogs, can significantly help addressing this issue. As microscopic and macroscopic anatomy of the canine and human menisci are similar, spontaneous meniscal pathologies in canine patients are thought to be highly relevant for translational medicine. However, it is not clear whether the biomolecular mechanisms of pain, degradation of extracellular matrix, and inflammatory responses are species dependent. The aims of this review are (1) to provide an overview of the anatomy, physiology, and pathology of the human and canine meniscus, (2) to compare the known signaling pathways involved in spontaneous meniscus pathology between both species, and (3) to assess the relevance of dogs with spontaneous meniscal pathology as a translational model. Understanding these mechanisms in human and canine meniscus can help to advance diagnostic and therapeutic strategies for painful knee disorders and improve clinical decision making. PMID:29713636

  5. Lateral femoral notch depth is not associated with increased rotatory instability in ACL-injured knees: a quantitative pivot shift analysis.

    PubMed

    Kanakamedala, Ajay C; Burnham, Jeremy M; Pfeiffer, Thomas R; Herbst, Elmar; Kowalczuk, Marcin; Popchak, Adam; Irrgang, James; Fu, Freddie H; Musahl, Volker

    2018-05-01

    A deep lateral femoral notch (LFN) on lateral radiographs is indicative of ACL injury. Prior studies have suggested that a deep LFN may also be a sign of persistent rotatory instability and a concomitant lateral meniscus tear. Therefore, the purpose of this study was to evaluate the relationship between LFN depth and both quantitative measures of rotatory knee instability and the incidence of lateral meniscus tears. It was hypothesized that greater LFN depth would be correlated with increased rotatory instability, quantified by lateral compartment translation and tibial acceleration during a quantitative pivot shift test, and incidence of lateral meniscus tears. ACL-injured patients enrolled in a prospective ACL registry from 2014 to 2016 were analyzed. To limit confounders, patients were only included if they had primary ACL tears, no concurrent ligamentous or bony injuries requiring operative treatment, and no previous knee injuries or surgeries to either knee. Eighty-four patients were included in the final analysis. A standardized quantitative pivot shift test was performed pre-operatively under anesthesia in both knees, and rotatory instability, specifically lateral compartment translation and tibial acceleration, was quantified using tablet image analysis software and accelerometer sensors. Standard lateral radiographs and sagittal magnetic resonance images (MRI) of the injured knee were evaluated for LFN depth. There were no significant correlations between LFN depth on either imaging modality and ipsilateral lateral compartment translation or tibial acceleration during a quantitative pivot shift test or side-to-side differences in these measurements. Patients with lateral meniscus tears were found to have significantly greater LFN depths than those without on conventional radiograph and MRI (1.0 vs. 0.6 mm, p < 0.05; 1.2 vs. 0.8 mm, p < 0.05, respectively). There was no correlation between lateral femoral notch depth on conventional radiographs or

  6. [Rotator cuff tear athropathy prevalence].

    PubMed

    Guerra-Soriano, F; Encalada-Díaz, M I; Ruiz-Suárez, M; Valero-González, F S

    2017-01-01

    Glenohumeral arthritis secondary to massive rotator cuff tear presents with a superior displacement and femoralization of the humeral head with coracoacromial arch acetabularization. The purpose of this study was to establish prevalence of rotator cuff tear artropathy (CTA) at our institution. Four hundred electronic records were reviewed from which we identified 136 patients with rotator cuff tears. A second group was composed with patients with massive cuff tears that were analized and staged by the Seebauer cuff tear arthropathy classification. Thirty four patients with massive rotator cuff tears were identified, 8 male and 26 female (age 60.1 ± 10.26 years). Massive rotator cuff tear prevalence was 25%. CTA prevalence found in the rotator cuff group was 19 and 76% in the massive cuff tears group. Patients were staged according to the classification with 32% in stage 1a, 11% 1b, 32% 2a and 0% 2b. CTA prevalence in patients with rotator cuff tears and massive cuff tears is higher than the one reported in American population. We consider that a revision of the Seebauer classification to be appropriate to determine its reliability.

  7. Antimicrobial Compounds in Tears

    PubMed Central

    McDermott, Alison M.

    2013-01-01

    The tear film coats the cornea and conjunctiva and serves several important functions. It provides lubrication, prevents drying of the ocular surface epithelia, helps provide a smooth surface for refracting light, supplies oxygen and is an important component of the innate defense system of the eye providing protection against a range of potential pathogens. This review describes both classic antimicrobial compounds found in tears such as lysozyme and some more recently identified such as members of the cationic antimicrobial peptide family and surfactant protein-D as well as potential new candidate molecules that may contribute to antimicrobial protection. As is readily evident from the literature review herein, tears, like all mucosal fluids, contain a plethora of molecules with known antimicrobial effects. That all of these are active in vivo is debatable as many are present in low concentrations, may be influenced by other tear components such as the ionic environment, and antimicrobial action may be only one of several activities ascribed to the molecule. However, there are many studies showing synergistic/additive interactions between several of the tear antimicrobials and it is highly likely that cooperativity between molecules is the primary way tears are able to afford significant antimicrobial protection to the ocular surface in vivo. In addition to effects on pathogen growth and survival some tear components prevent epithelial cell invasion and promote the epithelial expression of innate defense molecules. Given the protective role of tears a number of scenarios can be envisaged that may affect the amount and/or activity of tear antimicrobials and hence compromise tear immunity. Two such situations, dry eye disease and contact lens wear, are discussed here. PMID:23880529

  8. Weightbearing Versus Nonweightbearing After Meniscus Repair.

    PubMed

    VanderHave, Kelly L; Perkins, Crystal; Le, Michael

    2015-01-01

    Optimal rehabilitation after meniscal repair remains controversial. To review the current literature on weightbearing status after meniscal repairs and to provide evidence-based recommendations for postoperative rehabilitation. MEDLINE (January 1, 1993 to July 1, 2014) and Embase (January 1, 1993 to July 1, 2014) were queried with use of the terms meniscus OR/AND repair AND rehabilitation. Included studies were those with levels of evidence 1 through 4, with minimum 2 years follow-up and in an English publication. Systematic review. Level 4. Demographics and clinical and radiographic outcomes of meniscus repair at a minimum of 2 years follow-up were extracted. Successful clinical outcomes ranged from 70% to 94% with conservative rehabilitation. More recent studies using an accelerated rehabilitation protocol with full weightbearing and early range of motion reported 64% to 96% good results. Outcomes after both conservative (restricted weightbearing) protocols and accelerated rehabilitation (immediate weightbearing) yielded similar good to excellent results; however, lack of similar objective criteria and consistency among surgical techniques and existing studies makes direct comparison difficult. © 2015 The Author(s).

  9. Tear progression of symptomatic full-thickness and partial-thickness rotator cuff tears as measured by repeated MRI.

    PubMed

    Kim, Yang-Soo; Kim, Sung-Eun; Bae, Sung-Ho; Lee, Hyo-Jin; Jee, Won-Hee; Park, Chang Kyun

    2017-07-01

    The purpose of this study was to analyse the natural course of symptomatic full-thickness and partial-thickness rotator cuff tears treated non-operatively and to identify risk factors affecting tear enlargement. One hundred and twenty-two patients who received non-surgical treatment for a partial- or full-thickness supraspinatus tear were included in this study. All rotator cuff tears were diagnosed with magnetic resonance imaging (MRI), and the same modality was used for follow-up studies. Follow-up MRI was performed after at least a 6-month interval. We evaluated the correlation between tear enlargement and follow-up duration. Eleven risk factors were analysed by both univariate and multivariate analyses to identify factors that affect enlargement of rotator cuff tears. The mean follow-up period was 24.4 ± 19.5 months. Out of 122 patients, 34 (27.9%) patients had an initial full-thickness tear and 88 (72.1%) patients had a partial-thickness tear. Considering all patients together, tear size increased in 51/122 (41.8%) patients, was unchanged in 65/122 (53.3%) patients, and decreased in 6/122 (4.9%) patients. Tear size increased for 28/34 (82.4%) patients with full-thickness tears and 23/88 (26.1%) patients with partial-thickness tears. From the two groups which were followed over 12 months, a higher rate of enlargement was observed in full-thickness tears than in partial-thickness tears (6-12 months, n.s.; 12-24 months, P = 0.002; over 24 months, P < 0.001). Logistic regression revealed that having a full-thickness tear was the most reliable risk factor for tear progression (P < 0.001). This study found that 28/34 (82.4%) of symptomatic full-thickness rotator cuff tears and 23/88 (26.1%) of symptomatic partial-thickness tears increased in size over a follow-up period of 6-100 months. Full-thickness tears showed a higher rate of enlargement than partial-thickness tears regardless of the follow-up duration. Univariate and multivariate analyses

  10. Human tears contain a chemosignal.

    PubMed

    Gelstein, Shani; Yeshurun, Yaara; Rozenkrantz, Liron; Shushan, Sagit; Frumin, Idan; Roth, Yehudah; Sobel, Noam

    2011-01-14

    Emotional tearing is a poorly understood behavior that is considered uniquely human. In mice, tears serve as a chemosignal. We therefore hypothesized that human tears may similarly serve a chemosignaling function. We found that merely sniffing negative-emotion-related odorless tears obtained from women donors induced reductions in sexual appeal attributed by men to pictures of women's faces. Moreover, after sniffing such tears, men experienced reduced self-rated sexual arousal, reduced physiological measures of arousal, and reduced levels of testosterone. Finally, functional magnetic resonance imaging revealed that sniffing women's tears selectively reduced activity in brain substrates of sexual arousal in men.

  11. Subscapularis tendon tears

    PubMed Central

    Lenart, Brett A.; Ticker, Jonathan B.

    2017-01-01

    Tears of the subscapularis tendon have been under-recognised until recently. Therefore, a high index of suspicion is essential for diagnosis. A directed physical examination, including the lift-off, belly-press and increased passive external rotation can help identify tears of the subscapularis. All planes on MR imaging should be carefully evaluated to identify tears of the subscapularis, retraction, atrophy and biceps pathology. Due to the tendency of the tendon to retract medially, acute and traumatic full-thickness tears should be repaired. Chronic tears without significant degeneration should be considered for repair if no contraindication exists. Arthroscopic repair can be performed using a 30-degree arthroscope and a laterally-based single row repair; one anchor for full thickness tears ⩽ 50% of tendon length and two anchors for those ⩾ 50% of tendon length. Biceps pathology, which is invariably present, should be addressed by tenotomy or tenodesis. Timing of post-operative rehabilitation is dictated by the size of the repair and the security of the repair construct. The stages of rehabilitation typically involve a period of immobilisation followed by range of movement exercises, with a delay in active internal rotation (IR) and strengthening in IR. Cite this article: EFORT Open Rev 2017;2:484–495. DOI: 10.1302/2058-5241.2.170015 PMID:29387471

  12. Antimicrobial compounds in tears.

    PubMed

    McDermott, Alison M

    2013-12-01

    The tear film coats the cornea and conjunctiva and serves several important functions. It provides lubrication, prevents drying of the ocular surface epithelia, helps provide a smooth surface for refracting light, supplies oxygen and is an important component of the innate defense system of the eye providing protection against a range of potential pathogens. This review describes both classic antimicrobial compounds found in tears such as lysozyme and some more recently identified such as members of the cationic antimicrobial peptide family and surfactant protein-D as well as potential new candidate molecules that may contribute to antimicrobial protection. As is readily evident from the literature review herein, tears, like all mucosal fluids, contain a plethora of molecules with known antimicrobial effects. That all of these are active in vivo is debatable as many are present in low concentrations, may be influenced by other tear components such as the ionic environment, and antimicrobial action may be only one of several activities ascribed to the molecule. However, there are many studies showing synergistic/additive interactions between several of the tear antimicrobials and it is highly likely that cooperativity between molecules is the primary way tears are able to afford significant antimicrobial protection to the ocular surface in vivo. In addition to effects on pathogen growth and survival some tear components prevent epithelial cell invasion and promote the epithelial expression of innate defense molecules. Given the protective role of tears a number of scenarios can be envisaged that may affect the amount and/or activity of tear antimicrobials and hence compromise tear immunity. Two such situations, dry eye disease and contact lens wear, are discussed here. Copyright © 2013 Elsevier Ltd. All rights reserved.

  13. Asymptotic solutions for flow in microchannels with ridged walls and arbitrary meniscus protrusion

    NASA Astrophysics Data System (ADS)

    Kirk, Toby

    2017-11-01

    Flow over structured surfaces exhibiting apparent slip, such as parallel ridges, have received much attention experimentally and numerically, but analytical and asymptotic solutions that account for the microstructure have so far been limited to unbounded geometries such as shear-driven flows. Analysis for channel flows has been limited to (close to) flat interfaces spanning the grooves between ridges, but in applications the interfaces (menisci) can highly protrude and have a significant impact on the apparent slip. In this presentation, we consider pressure-driven flow through a microchannel with longitudinal ridges patterning one or both walls. With no restriction on the meniscus protrusion, we develop explicit formulae for the slip length using a formal matched asymptotic expansion. Assuming the ratio of channel height to ridge period is large, the periodicity is confined to an inner layer close to the ridges, and the expansion is found to all algebraic orders. As a result, the error is exponentially small and, under a further ``diluteness'' assumption, the explicit formulae are compared to finite element solutions. They are found to have a very wide range of validity in channel height (even when the menisci can touch the opposing wall) and so are useful for practitioners.

  14. Quantitative measures of meniscus extrusion predict incident radiographic knee osteoarthritis--data from the Osteoarthritis Initiative.

    PubMed

    Emmanuel, K; Quinn, E; Niu, J; Guermazi, A; Roemer, F; Wirth, W; Eckstein, F; Felson, D

    2016-02-01

    To test the hypothesis that quantitative measures of meniscus extrusion predict incident radiographic knee osteoarthritis (KOA), prior to the advent of radiographic disease. 206 knees with incident radiographic KOA (Kellgren Lawrence Grade (KLG) 0 or 1 at baseline, developing KLG 2 or greater with a definite osteophyte and joint space narrowing (JSN) grade ≥1 by year 4) were matched to 232 control knees not developing incident KOA. Manual segmentation of the central five slices of the medial and lateral meniscus was performed on coronal 3T DESS MRI and quantitative meniscus position was determined. Cases and controls were compared using conditional logistic regression adjusting for age, sex, BMI, race and clinical site. Sensitivity analyses of early (year [Y] 1/2) and late (Y3/4) incidence was performed. Mean medial extrusion distance was significantly greater for incident compared to non-incident knees (1.56 mean ± 1.12 mm SD vs 1.29 ± 0.99 mm; +21%, P < 0.01), so was the percent extrusion area of the medial meniscus (25.8 ± 15.8% vs 22.0 ± 13.5%; +17%, P < 0.05). This finding was consistent for knees restricted to medial incidence. No significant differences were observed for the lateral meniscus in incident medial KOA, or for the tibial plateau coverage between incident and non-incident knees. Restricting the analysis to medial incident KOA at Y1/2 differences were attenuated, but reached significance for extrusion distance, whereas no significant differences were observed at incident KOA in Y3/4. Greater medial meniscus extrusion predicts incident radiographic KOA. Early onset KOA showed greater differences for meniscus position between incident and non-incident knees than late onset KOA. Copyright © 2015 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

  15. Effect of Static Compressive Strain, Anisotropy, and Tissue Region on the Diffusion of Glucose in Meniscus Fibrocartilage.

    PubMed

    Kleinhans, Kelsey L; Jaworski, Lukas M; Schneiderbauer, Michaela M; Jackson, Alicia R

    2015-10-01

    Osteoarthritis (OA) is a significant socio-economic concern, affecting millions of individuals each year. Degeneration of the meniscus of the knee is often associated with OA, yet the relationship between the two is not well understood. As a nearly avascular tissue, the meniscus must rely on diffusive transport for nutritional supply to cells. Therefore, quantifying structure-function relations for transport properties in meniscus fibrocartilage is an important task. The purpose of the present study was to determine how mechanical loading, tissue anisotropy, and tissue region affect glucose diffusion in meniscus fibrocartilage. A one-dimensional (1D) diffusion experiment was used to measure the diffusion coefficient of glucose in porcine meniscus tissues. Results show that glucose diffusion is strain-dependent, decreasing significantly with increased levels of compression. It was also determined that glucose diffusion in meniscus tissues is anisotropic, with the diffusion coefficient in the circumferential direction being significantly higher than that in the axial direction. Finally, the effect of tissue region was not statistically significant, comparing axial diffusion in the central and horn regions of the tissue. This study is important for better understanding the transport and nutrition-related mechanisms of meniscal degeneration and related OA in the knee.

  16. Effect of basic physical parameters to control plasma meniscus and beam halo formation in negative ion sources

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Miyamoto, K.; Okuda, S.; Nishioka, S.

    2013-09-14

    Our previous study shows that the curvature of the plasma meniscus causes the beam halo in the negative ion sources: the negative ions extracted from the periphery of the meniscus are over-focused in the extractor due to the electrostatic lens effect, and consequently become the beam halo. In this article, the detail physics of the plasma meniscus and beam halo formation is investigated with two-dimensional particle-in-cell simulation. It is shown that the basic physical parameters such as the H{sup −} extraction voltage and the effective electron confinement time significantly affect the formation of the plasma meniscus and the resultant beammore » halo since the penetration of electric field for negative ion extraction depends on these physical parameters. Especially, the electron confinement time depends on the characteristic time of electron escape along the magnetic field as well as the characteristic time of electron diffusion across the magnetic field. The plasma meniscus penetrates deeply into the source plasma region when the effective electron confinement time is short. In this case, the curvature of the plasma meniscus becomes large, and consequently the fraction of the beam halo increases.« less

  17. Warping and tearing of misaligned circumbinary disks around eccentric supermassive black hole binaries

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Hayasaki, K.; Sohn, B.W.; Jung, T.

    2015-07-01

    We study the warping and tearing of a geometrically thin, non-self-gravitating disk surrounding binary supermassive black holes on an eccentric orbit. The circumbinary disk is significantly misaligned with the binary orbital plane, and is subject to the time-dependent tidal torques. In principle, such a disk is warped and precesses, and is torn into mutually misaligned rings in the region, where the tidal precession torques are stronger than the local viscous torques. We derive the tidal-warp and tearing radii of the misaligned circumbinary disks around eccentric SMBH binaries. We find that in disks with the viscosity parameter α larger than amore » critical value depending on the disk aspect ratio, the disk warping appears outside the tearing radius. This condition is expressed for small amplitude warps as α > √H/(3r) for H/r∼<0.1, where H is the disk scale height. If α < √H/(3r), only the disk tearing occurs because the tidal warp radius is inside the tearing radius, where most of disk material is likely to rapidly accrete onto SMBHs. In warped and torn disks, both the tidal-warp and the tearing radii most strongly depend on the binary semi-major axis, although they also mildly depend on the other orbital and disk parameters. This strong dependence enables us to estimate the semi-major axis, once the tidal warp or tearing radius is determined observationally: for the tidal warp radius of 0.1 pc, the semi-major axis is estimated to be ∼10{sup −2} pc for 10{sup 7} M{sub ⊙} black hole with typical orbital and disk parameters. We also briefly discuss the possibility that central objects of observed warped maser disks in active galactic nuclei are supermassive black hole binaries.« less

  18. Mean curvature model for a quasi-static advancing meniscus: a drop tower test

    NASA Astrophysics Data System (ADS)

    Chen, Yongkang; Tavan, Noel; Weislogel, Mark

    A critical geometric wetting condition resulting in a significant shift of a capillary fluid from one region of a container to another was recently demonstrated during experiments performed aboard the International Space Station (the Capillary Flow Experiments, Vane Gap test units, bulk shift phenomena). Such phenomena are of interest for advanced methods of control for large quantities of liquids aboard spacecraft. The dynamics of the flows are well understood, but analytical models remain qualitative without the correct capillary pressure driving force for the shifting bulk fluid—where one large interface (meniscus) advances while another recedes. To determine this pressure an investigation of the mean curvature of the advancing meniscus is presented which is inspired by earlier studies of receding bulk menisci in non-circular cylindrical containers. The approach is permissible only in the quasi-static limit. It will be shown that the mean curvature of the advancing bulk meniscus is related to that of the receding bulk meniscus, both of which are highly sensitive to container geometry and wetting conditions. The two meniscus curvatures are identical for any control parameter at the critical value identified by the Concus-Finn analysis. However, they differ when the control parameter is below its critical value. Experiments along these lines are well suited for drop towers and comparisons with the analytical predictions implementing the mean curvature model are presented. The validation opens a pathway to the analysis of such flows in containers of great geometric complexity.

  19. Randomized Controlled Crossover Trial Comparing the Impact of Sham or Intranasal Tear Neurostimulation on Conjunctival Goblet Cell Degranulation.

    PubMed

    Gumus, Koray; Schuetzle, Karri L; Pflugfelder, Stephen C

    2017-05-01

    The aim of the study was to investigate the effects of the Allergan Intranasal Tear Neurostimulator (ITN) on conjunctival goblet cell (GC) degranulation. A randomized, double-masked, placebo-controlled crossover trial. A total of 15 subjects (5 normal and 10 dry eye) were enrolled in a 3-visit study consisting of 1 screening and 2 separate randomized-masked ITN treatments (sham extranasal or intranasal). Tear meniscus height (TMH) was measured by anterior segment optical coherence tomography before and after applications. Impression cytology (IC) was taken from the bulbar conjunctiva of the right eye for periodic acid-Schiff staining and from the left eye for MUC5AC mucin immunostaining at baseline and after each treatment. The ratio of degranulated to nondegranulated GCs was measured as a marker of secretion. In all participants, both inferior bulbar (IB) and temporal bulbar (TB) cytology specimens stained for MUC5AC revealed a significantly higher ratio of degranulated to nondegranulated GCs after the ITN (IB: 2.28 ± 1.27 and TB: 1.81 ± 1.01) compared to baseline (IB: 0.56 ± 0.55, P = .015) (TB: 0.56 ± 0.32, P = .003) and extranasal sham application (IB: 0.37 ± 0.29, P = .001) (TB: 0.39 ± 0.33, P = .001). When the same analysis was repeated in the dry eye or control groups, the ratio was significantly higher after ITN than the baseline ratio and ratio after extranasal application in both groups (P < .05). Moreover, although control subjects had a higher ratio of degranulated to nondegranulated GCs at baseline (0.75 ± 0.52) compared with the dry eye group (0.41 ± 0.27), the ratio became slightly higher in dry eye (2.04 ± 1.12 vs 1.99 ± 1.21 in control) after the ITN application. There was no significant difference between the IB or TB conjunctiva locations in terms of the effectiveness of the ITN application on conjunctival goblet cell secretory response. These preliminary results document that the Allergan ITN can stimulate degranulation of goblet

  20. The importance of the posterior oblique ligament in repairs of acute tears of the medial ligaments in knees with and without an associated rupture of the anterior cruciate ligament. Results of long-term follow-up.

    PubMed

    Hughston, J C

    1994-09-01

    Forty-one of fifty patients (fifty knees) who had had a repair of an acute tear of the medial ligaments, a procedure in which repair of the posterior oblique ligament and the semimembranosus complex was emphasized, were re-evaluated after an average duration of follow-up of twenty-two years (range, eighteen to thirty years). The ages of the patients at the time of the injury had ranged from fifteen to twenty-one years. In twenty-four of the forty-one knees, the anterior cruciate ligament had been torn. In seventeen of these knees, the torn ligament had been debrided; in six others, which had had avulsion of a bone fragment or a terminal tear, the ligament had been repaired with absorbable sutures; and in the remaining knee, the repaired anterior cruciate ligament had been augmented. Four patients had had a pes anserinus transfer to supplement the medial repair. The medial meniscus had been intact or repaired in twenty-five of the forty-one knees and had been removed from the remaining sixteen. The lateral meniscus had been retained in thirty-nine knees and removed from two. Postoperatively, all knees had been immobilized for six weeks in 60 degrees of flexion by means of a plaster cast. This had not caused lasting loss of motion, persistent muscle atrophy, or clinically demonstrable deterioration of the articular cartilage. In the twenty-four knees that had had a tear of the anterior cruciate ligament, the rates of instability, meniscal injury, and deterioration of the joint had not increased since the time of treatment, compared with those in the knees with an intact ligament, even though repair and augmentation of this ligament had not been performed (except in one patient, in whom it was unsuccessful). Thirty-eight patients had good stability and a normal range of motion, as well as little or no muscle atrophy. Radiographic changes were slight or absent in all but four knees. Most patients had maintained a high level of physical fitness and recreational athletic

  1. An Analysis of Pathological Activities of CCN Proteins in Joint Disorders: Mechanical Stretch-Mediated CCN2 Expression in Cultured Meniscus Cells.

    PubMed

    Furumatsu, Takayuki; Ozaki, Toshifumi

    2017-01-01

    The multifunctional growth factor CYR61/CTGF/NOV (CCN) 2, also known as connective tissue growth factor, regulates cellular proliferation, differentiation, and tissue regeneration. Recent literatures have described important roles of CCN2 in the meniscus metabolism. However, the mechanical stress-mediated transcriptional regulation of CCN2 in the meniscus remains unclear. The meniscus is a fibrocartilaginous tissue that controls complex biomechanics of the knee joint. Therefore, the injured unstable meniscus has a poor healing potential especially in the avascular inner region. In addition, dysfunction of the meniscus correlates with the progression of degenerative knee joint disorders and joint space narrowing. Here, we describe an experimental approach that investigates the distinct cellular behavior of inner and outer meniscus cells in response to mechanical stretch. Our experimental model can analyze the relationships between stretch-induced CCN2 expression and its functional role in the meniscus homeostasis.

  2. Protein-releasing polymeric scaffolds induce fibrochondrocytic differentiation of endogenous cells for knee meniscus regeneration in sheep.

    PubMed

    Lee, Chang H; Rodeo, Scott A; Fortier, Lisa Ann; Lu, Chuanyong; Erisken, Cevat; Mao, Jeremy J

    2014-12-10

    Regeneration of complex tissues, such as kidney, liver, and cartilage, continues to be a scientific and translational challenge. Survival of ex vivo cultured, transplanted cells in tissue grafts is among one of the key barriers. Meniscus is a complex tissue consisting of collagen fibers and proteoglycans with gradient phenotypes of fibrocartilage and functions to provide congruence of the knee joint, without which the patient is likely to develop arthritis. Endogenous stem/progenitor cells regenerated the knee meniscus upon spatially released human connective tissue growth factor (CTGF) and transforming growth factor-β3 (TGFβ3) from a three-dimensional (3D)-printed biomaterial, enabling functional knee recovery. Sequentially applied CTGF and TGFβ3 were necessary and sufficient to propel mesenchymal stem/progenitor cells, as a heterogeneous population or as single-cell progenies, into fibrochondrocytes that concurrently synthesized procollagens I and IIα. When released from microchannels of 3D-printed, human meniscus scaffolds, CTGF and TGFβ3 induced endogenous stem/progenitor cells to differentiate and synthesize zone-specific type I and II collagens. We then replaced sheep meniscus with anatomically correct, 3D-printed scaffolds that incorporated spatially delivered CTGF and TGFβ3. Endogenous cells regenerated the meniscus with zone-specific matrix phenotypes: primarily type I collagen in the outer zone, and type II collagen in the inner zone, reminiscent of the native meniscus. Spatiotemporally delivered CTGF and TGFβ3 also restored inhomogeneous mechanical properties in the regenerated sheep meniscus. Survival and directed differentiation of endogenous cells in a tissue defect may have implications in the regeneration of complex (heterogeneous) tissues and organs. Copyright © 2014, American Association for the Advancement of Science.

  3. An evaluation of the thermal and mechanical properties of a salt-modified polyvinyl alcohol hydrogel for a knee meniscus application.

    PubMed

    Curley, Colin; Hayes, Jennifer C; Rowan, Neil J; Kennedy, James E

    2014-12-01

    The treatment of irreparable knee meniscus tears remains a major challenge for the orthopaedic community. The main purpose of this research was to analyse the mechanical properties and thermal behaviour of a salt-modified polyvinyl alcohol hydrogel, in order to assess its potential for use as an artificial meniscal implant. Aqueous poly vinyl alcohol was treated with a sodium sulphate solution to precipitate out the polyvinyl alcohol resulting in a pliable hydrogel. The freeze-thaw process, a strictly physical method of crosslinking, was employed to crosslink the hydrogel. Physical crosslinks in the form of crystalline regions were induced within the hydrogel structure which resulted in a large increase in mechanical resistance. Results showed that the optimal sodium sulphate addition of 6.6% (w/v) Na2SO4 in 8.33% (w/v) PVA causes the PVA to precipitate out of its solution. The effect of multiple freeze thaw cycles was also investigated. Investigation comprised of a variety of well-established characterisation techniques such as differential scanning calorimetry (DSC), Fourier transform infrared spectroscopy (FTIR), mechanical analysis, rheometry and swelling studies. DSC analysis showed that samples cross-linked using the freeze thaw process display a thermal shift due to increased crosslink density. FTIR analysis confirmed crystallisation is present at 1142cm(-1) and also showed that no chemical alteration occurs when PVA is treated with sodium sulphate. Swelling studies indicated that that PVA/sodium sulphate hydrogels absorb less water than untreated hydrogels due to increased amounts of PVA present. Compressive strength analysis of PVA/sodium sulphate hydrogels prepared at -80°C displayed average maximum loads of 2472N, 2482.4N and 2476N of over 1, 3 and 5 freeze thaw cycles respectively. Mechanical analysis of the hydrogel indicated that the material is thermally stable and resistant to breakdown by compressive force. These properties are crucial for

  4. TFOS DEWS II Tear Film Report.

    PubMed

    Willcox, Mark D P; Argüeso, Pablo; Georgiev, Georgi A; Holopainen, Juha M; Laurie, Gordon W; Millar, Tom J; Papas, Eric B; Rolland, Jannick P; Schmidt, Tannin A; Stahl, Ulrike; Suarez, Tatiana; Subbaraman, Lakshman N; Uçakhan, Omür Ö; Jones, Lyndon

    2017-07-01

    The members of the Tear Film Subcommittee reviewed the role of the tear film in dry eye disease (DED). The Subcommittee reviewed biophysical and biochemical aspects of tears and how these change in DED. Clinically, DED is characterized by loss of tear volume, more rapid breakup of the tear film and increased evaporation of tears from the ocular surface. The tear film is composed of many substances including lipids, proteins, mucins and electrolytes. All of these contribute to the integrity of the tear film but exactly how they interact is still an area of active research. Tear film osmolarity increases in DED. Changes to other components such as proteins and mucins can be used as biomarkers for DED. The Subcommittee recommended areas for future research to advance our understanding of the tear film and how this changes with DED. The final report was written after review by all Subcommittee members and the entire TFOS DEWS II membership. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. The FasT-Fix Repair Technique for Ramp Lesion of the Medial Meniscus.

    PubMed

    Li, Wei-Ping; Chen, Zhong; Song, Bin; Yang, Rui; Tan, Weiquan

    2015-03-01

    This technical note describes a new arthroscopic technique to repair the peripheral attachment lesion of the posterior horn of the medial meniscus. The operation was performed under arthroscopy using a standard anterior portal. A FasT-Fix needle was inserted obliquely close to the tibial plateau and the first implant was inserted into the joint capsule depending on its bending angle underneath the meniscus. The second implant was inserted through 1/3 periphery of the meniscus into the meniscocapsular area. The pre-tied self-sliding knot was tensioned to achieve secure fixation of the posterior meniscal peripheral attachment at the original attachment point. From August 2011 to February 2014, 23 knees were diagnosed as ramp lesion, underwent meniscal repair using FasT-Fix technique. All patients were followed up for average 14 months. The Lysholm score improved from preoperative 64.4±4.52 to postoperative 91.2±4.60. We believe that the FasT-Fix technique via the standard anterior portal can be a more convenient and less traumatic alternative for repair of the peripheral attachment lesion of the posterior horn of the medial meniscus in the anterior cruciate ligament deficient knee.

  6. Rupture of posterior cruciate ligament leads to radial displacement of the medial meniscus.

    PubMed

    Zhang, Can; Deng, Zhenhan; Luo, Wei; Xiao, Wenfeng; Hu, Yihe; Liao, Zhan; Li, Kanghua; He, Hongbo

    2017-07-11

    To explore the association between the rupture of posterior cruciate ligament (PCL) and the radial displacement of medial meniscus under the conditions of different flexion and various axial loads. The radial displacement value of medial meniscus was measured for the specimens of normal adult knee joints, including 12 intact PCLs, 6 ruptures of the anterolateral bundle (ALB), 6 ruptures of the postmedial bundle (PMB), and 12 complete ruptures. The measurement was conducted at 0°, 30°, 60°, and 90° of knee flexion angles under 200 N, 400 N, 600 N, 800 N and 1000 N of axial loads respectively. The displacement values of medial meniscus of the ALB rupture group increased at 0° flexion under 800 N and 1000 N, and at 30°, 60° and 90° flexion under all loads in comparison with the PCL intact group. The displacement values of the PMB rupture group was higher at 0° and 90° flexion under all loads, and at 30° and 60° flexion under 800 N and 1000 N loads. The displacement of the PCL complete rupture group increased at all flexion angles under all loads. Either partial or complete rupture of the PCL can increase in the radial displacement of the medial meniscus, which may explain the degenerative changes that occuring in the medial meniscus due to PCL injury. Therefore, early reestablishment of the PCL is necessarily required in order to maintain stability of the knee joint after PCL injury.

  7. A novel method to predict the dry eye symptoms in new contact lens wearers.

    PubMed

    Pult, Heiko; Murphy, Paul J; Purslow, Christine

    2009-09-01

    Lid wiper epitheliopathy (LWE) and lid parallel conjunctival folds (LIPCOF) give moderate prediction levels for dryness symptoms in experienced contact lens (CL) wearers. This study investigated whether a combination of LWE and LIPCOF plus other tear film tests and subjective evaluation before contact lens fitting was better able to predict CL-induced dry eye (CLIDE) symptoms. Tear meniscus height, non-invasive break-up time (NIBUT), ocular hyperaemia, LIPCOF, phenol red thread test, corneal and conjunctival staining, and LWE of the right eye of 33 new soft CL wearers (12 males, 21 females, median age = 30.5 years; range = 19 to 44) were assessed in a prospective 2-mo longitudinal study. Symptoms were evaluated by the Ocular Surface Disease Index (OSDI) and subjects were grouped according to their response in the Contact Lens Dry Eye Questionnaire (CLDEQ) during the study (20 symptomatic and 13 asymptomatic). The subjects were fitted with vifilcon A and senofilcon A lenses for a 2-week period, consecutively. Limbal hyperaemia (repeated measures analysis of variance; p < 0.05) and LWE (Friedman; p < 0.004) increased significantly during the study but not LIPCOF (p > or = 0.318; temporal, nasal, and Sum), bulbar hyperaemia (p = 0.432), staining (p > or = 0.060), OSDI (p = 0.126), or CLDEQ (p = 0.317, kappa = 0.279). Limbal hyperaemia significantly decreased in senofilcon A lenses. Wearing comfort among symptomatics was significantly better with senofilcon A (p = 0.005). At the enrolment visit, the subjects who became symptomatic exhibited significantly decreased NIBUT and increased LIPCOF and OSDI (range, p < 0.027). The best test combination to predict CLIDE (logistic regression analyses) was LIPCOF Sum plus NIBUT and OSDI, (positive predictive value = 87% and accuracy = 91%). LIPCOF, NIBUT, and OSDI are significant discriminators for CLIDE in new CL wearers compared with hyperaemia, tear meniscus height, phenol red thread test, staining, and LWE. The best test

  8. Quantitative measures of meniscus extrusion predict incident radiographic knee osteoarthritis – data from the Osteoarthritis Initiative

    PubMed Central

    Emmanuel, K.; Quinn, E.; Niu, J.; Guermazi, A.; Roemer, F.; Wirth, W.; Eckstein, F.; Felson, D.

    2017-01-01

    SUMMARY Objective To test the hypothesis that quantitative measures of meniscus extrusion predict incident radiographic knee osteoarthritis (KOA), prior to the advent of radiographic disease. Methods 206 knees with incident radiographic KOA (Kellgren Lawrence Grade (KLG) 0 or 1 at baseline, developing KLG 2 or greater with a definite osteophyte and joint space narrowing (JSN) grade ≥1 by year 4) were matched to 232 control knees not developing incident KOA. Manual segmentation of the central five slices of the medial and lateral meniscus was performed on coronal 3T DESS MRI and quantitative meniscus position was determined. Cases and controls were compared using conditional logistic regression adjusting for age, sex, BMI, race and clinical site. Sensitivity analyses of early (year [Y] 1/2) and late (Y3/4) incidence was performed. Results Mean medial extrusion distance was significantly greater for incident compared to non-incident knees (1.56 mean ± 1.12 mm SD vs 1.29 ± 0.99 mm; +21%, P < 0.01), so was the percent extrusion area of the medial meniscus (25.8 ± 15.8% vs 22.0 ± 13.5%; +17%, P < 0.05). This finding was consistent for knees restricted to medial incidence. No significant differences were observed for the lateral meniscus in incident medial KOA, or for the tibial plateau coverage between incident and non-incident knees. Restricting the analysis to medial incident KOA at Y1/2 differences were attenuated, but reached significance for extrusion distance, whereas no significant differences were observed at incident KOA in Y3/4. Conclusion Greater medial meniscus extrusion predicts incident radiographic KOA. Early onset KOA showed greater differences for meniscus position between incident and non-incident knees than late onset KOA. PMID:26318658

  9. A new method for meniscus repair using type I collagen scaffold and infrapatellar fat pad.

    PubMed

    Oda, Shuhei; Otsuki, Shuhei; Kurokawa, Yoshitaka; Hoshiyama, Yoshiaki; Nakajima, Mikio; Neo, Masashi

    2015-05-01

    The aim of this study was to investigate a new method for meniscal repair by combinative transplantation with type I collagen scaffold and infrapatellar fat pad. Two-mm cylindrical defects at the anterior part of bilateral medial menisci were prepared in nine Japanese white rabbits. The 18 knees were equally divided into three groups: I, no treatment; II, collagen scaffold transplantation; and III, collagen scaffold and infrapatellar fat pad transplantation. Another three rabbits (six knees) underwent sham surgery and served as controls. Rabbits were sacrificed at eight weeks after transplantation. Surface area of the medial meniscus was evaluated using macrophotographs. Ishida score for meniscal regeneration was used for assessment. To evaluate the composition of regenerated tissue, immunohistochemistry was analyzed with anti-type I and anti-type II collagen antibodies, and anti-Ki67 antibody. To investigate the effects of collagen scaffold on human meniscus, cells were isolated from human meniscus and infrapatellar fat pad, and cultured with collagen scaffold for three weeks. After that, gene expression was evaluated by using quantitative real-time polymerase chain reaction. In group I, the meniscus shrank anterior to posterior, and the surface area was significantly less than that of normal meniscus. However, the surface area was maintained in group III. Ishida score and Ki67-positive cell ratio in group III were significantly higher than that in any other group, and staining with type I and type II collagen was similar to that of the control. Expression of matrix metalloproteinase was significantly lower in cocultures of collagen scaffold, meniscus cell, and infrapatellar fat pad cell than in monocultured meniscus cell, and expression of interleukin-1β was not increased. This new method for meniscal repair by combinative transplantation with type I collagen scaffold and infrapatellar fat pad showed meniscal regeneration and potential for suppressing

  10. Exploring topical anti-glaucoma medication effects on the ocular surface in the context of the current understanding of dry eye.

    PubMed

    Wong, Aaron B C; Wang, Michael T M; Liu, Kevin; Prime, Zak J; Danesh-Meyer, Helen V; Craig, Jennifer P

    2018-07-01

    To assess tear film parameters, ocular surface characteristics, and dry eye symptomology in patients receiving topical anti-glaucoma medications. Thirty-three patients with a diagnosis of open angle glaucoma or ocular hypertension, receiving unilateral topical anti-glaucoma medication for at least 6 months, were recruited in a cross-sectional, investigator-masked, paired-eye comparison study. Tear film parameters, ocular surface characteristics, and dry eye symptomology of treated and fellow eyes were evaluated and compared. The mean ± SD age of the participants was 67 ± 12 years, and the mean ± SD treatment duration was 5.3 ± 4.4 years. Treated eyes had poorer non-invasive tear film breakup time (p = 0.03), tear film osmolarity (p = 0.04), bulbar conjunctival hyperaemia (p = 0.04), eyelid margin abnormality grade (p = 0.01), tear meniscus height (p = 0.03), and anaesthetised Schirmer value (p = 0.04) than fellow eyes. There were no significant differences in dry eye symptomology, meibomian gland assessments, and ocular surface staining between treated and fellow eyes (all p > 0.05). Adverse changes in tear film stability, tear osmolarity, conjunctival hyperaemia, and eyelid margins were observed in treated eyes. This suggests that inflammatory mechanisms may be implicated in the development of dry eye in patients receiving long term topical anti-glaucoma therapy. Copyright © 2018 Elsevier Inc. All rights reserved.

  11. Tear analysis in contact lens wearers.

    PubMed Central

    Farris, R L

    1985-01-01

    Tear analysis in contact lens wearers was compared with tear analysis in aphakics without contact lens wear and normal phakic patients. Subjects were divided into five groups: group 1, aphakic without contact lens; group 2, phakic with daily-wear hard contact lens; group 3, phakic with daily-wear soft contact lens; group 4, phakic with extended-wear soft contact lens; and group 5, aphakic with extended-wear soft contact lens. The experimental groups were compared with age- and sex-matched control groups for statistical analysis of tear variables by means of the Student's t-test. The variables measured were tear osmolarity, tear albumin, and lysozyme and lactoferrin concentrations in basal and reflex tears. Highly significant elevations of tear osmolarity were found in aphakic subjects without contact lenses. Less significant differences in tear osmolarity were found in phakic subjects with hard daily-wear lenses or with extended-wear soft lenses. Tear albumin, lysozyme, and lactoferrin in basal and reflex tears were not significantly different in the different groups of contact lens wearers or in the group of aphakic subjects without contact lenses compared with their control groups. Individual variations in tear albumin, lysozyme, and lactoferrin appeared to be responsible for the inability to demonstrate significant differences in tear composition in association with the wearing of different types of contact lenses. Older and aphakic patients demonstrated a tendency to have increased concentrations of proteins in the tears compared with younger, phakic contact lens wearers and normal controls without contact lenses. PMID:3914131

  12. Does Release of the Superficial Medial Collateral Ligament Result in Clinically Harmful Effects After the Fixation of Medial Meniscus Posterior Root Tears?

    PubMed

    Chung, Kyu Sung; Ha, Jeong Ku; Ra, Ho Jong; Kim, Jin Goo

    2017-01-01

    To investigate pain and tenderness, stress testing, clinical outcome scores, complications, and operation time at 24 months and magnetic resonance imaging (MRI) analysis at 12 months after the release of the distal attachment of the superficial medial collateral ligament (sMCL) during medial meniscus posterior root tear (MMPRT) fixation. Patients who received MMPRT fixation with a follow-up of at least 2 years were included. During fixation, the release of the distal attachment of the sMCL on the proximal tibia was performed to improve visualization and provide sufficient working space. Pain and tenderness at the released area, manual valgus stress tests of 30° and 0° flexion (grade 0/1/2/3), and subjective instability during weight bearing were evaluated serially at postoperative 3, 6, 12, and 24+ months. The contour of detachment area was assessed using MRI 12 months postoperatively. As a subgroup analysis, tourniquet time (minutes) and final clinical scores were compared between release and nonrelease groups. The numbers of participants in the release and nonrelease groups were 118 and 20 patients, and their mean follow-up durations were 42.4 ± 19.3 (24-95) and 37.2 ± 7.8 (30-55) months, respectively. In the release group, percentages of patients with pain and tenderness at 3 months were 15% and 18%, respectively; however, no patients had symptoms at 12 months. In valgus stress tests (30°, 0°), 12% and 2% of patients showed grade 1 laxity at 3 months, and 7% had grade 1 laxity in only 30° flexion at the final follow-up. However, no patients had subjective valgus laxity. An intact contour was confirmed in all cases among 94 patients checked by performing follow-up MRI. Tourniquet time was significantly shorter in the release group (42.4 ± 19.3) than in the nonrelease group (58.5 ± 9.5; P < .001). Between release and nonrelease groups, Lysholm (84.4 ± 12.1, 88.1 ± 12.8; P = .117) and International Knee Documentation Committee scores (73.6 ± 11

  13. Quantitative analysis of tear film fluorescence and discomfort during tear film instability and thinning.

    PubMed

    Begley, Carolyn; Simpson, Trefford; Liu, Haixia; Salvo, Eliza; Wu, Ziwei; Bradley, Arthur; Situ, Ping

    2013-04-12

    The purpose of this study was to test the association between tear film fluorescence changes during tear break-up (TBU) or thinning and the concurrent ocular sensory response. Sixteen subjects kept one eye open as long as possible (MBI), indicated their discomfort level continuously, and rated ocular sensations of irritation, stinging, burning, pricking, and cooling using visual analog scales (VAS). Fluorescence of the tear film was quantified by a pixel-based analysis of the median pixel intensity (PI), TBU, and percentage of dark pixels (DarkPix) over time. A cutoff of 5% TBU was used to divide subjects into either break-up (BU) or minimal break-up (BUmin) groups. Tear film fluorescence decreased (median PI) and the percentage of TBU and DarkPix increased in all trials, with the rate significantly greater in the BU than the BUmin group (Mann-Whitney U test, P < 0.05). The rate of increasing discomfort during trials was highly correlated with the rate of decrease in median PI and developing TBU (Spearman's, r ≥ 0.70). Significant correlations were found between corneal fluorescence, MBI, and sensory measures. Concentration quenching of fluorescein dye with tear film thinning best explains decreasing tear film fluorescence during trials. This was highly correlated with increasing ocular discomfort, suggesting that both tear film thinning and TBU stimulate underlying corneal nerves, although TBU produced more rapid stimulation. Slow increases in tear film hyperosmolarity may cause the gradual increase in discomfort during slow tear film thinning, whereas the sharp increases in discomfort during TBU suggest a more complex stimulus.

  14. Classification of ulnar triangular fibrocartilage complex tears. A treatment algorithm for Palmer type IB tears.

    PubMed

    Atzei, A; Luchetti, R; Garagnani, L

    2017-05-01

    The classical definition of 'Palmer Type IB' triangular fibrocartilage complex tear, includes a spectrum of clinical conditions. This review highlights the clinical and arthroscopic criteria that enable us to categorize five classes on a treatment-oriented classification system of triangular fibrocartilage complex peripheral tears. Class 1 lesions represent isolated tears of the distal triangular fibrocartilage complex without distal radio-ulnar joint instability and are amenable to arthroscopic suture. Class 2 tears include rupture of both the distal triangular fibrocartilage complex and proximal attachments of the triangular fibrocartilage complex to the fovea. Class 3 tears constitute isolated ruptures of the proximal attachment of the triangular fibrocartilage complex to the fovea; they are not visible at radio-carpal arthroscopy. Both Class 2 and Class 3 tears are diagnosed with a positive hook test and are typically associated with distal radio-ulnar joint instability. If required, treatment is through reattachment of the distal radio-ulnar ligament insertions to the fovea. Class 4 lesions are irreparable tears due to the size of the defect or to poor tissue quality and, if required, treatment is through distal radio-ulnar ligament reconstruction with tendon graft. Class 5 tears are associated with distal radio-ulnar joint arthritis and can only be treated with salvage procedures. This subdivision of type IB triangular fibrocartilage complex tear provides more insights in the pathomechanics and treatment strategies. II.

  15. Partial articular-sided rotator cuff tears: in situ repair versus tear completion prior to repair.

    PubMed

    Sethi, Paul M; Rajaram, Arun; Obopilwe, Elifho; Mazzocca, Augustus D

    2013-06-01

    Uncertainty exists over the ideal surgical treatment method for partial articular-sided rotator cuff tears, with options ranging from debridement to in situ repair to tear completion prior to repair. The purpose of this study was to determine whether in situ repair was a viable biomechanical treatment option compared with tear completion prior to repair of partial articular-sided rotator cuff tears. Fourteen fresh-frozen cadaveric shoulders were dissected. Partial articular-sided tears were created and repaired using in situ repair or tear completion prior to the repair. Strain and displacement were measured at 45°, 60°, and 90° of glenohumeral abduction. Testing was performed with a load of 100 N applied for 30 cycles. Data from the biomechanical testing displayed 4 conditions that showed improved characteristics of in situ repair over completion and repair: bursal-sided strain anteriorly at 45°, bursal-sided strain anteriorly at 90°, bursal-sided displacement anteriorly at 45°, and bursal-sided displacement anteriorly at 90°. The data indicate that in situ repair is a viable biomechanical treatment option compared with tear completion prior to repair of partial articular-sided rotator cuff tears. When clinically appropriate, the in situ repair may offer some biomechanical advantages, with lower strain and displacement observed on the bursal side compared with tear completion prior to repair. Copyright 2013, SLACK Incorporated.

  16. Tear-Duct Obstruction and Surgery

    MedlinePlus

    ... Staying Safe Videos for Educators Search English Español Tear-Duct Obstruction and Surgery KidsHealth / For Parents / Tear- ... year old with little or no treatment. About Tear Ducts Our eyes are continually exposed to dust, ...

  17. Bonding and fusion of meniscus fibrocartilage using a novel chondroitin sulfate bone marrow tissue adhesive.

    PubMed

    Simson, Jacob A; Strehin, Iossif A; Allen, Brian W; Elisseeff, Jennifer H

    2013-08-01

    The weak intrinsic meniscus healing response and technical challenges associated with meniscus repair contribute to a high rate of repair failures and meniscectomies. Given this limited healing response, the development of biologically active adjuncts to meniscal repair may hold the key to improving meniscal repair success rates. This study demonstrates the development of a bone marrow (BM) adhesive that binds, stabilizes, and stimulates fusion at the interface of meniscus tissues. Hydrogels containing several chondroitin sulfate (CS) adhesive levels (30, 50, and 70 mg/mL) and BM levels (30%, 50%, and 70%) were formed to investigate the effects of these components on hydrogel mechanics, bovine meniscal fibrochondrocyte viability, proliferation, matrix production, and migration ability in vitro. The BM content positively and significantly affected fibrochondrocyte viability, proliferation, and migration, while the CS content positively and significantly affected adhesive strength (ranged from 60±17 kPa to 335±88 kPa) and matrix production. Selected material formulations were translated to a subcutaneous model of meniscal fusion using adhered bovine meniscus explants implanted in athymic rats and evaluated over a 3-month time course. Fusion of adhered meniscus occurred in only the material containing the highest BM content. The technology can serve to mechanically stabilize the tissue repair interface and stimulate tissue regeneration across the injury site.

  18. Does partial tear repair of adjacent tendons improve the outcome of supraspinatus tendonfull-thickness tear reinsertion?

    PubMed

    Nich, C; Dhiaf, N; Di Schino, M; Augereau, B

    2014-11-01

    Partial tearing of the infraspinatus and/or subscapularis tendon(s) is frequently associated with supraspinatus full-thickness tears. However, limited data regarding its influence on supraspinatus surgical repair is available. Our aim was to assess the functional and anatomical outcomes of open repair of supraspinatus full-thickness tears combined with adjacent partial tearing, comparatively to a control. We retrospectively identified 22 patients (22 shoulders) with a partial tear, most of them being a delamination tear, of the infraspinatus and/or subscapularis tendons associated with a complete detachment of the supraspinatus tendon. Twenty-seven patients (27 shoulders) treated for an isolated complete detachment of the supraspinatus tendon by open repair served as controls. The mean age was 58 years. A proximalized trans-osseous reinsertion of the supraspinatus tendon was combined with a curettage-closure of the delamination tear. Patients were evaluated with standardized MRI at last follow-up. At a mean of 75-month follow-up, the presence of a partial tear of either infraspinatus or subscapularis, or both, did not influence function and healing rates of supraspinatus tendon repair. Conversely to the control, when a retear occurred, the functional score tended to worsen. Preoperatively, fatty muscular degeneration was more pronounced when a partial tear was present. Fatty degeneration worsened regardless of repair healing. Open reinsertion of a supraspinatus full-thickness tear associated with a thorough treatment of partial tear of adjacent tendons led to optimal functional and anatomical mid term outcomes. Our results suggest the presence of a partial tear of adjacent tendons could be associated with poorer function in case of supraspinatus tendon re-rupture. Level III case-control study. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  19. Mechanical modeling and characterization of meniscus tissue using flat punch indentation and inverse finite element method.

    PubMed

    Seyfi, Behzad; Fatouraee, Nasser; Imeni, Milad

    2018-01-01

    In this paper, to characterize the mechanical properties of meniscus by considering its local microstructure, a novel nonlinear poroviscoelastic Finite Element (FE) model has been developed. To obtain the mechanical response of meniscus, indentation experiments were performed on bovine meniscus samples. The ramp-relaxation test scenario with different depths and preloads was designed to capture the mechanical characteristics of the tissue in different regions of the medial and lateral menisci. Thereafter, a FE simulation was performed considering experimental conditions. Constitutive parameters were optimized by solving a FE-based inverse problem using the heuristic Simulated Annealing (SA) optimization algorithm. These parameters were ranged according to previously reported data to improve the optimization procedure. Based on the results, the mechanical properties of meniscus were highly influenced by both superficial and main layers. At low indentation depths, a high percentage relaxation (p < 0.01) with a high relaxation rate (p < 0.05) was obtained, due to the poroelastic and viscoelastic nature of the superficial layer. Increasing both penetration depth and preload level involved the main layer response and caused alterations in hyperelastic and viscoelastic parameters of the tissue, such that for both layers, the shear modulus was increased (p < 0.01) while the rate and percentage of relaxation were decreased (p < 0.01). Results reflect that, shear modulus of the main layer in anterior region is higher than central and posterior sites in medial meniscus. In contrast, in lateral meniscus, posterior side is stiffer than central and anterior sides. Copyright © 2017 Elsevier Ltd. All rights reserved.

  20. An observational study on MR images of the effect of the discoid meniscus on articular cartilage thickness.

    PubMed

    Oni, David Babajide; Jeyapalan, K; Oni, Olusola O A

    2011-06-01

    The discoid meniscus is known to affect the morphology and mechanics of the knee compartment in which it is housed. To determine whether it also is determinative of the articular cartilage thickness, measurements were made on MR images. There was no statistically significant difference in femoral or tibial articular cartilage thickness between compartments with normal meniscus and compartments with discoid meniscus. These findings suggest that mechanical disturbances wrought by the discoid shape do not have a 'Wolff law' effect. Copyright © 2010. Published by Elsevier B.V.

  1. Artificial tears potpourri: a literature review

    PubMed Central

    Moshirfar, Majid; Pierson, Kasey; Hanamaikai, Kamalani; Santiago-Caban, Luis; Muthappan, Valliammai; Passi, Samuel F

    2014-01-01

    Numerous brands and types of artificial tears are available on the market for the treatment of dysfunctional tear syndrome. Past literature has focused on comparing the components of these products on patient’s clinical improvement. The wide array of products on the market presents challenges to both clinicians and patients when trying to choose between available tear replacement therapies. Different formulations affect patients based on etiology and severity of disease. In order to provide an unbiased comparison between available tear replacement therapies, we conducted a literature review of existing studies and National Institutes of Health clinical trials on commercially available, brand name artificial tears. Outcomes evaluated in each study, as well as the percent of patients showing clinical and symptomatic improvement, were analyzed. Fifty-one studies evaluating different brands of artificial tears, and their efficacy were identified. Out of the 51 studies, 18 were comparison studies testing brand name artificial tears directly against each other. Nearly all formulations of artificial tears provided significant benefit to patients with dysfunctional tear syndrome, but some proved superior to others. From the study data, a recommended treatment flowchart was derived. PMID:25114502

  2. Interaction of corneal nociceptive stimulation and lacrimal secretion.

    PubMed

    Situ, Ping; Simpson, Trefford L

    2010-11-01

    To investigate the interaction between corneal stimuli at different positions and tear secretion and to establish relationships between nociceptive stimuli detection thresholds and stimulated tearing. Using a computerized Belmonte-esthesiometer, mechanical and chemical stimuli, from 0% to 200% of the threshold in 50% steps, were delivered (in random order) to the central and peripheral (approximately 2-mm inside the limbus) cornea during four separate sessions to 15 subjects. Immediately after each stimulus, tear meniscus height (TMH) was measured using optical coherence tomography to quantify the amount of lacrimal secretion, and subjects reported whether they felt tears starting to accumulate in their eyes. Thresholds (50% detection) for detection of tearing were estimated. TMH increased with increasing stimulus intensity (P < 0.05), and the overall increase was higher with central stimulation than with peripheral stimulation (P < 0.05). The changes in TMH with threshold-scaled stimulus intensity depended on test location (P < 0.05) and stimulus modality (P < 0.05). The maximum intensity of mechanical stimulation of the central cornea induced the greatest TMH (all P < 0.05). For chemical stimulation, the stimulus intensity required to induce detectable tearing was higher than that required to detect a stimulus and higher in the periphery than at the center (all P < 0.05). Noxious mechanical and chemical stimuli evoked measurable tear secretion, with central corneal mechanical stimulation evoking the strongest lacrimation reflex. Central mechanical corneal stimulation is the most effective stimulus-position pairing and appears to be the major sensory driving force for reflex tear secretion by the lacrimal functional unit.

  3. 49 CFR 178.1070 - Tear test.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 3 2013-10-01 2013-10-01 false Tear test. 178.1070 Section 178.1070... Containers § 178.1070 Tear test. (a) General. The tear test must be conducted for the qualification of all of Flexible Bulk Containers design types. (b) Special preparation for the tear test. Flexible Bulk Container...

  4. Effects of Menthol-Containing Artificial Tears on Tear Stimulation and Ocular Surface Integrity in Normal and Dry Eye Rat Models.

    PubMed

    Ahn, Somin; Eom, Youngsub; Kang, Boram; Park, Jungboung; Lee, Hyung Keun; Kim, Hyo Myung; Song, Jong Suk

    2018-05-01

    To evaluate the effects of menthol-containing artificial tears on tear stimulation and ocular surface integrity in normal and dry eye rat models. A total of 54 male Lewis rats were used. The levels of tear secretion and tear MUC5AC concentrations were compared between the menthol-containing artificial tear-treated group (menthol group) and the vehicle-treated group (vehicle group). The groups were compared after a single instillation to evaluate the immediate effects, and after repeated instillation (five times a day for 5 days) to evaluate the longer-term effects. Tear lactate dehydrogenase (LDH) activity was measured to evaluate eye drop instillation-induced ocular surface damage. The effects of menthol-containing artificial tears were also evaluated in a dry eye rat model. After a single instillation of menthol-containing artificial tears, tear secretion increased from 4.37 (±0.75) mm at baseline to 7.37 (±1.60) mm. However, after repeated instillations, the effects of tear stimulation decreased. The tear MUC5AC concentration was significantly lower in the menthol group than in the vehicle group after a single instillation, but not after repeated instillation. However, the tear LDH concentration was significantly increased in the menthol group after repeated instillation. In the dry eye rat model, the extent of menthol-induced tear stimulation was reduced. Menthol-containing artificial tears increased tear secretion, but lowered the tear MUC5AC concentration. Menthol-induced tear stimulation was reduced after repeated instillation for 5 days and in the dry eye rat model. Conversely, repeated instillation of menthol-induced ocular surface damage, resulting in increased tear LDH activity.

  5. 49 CFR 178.818 - Tear test.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 3 2013-10-01 2013-10-01 false Tear test. 178.818 Section 178.818 Transportation... Tear test. (a) General. The tear test must be conducted for the qualification of all flexible IBC design types. (b) Special preparation for the tear test. The flexible IBC must be filled to not less than...

  6. 49 CFR 178.818 - Tear test.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 2 2010-10-01 2010-10-01 false Tear test. 178.818 Section 178.818 Transportation... § 178.818 Tear test. (a) General. The tear test must be conducted for the qualification of all flexible IBC design types. (b) Special preparation for the tear test. The flexible IBC must be filled to not...

  7. Advances and Prospects in Tissue-Engineered Meniscal Scaffolds for Meniscus Regeneration

    PubMed Central

    Guo, Weimin; Liu, Shuyun; Zhu, Yun; Yu, Changlong; Lu, Shibi; Yuan, Mei; Huang, Jingxiang; Yuan, Zhiguo; Peng, Jiang; Wang, Aiyuan; Wang, Yu; Chen, Jifeng; Zhang, Li; Sui, Xiang; Xu, Wenjing; Guo, Quanyi

    2015-01-01

    The meniscus plays a crucial role in maintaining knee joint homoeostasis. Meniscal lesions are relatively common in the knee joint and are typically categorized into various types. However, it is difficult for inner avascular meniscal lesions to self-heal. Untreated meniscal lesions lead to meniscal extrusions in the long-term and gradually trigger the development of knee osteoarthritis (OA). The relationship between meniscal lesions and knee OA is complex. Partial meniscectomy, which is the primary method to treat a meniscal injury, only relieves short-term pain; however, it does not prevent the development of knee OA. Similarly, other current therapeutic strategies have intrinsic limitations in clinical practice. Tissue engineering technology will probably address this challenge by reconstructing a meniscus possessing an integrated configuration with competent biomechanical capacity. This review describes normal structure and biomechanical characteristics of the meniscus, discusses the relationship between meniscal lesions and knee OA, and summarizes the classifications and corresponding treatment strategies for meniscal lesions to understand meniscal regeneration from physiological and pathological perspectives. Last, we present current advances in meniscal scaffolds and provide a number of prospects that will potentially benefit the development of meniscal regeneration methods. PMID:26199629

  8. Effects of topical cyclosporine a plus artificial tears versus artificial tears treatment on conjunctival goblet cell density in dysfunctional tear syndrome.

    PubMed

    Demiryay, Elvan; Yaylali, Volkan; Cetin, Ebru Nevin; Yildirim, Cem

    2011-09-01

    The aim was to compare the effects of topical cyclosporine A and artificial tears combination with artificial tears alone in patients with dysfunctional tear syndrome (DTS). Forty-two eyes of 42 patients with DTS were enrolled in the study. The inclusion criteria for the study were Schirmer I (without anesthesia) scores below 10 mm/5 min and tear film break-up time (BUT) below 10 sec. The patients were randomly divided into two groups. The study group (22 patients) underwent 0.05% cyclosporine A treatment twice a day and preservative-free artificial tears for four times a day for 4 months. The control group (20 patients) was administered only preservative-free artificial tears four times a day for 4 months. The BUT, Schirmer test scores, corneal fluorescein staining, conjunctival lissamine green staining, and goblet cell density derived by impression cytology were recorded before and after treatment in each group. In the study group, all parameters improved statistically significantly after treatment at the 4-month follow-up compared with the pretreatment values (P<0.001 for all). In the control group, corneal fluorescein staining (P<0.001) and conjunctival lissamine green staining (P=0.014) improved, but BUT and Schirmer scores did not change significantly after treatment. At the end of the 4-month follow-up, the study group demonstrated statistically significantly better BUT (P=0.020), Schirmer scores (P=0.002), goblet cell density (P=0.006), corneal fluorescein staining (P=0.003), and conjunctival lissamine green staining (P=0.017) scores than did the control group. Topical cyclosporine A and artificial tears treatment significantly increases goblet cell density, decreases the signs of DTS, and improves ocular surface health.

  9. Light emitting diode package element with internal meniscus for bubble free lens placement

    DOEpatents

    Tarsa, Eric; Yuan, Thomas C.; Becerra, Maryanne; Yadev, Praveen

    2010-09-28

    A method for fabricating a light emitting diode (LED) package comprising providing an LED chip and covering at least part of the LED chip with a liquid encapsulant having a radius of curvature. An optical element is provided having a bottom surface with at least a portion having a radius of curvature larger than the liquid encapsulant. The larger radius of curvature portion of the optical element is brought into contact with the liquid encapsulant. The optical element is then moved closer to the LED chip, growing the contact area between said optical element and said liquid encapsulant. The liquid encapsulant is then cured. A light emitting diode comprising a substrate with an LED chip mounted to it. A meniscus ring is on the substrate around the LED chip with the meniscus ring having a meniscus holding feature. An inner encapsulant is provided over the LED chip with the inner encapsulant having a contacting surface on the substrate, with the meniscus holding feature which defines the edge of the contacting surface. An optical element is included having a bottom surface with at least a portion that is concave. The optical element is arranged on the substrate with the concave portion over the LED chip. A contacting encapsulant is included between the inner encapsulant and optical element.

  10. Influence of Rotator Cuff Tear Size and Repair Technique on the Creation and Management of Dog Ear Deformities in a Transosseous-Equivalent Rotator Cuff Repair Model

    PubMed Central

    Redler, Lauren H.; Byram, Ian R.; Luchetti, Timothy J.; Tsui, Ying Lai; Moen, Todd C.; Gardner, Thomas R.; Ahmad, Christopher S.

    2014-01-01

    Background: Redundancies in the rotator cuff tissue, commonly referred to as “dog ear” deformities, are frequently encountered during rotator cuff repair. Knowledge of how these deformities are created and their impact on rotator cuff footprint restoration is limited. Purpose: The goals of this study were to assess the impact of tear size and repair method on the creation and management of dog ear deformities in a human cadaveric model. Study Design: Controlled laboratory study. Methods: Crescent-shaped tears were systematically created in the supraspinatus tendon of 7 cadaveric shoulders with increasing medial to lateral widths (0.5, 1.0, and 1.5 cm). Repair of the 1.5-cm tear was performed on each shoulder with 3 methods in a randomized order: suture bridge, double-row repair with 2-mm fiber tape, and fiber tape with peripheral No. 2 nonabsorbable looped sutures. Resulting dog ear deformities were injected with an acrylic resin mixture, digitized 3-dimensionally (3D), and photographed perpendicular to the footprint with calibration. The volume, height, and width of the rotator cuff tissue not in contact with the greater tuberosity footprint were calculated using the volume injected, 3D reconstructions, and calibrated photographs. Comparisons were made between tear size, dog ear measurement technique, and repair method utilizing 2-way analysis of variance and Student-Newman-Keuls multiple-comparison tests. Results: Utilizing 3D digitized and injection-derived volumes and dimensions, anterior dog ear volume, height, and width were significantly smaller for rotator cuff repair with peripheral looped sutures compared with a suture bridge (P < .05) or double-row repair with 2-mm fiber tape alone (P < .05). Similarly, posterior height and width were significantly smaller for repair with looped peripheral sutures compared with a suture bridge (P < .05). Dog ear volumes and heights trended larger for the 1.5-cm tear, but this was not statistically significant

  11. Hot tearing studies in AA5182

    NASA Astrophysics Data System (ADS)

    van Haaften, W. M.; Kool, W. H.; Katgerman, L.

    2002-10-01

    One of the major problems during direct chill (DC) casting is hot tearing. These tears initiate during solidification of the alloy and may run through the entire ingot. To study the hot tearing mechanism, tensile tests were carried out in semisolid state and at low strain rates, and crack propagation was studied in situ by scanning electron microscopy (SEM). These experimentally induced cracks were compared with hot tears developed in an AA5182 ingot during a casting trial in an industrial research facility. Similarities in the microstructure of the tensile test specimens and the hot tears indicate that hot tearing can be simulated by performing tensile tests at semisolid temperatures. The experimental data were compared with existing hot tearing models and it was concluded that the latter are restricted to relatively high liquid fractions because they do not take into account the existence of solid bridges in the crack.

  12. Regional variations in the distribution and colocalization of extracellular matrix proteins in the juvenile bovine meniscus

    PubMed Central

    Vanderploeg, Eric J; Wilson, Christopher G; Imler, Stacy M; Ling, Carrie Hang-Yin; Levenston, Marc E

    2012-01-01

    A deeper understanding of the composition and organization of extracellular matrix molecules in native, healthy meniscus tissue is required to fully appreciate the degeneration that occurs in joint disease and the intricate environment in which an engineered meniscal graft would need to function. In this study, regional variations in the tissue-level and pericellular distributions of collagen types I, II and VI and the proteoglycans aggrecan, biglycan and decorin were examined in the juvenile bovine meniscus. The collagen networks were extensively, but not completely, colocalized, with tissue-level organization that varied with radial position across the meniscus. Type VI collagen exhibited close association with large bundles composed of type I and II collagen and, in contrast to type I and II collagen, was further concentrated in the pericellular matrix. Aggrecan was detected throughout the inner region of the meniscus but was restricted to the pericellular matrix and sheaths of collagen bundles in the middle and outer regions. The small proteoglycans biglycan and decorin exhibited regional variations in staining intensity but were consistently localized in the intra- and/or peri-cellular compartments. These results provide insight into the complex hierarchy of extracellular matrix organization in the meniscus and provide a framework for better understanding meniscal degeneration and disease progression and evaluating potential repair and regeneration strategies. PMID:22703476

  13. Ultrasound determination of rotator cuff tear repairability

    PubMed Central

    Tse, Andrew K; Lam, Patrick H; Walton, Judie R; Hackett, Lisa

    2015-01-01

    Background Rotator cuff repair aims to reattach the torn tendon to the greater tuberosity footprint with suture anchors. The present study aimed to assess the diagnostic accuracy of ultrasound in predicting rotator cuff tear repairability and to assess which sonographic and pre-operative features are strongest in predicting repairability. Methods The study was a retrospective analysis of measurements made prospectively in a cohort of 373 patients who had ultrasounds of their shoulder and underwent rotator cuff repair. Measurements of rotator cuff tear size and muscle atrophy were made pre-operatively by ultrasound to enable prediction of rotator cuff repairability. Tears were classified following ultrasound as repairable or irreparable, and were correlated with intra-operative repairability. Results Ultrasound assessment of rotator cuff tear repairability has a sensitivity of 86% (p < 0.0001) and a specificity of 67% (p < 0.0001). The strongest predictors of rotator cuff repairability were tear size (p < 0.001) and age (p = 0.004). Sonographic assessments of tear size ≥4 cm2 or anteroposterior tear length ≥25 mm indicated an irreparable rotator cuff tear. Conclusions Ultrasound assessment is accurate in predicting rotator cuff tear repairability. Tear size or anteroposterior tear length and age were the best predictors of repairability. PMID:27582996

  14. The popliteus tendon provides a safe and reliable location for all-inside meniscal repair device placement.

    PubMed

    Ouanezar, Hervé; Blakeney, William G; Latrobe, Charles; Saithna, Adnan; Fernandes, Levi Reina; Delaloye, Jean Romain; Thaunat, Mathieu; Sonnery-Cottet, Bertrand

    2018-03-03

    Repairs of the posterior horn of the lateral meniscus can be technically challenging. In contrast to medial meniscus repairs, the capsule around the posterior segment attachment of the lateral meniscus is quite thin. This study evaluates the clinical results of an arthroscopic all-inside repair technique for unstable, vertical, lateral meniscus tears, using a suture repair placed directly into the popliteus tendon. A retrospective analysis of prospectively collected data from the SANTI database was performed. All patients who had undergone combined ACL reconstruction with lateral meniscus all-inside repair, using sutures placed in the popliteus tendon, between 2011 and 2015, were included. Patients were reviewed clinically at 1 and 2 years' follow-up. At final follow-up, all patients were contacted to identify if they underwent further surgery or had knee pain, locking or effusion. Symptomatic patients were recalled for clinical evaluation by a physician and Magnetic Resonance Imaging of the knee. Operative notes for those undergoing further surgery were reviewed and rates and type of re-operation, including for failed lateral meniscal repair were recorded. Two hundred patients (mean age 28.6 ± 10.2 years) with a mean follow-up of 45.5 ± 12.8 months (range 24.7-75.2) were included. The mean Subjective International Knee Documentation Committee (IKDC) at final follow-up was 85.0 ± 11.3. The post-operative mean side-to-side laxity measured at 1 year was 0.6 ± 1.0 mm. Twenty-six patients underwent re-operation (13%) at a mean follow-up of 14.8 ± 7.8 months. The ACL graft rupture rate was 5.0%. Other causes for re-operation included medial meniscus tear (2.5%), cyclops lesion (1.5%) and septic arthritis (0.5%). The lateral meniscus repair failure rate was 3.5%. No specific complications relating to placement of sutures in the popliteus tendon were identified. Arthroscopic all-inside repair of unstable, vertical, lateral meniscus tears

  15. Plasminogen activator activity in tears of pregnant women.

    PubMed

    Csutak, Adrienne; Steiber, Zita; Tőzsér, József; Jakab, Attila; Berta, András; Silver, David M

    2017-01-01

    Plasminogen activator activity (PAA) in tears of pregnant women was investigated at various gestation times to assess the availability of plasminogen activator for aiding potential corneal wound healing processes during pregnancy. PAA was measured by a spectrophotometric method. The analysis used 91 tear samples from pregnant and non-pregnant women, supplemented with 10 additional tear PAA measurements from non-pregnant women obtained in a previous study. Tear levels of PAA in pregnant women formed a bimodal distribution. Either the tear PAA level was zero or non-zero during pregnancy. When non-zero, the tear PAA level was dissociated from gestation time and not different than non-pregnant and post-pregnant levels. The frequency of occurrence of zero level tear PAA increased with gestation: 16%, 17% and 46% had zero tear PAA in samples taken from women in the first, second and third trimester, respectively. Overall, of the tear samples taken from women during pregnancy, a total of 26% were at zero tear PAA. The remaining tear samples had non-zero tear PAA values throughout gestation equivalent to non-pregnant tear PAA values, suggesting local control of the source of PAA in tears. Given the importance of the plasminogen activator system in tears to wound healing in the cornea, and the high occurrence of zero tear PAA in our sample of pregnant women, elective corneal surgery would be contraindicated. If corneal surgery is nevertheless necessary, the tear PAA level would be worth checking and patients with low level should be closely observed during the postoperative period.

  16. Posterior medial meniscus-femoral insertion into the anterior cruciate ligament. A case report.

    PubMed

    Bhargava, A; Ferrari, D A

    1998-03-01

    Medial meniscal anomalies are rare. The anterior horn insertion into the anterior cruciate ligament is the most common. In the course of an arthroscopy for torn lateral meniscus, an anomalous band in continuity with the posterior horn of the medial meniscus was observed to insert into the anterior cruciate ligament. Although the tibial portion of the anterior cruciate was redundant, the anomalous band provided tension to the anterior cruciate ligament and a negative pivot shift. A previously unreported posterior medial meniscal femoral insertion is described.

  17. Bilateral discoid medial menisci: a rare phenomenon

    PubMed Central

    Samal, Puspak; Bhagwat, Kishan; Panigrahi, Tapas; Gopinathan, Nirmalraj

    2014-01-01

    Discoid medial meniscus is a relatively rare pathology of the knee joint, with bilateral cases even rarer. Herein, we report the case of a 25-year-old man diagnosed with discoid medial meniscus in the right knee with a horizontal tear. Increased cupping of the medial condyle of the tibia, widening of the medial joint space and the presence of discoid meniscus in the right knee prompted investigation of the asymptomatic left knee with magnetic resonance imaging. The contralateral asymptomatic knee also showed evidence of discoid medial meniscus. The symptomatic knee was successfully treated by arthroscopic partial meniscectomy, with excellent functional outcome. PMID:25273941

  18. Effects of hydrostatic pressure on leporine meniscus cell-seeded PLLA scaffolds.

    PubMed

    Gunja, Najmuddin J; Athanasiou, Kyriacos A

    2010-03-01

    Hydrostatic pressure (HP) is an important component of the loading environment of the knee joint. Studies with articular chondrocytes and TMJ disc fibrochondrocytes have identified certain benefits of HP for tissue engineering purposes. However, similar studies with meniscus cells are lacking. Thus, in this experiment, the effects of applying 10 MPa of HP at three different frequencies (0, 0.1, and 1 Hz) to leporine meniscus cell-seeded PLLA scaffolds were examined. HP was applied once every 3 days for 1 h for a period of 28 days. Constructs were analyzed for cellular, biochemical, and biomechanical properties. At t = 4 weeks, total collagen/scaffold was found to be significantly higher in the 10 MPa, 0 Hz group when compared with other groups. This despite the fact that the cell numbers/scaffold were found to be lower in all HP groups when compared with the culture control. Additionally, the total GAG/scaffold, instantaneous modulus, and relaxation modulus were significantly increased in the 10 MPa, 0 Hz group when compared with the culture control. In summary, this experiment provides evidence for the benefit of a 10 MPa, 0 Hz stimulus, on both biochemical and biomechanical aspects, for the purposes of meniscus tissue engineering using PLLA scaffolds. (c) 2009 Wiley Periodicals, Inc.

  19. Tear exchange and contact lenses: A review

    PubMed Central

    Muntz, Alex; Subbaraman, Lakshman N.; Sorbara, Luigina; Jones, Lyndon

    2015-01-01

    Tear exchange beneath a contact lens facilitates ongoing fluid replenishment between the ocular surface and the lens. This exchange is considerably lower during the wear of soft lenses compared with rigid lenses. As a result, the accumulation of tear film debris and metabolic by-products between the cornea and a soft contact lens increases, potentially leading to complications. Lens design innovations have been proposed, but no substantial improvement in soft lens tear exchange has been reported. Researchers have determined post-lens tear exchange using several methods, notably fluorophotometry. However, due to technological limitations, little remains known about tear hydrodynamics around the lens and, to-date, true tear exchange with contact lenses has not been shown. Further knowledge regarding tear exchange could be vital in aiding better contact lens design, with the prospect of alleviating certain adverse ocular responses. This article reviews the literature to-date on the significance, implications and measurement of tear exchange with contact lenses. PMID:25575892

  20. Electronic enhancement of tear secretion

    NASA Astrophysics Data System (ADS)

    Brinton, Mark; Lim Chung, Jae; Kossler, Andrea; Kook, Koung Hoon; Loudin, Jim; Franke, Manfred; Palanker, Daniel

    2016-02-01

    Objective. To study electrical stimulation of the lacrimal gland and afferent nerves for enhanced tear secretion, as a potential treatment for dry eye disease. We investigate the response pathways and electrical parameters to safely maximize tear secretion. Approach. We evaluated the tear response to electrical stimulation of the lacrimal gland and afferent nerves in isofluorane-anesthetized rabbits. In acute studies, electrical stimulation was performed using bipolar platinum foil electrodes, implanted beneath the inferior lacrimal gland, and a monopolar electrode placed near the afferent ethmoid nerve. Wireless microstimulators with bipolar electrodes were implanted beneath the lacrimal gland for chronic studies. To identify the response pathways, we applied various pharmacological inhibitors. To optimize the stimulus, we measured tear secretion rate (Schirmer test) as a function of pulse amplitude (1.5-12 mA), duration (0.1-1 ms) and repetition rate (10-100 Hz). Main results. Stimulation of the lacrimal gland increased tear secretion by engaging efferent parasympathetic nerves. Tearing increased with stimulation amplitude, pulse duration and repetition rate, up to 70 Hz. Stimulation with 3 mA, 500 μs pulses at 70 Hz provided a 4.5 mm (125%) increase in Schirmer score. Modulating duty cycle further increased tearing up to 57%, compared to continuous stimulation in chronically implanted animals (36%). Ethmoid (afferent) nerve stimulation increased tearing similar to gland stimulation (3.6 mm) via a reflex pathway. In animals with chronically implanted stimulators, a nearly 6 mm increase (57%) was achieved with 12-fold less charge density per pulse (0.06-0.3 μC mm-2 with 170-680 μs pulses) than the damage threshold (3.5 μC mm-2 with 1 ms pulses). Significance. Electrical stimulation of the lacrimal gland or afferent nerves may be used as a treatment for dry eye disease. Clinical trials should validate this approach in patients with aqueous tear deficiency, and

  1. Effects of matrix stabilization when using glutaraldehyde on the material properties of porcine meniscus.

    PubMed

    Hunter, Shawn A; Noyes, Frank R; Haridas, Balakrishna; Levy, Martin S; Butler, David L

    2003-12-15

    Meniscus transplantation frequently is one of the only options available for treating symptomatic younger patients with tibiofemoral pain and early arthrosis after a prior meniscectomy. However, clinical results indicate that current meniscal allografts may undergo degenerative changes due to enzymatic degradation during the remodeling phase. The objective of this study was to evaluate the effects of glutaraldehyde-induced matrix stabilization on the material properties of porcine meniscus prior to surgical implantation. Protocols for fabricating heart-valve replacements were examined, followed by an exploration of the effects of reducing glutaraldehyde concentration and exposure time. Cylindrical meniscus specimens were tested in uniaxial confined compression under a 0.196 MPa compressive stress, and aggregate modulus (H(A)), permeability (k), and compressive strains at equilibrium (epsilon(eq)) were calculated from the creep response. Compared to controls, the mean values for H(A) and k increased, on average, by 213 and 709%, respectively, and epsilon(eq) decreased by 57% for all "heart-valve" treatments. Reducing tissue exposure time to glutaraldehyde had little effect, but decreasing glutaraldehyde concentration to 0.02% resulted in tissues with material properties no different from the untreated controls. We conclude that minimal concentrations of glutaraldehyde (less than 0.2%) should be used in future studies to preserve normal meniscus properties. Copyright 2003 Wiley Periodicals, Inc. J Biomed Mater Res 67A: 1245-1254, 2003

  2. Dynamic interfacial properties of human tear-lipid films and their interactions with model-tear proteins in vitro.

    PubMed

    Svitova, Tatyana F; Lin, Meng C

    2016-07-01

    This review summarizes the current state of knowledge regarding interfacial properties of very complex biological colloids, specifically, human meibum and tear lipids, and their interactions with proteins similar to the proteins found in aqueous part of human tears. Tear lipids spread as thin films over the surface of tear-film aqueous and play crucial roles in tear-film stability and overall ocular-surface health. The vast majority of papers published to date report interfacial properties of meibum-lipid monolayers spread on various aqueous sub-phases, often containing model proteins, in Langmuir trough. However, it is well established that natural human ocular tear lipids exist as multilayered films with a thickness between 30 and 100nm, that is very much disparate from 1 to 2nm thick meibum monolayers. We employed sessile-bubble tensiometry to study the dynamic interfacial and rheological properties of reconstituted multilayered human tear-lipid films. Small amounts (0.5-1μg) of human tear lipids were deposited on an air-bubble surface to produce tear-lipid films in thickness range 30-100nm corresponding to ocular lipid films. Thus, we were able to overcome major Langmuir-trough method limitations because ocular tear lipids can be safely harvested only in minute, sub-milligram quantities, insufficient for Langmuir through studies. Sessile-bubble method is demonstrated to be a versatile tool for assessing conventional synthetic surfactants adsorption/desorption dynamics at an air-aqueous solution interface. (Svitova T., Weatherbee M., Radke C.J. Dynamics of surfactant sorption at the air/water interface: continuous-flow tensiometry. J. Colloid Interf. Sci. 2003;261:1170-179). The augmented flow-sessile-bubble setup, with step-strain relaxation module for dynamic interfacial rheological properties and high-precision syringe pump to generate larger and slow interfacial area expansions-contractions, was developed and employed in our studies. We established that

  3. Comparison of low-abundance biomarker levels in capillary-collected nonstimulated tears and washout tears of aqueous-deficient and normal patients.

    PubMed

    Guyette, Nicole; Williams, Larezia; Tran, My-Tho; Than, Tammy; Bradley, John; Kehinde, Lucy; Edwards, Clara; Beasley, Mark; Fullard, Roderick

    2013-05-01

    Low tear volume limits the use of nonstimulated (NS) microcapillary tear collection in aqueous-deficient (AD) patients. Adding a small amount of "washout" fluid to the eye prior to tear collection is a potentially viable alternative method for abundant proteins, but is relatively untested for low-abundance biomarkers. This study determined the feasibility of the washout (WO) method as an NS alternative for low-abundance biomarkers. NS and WO biomarker profiles were compared between AD patients and non-AD controls to determine if the two methods identify the same intergroup differences. Matching NS and WO tears were collected from 48 patients by micropipette, the WO sample after instillation of 10 μL saline. Tear cytokine levels were measured by 27-Plex Bio-Rad assay. Bland-Altman analyses for each biomarker determined the agreement between tear sample types. Patients were grouped as AD or non-AD based on Schirmer score to determine if NS profile between-group differences were preserved in WO tears. Bland-Altman plots showed good biomarker level agreement between NS and WO tears for most cytokines. Five biomarkers, among those most often cited as differing in AD dry eye, differed significantly between non-AD and AD groups in both tear types. Additional biomarker differences were seen in NS tears only. The WO tear collection method is a viable alternative to NS tears for many low-abundance biomarkers and is able to replicate major NS tear differences between dry eye groups. More subtle intergroup differences are lost in WO samples because of reduced statistical power.

  4. Warm and touching tears: tearful individuals are perceived as warmer because we assume they feel moved and touched.

    PubMed

    Zickfeld, Janis H; Schubert, Thomas W

    2018-01-31

    Recent work investigated the inter-individual functions of emotional tears in depth. In one study (Van de Ven, N., Meijs, M. H. J., & Vingerhoets, A. (2017). What emotional tears convey: Tearful individuals are seen as warmer, but also as less competent. British Journal of Social Psychology, 56(1), 146-160. Https://doi.org/10.1111/bjso.12162) tearful individuals were rated as warmer, and participants expressed more intentions to approach and help such individuals. Simultaneously, tearful individuals were rated as less competent, and participants expressed less intention to work with the depicted targets. While tearful individuals were perceived as sadder, perceived sadness mediated only the effect on competence, but not on warmth. We argue that tearful individuals might be perceived as warm because they are perceived as feeling moved and touched. We ran a pre-registered extended replication of Van de Ven et al. Results replicate the warmth and helping findings, but not the competence and work effects. The increase in warmth ratings was completely mediated by perceiving feeling moved and touched. Possible functions of feeling moved and touched with regard to emotional tears are discussed.

  5. Assay of mucins in human tear fluid.

    PubMed

    Spurr-Michaud, Sandra; Argüeso, Pablo; Gipson, Ilene

    2007-05-01

    Mucin genes, both secreted (MUC2, MUC5AC, MUC5B, MUC7) and membrane associated (MUC1, MUC4, MUC16), have been reported to be expressed by ocular surface epithelia. The purpose of this study was to comprehensively assay the mucin content of human tear fluid using multiple antibodies for each mucin and to develop a sensitive, semi-quantitative method for the assay of mucins in tears. Tear washes were obtained by instillation of saline onto the ocular surface, followed by collection from the inferior fornix. Tear proteins were separated in 1% agarose gels, transferred to nitrocellulose membrane by vacuum blotting and probed with multiple antibodies recognizing MUC1, MUC2, MUC4, MUC5AC, MUC5B, MUC7 and MUC16. Binding was detected using chemiluminescence, and quantity was determined by densitometry. Serial dilutions of pooled tears from normal individuals were assayed to determine the linear range of detectability. MUC1, MUC4, MUC16, MUC5AC and low levels of MUC2 were consistently detected in human tear fluid, while MUC5B and MUC7 were not. Use of several antibodies recognizing different epitopes on the same mucin confirmed these findings. The antibodies to mucins bound to serial dilutions of tears in a linear fashion (r2 > 0.9), indicating the feasibility of semi-quantitation. MUC5AC in tear fluid had an increased electrophoretic mobility compared to MUC5AC isolated from conjunctival tissue. This study provides clear evidence that the mucin component of tears is a mixture of secreted and shed membrane-associated mucins, and for the first time demonstrates MUC16 in tear fluid. Immunoblots of tears using agarose gel electrophoresis and chemiluminescence detection provide a semi-quantitative assay for mucin protein that will be useful for comparisons with tears from diseased eyes or after pharmacological intervention.

  6. Assay of Mucins in Human Tear Fluid

    PubMed Central

    Spurr-Michaud, Sandra; Argüeso, Pablo; Gipson, Ilene

    2007-01-01

    Mucin genes, both secreted (MUC2, MUC5AC, MUC5B, MUC7) and membrane associated (MUC1, MUC4, MUC16), have been reported to be expressed by ocular surface epithelia. The purpose of this study was to comprehensively assay the mucin content of human tear fluid using multiple antibodies for each mucin and to develop a sensitive, semi-quantitative method for the assay of mucins in tears. Tear washes were obtained by instillation of saline onto the ocular surface, followed by collection from the inferior fornix. Tear proteins were separated in 1% agarose gels, transferred to nitrocellulose membrane by vacuum blotting and probed with multiple antibodies recognizing MUC1, MUC2, MUC4, MUC5AC, MUC5B, MUC7 and MUC16. Binding was detected using chemiluminescence, and quantity was determined by densitometry. Serial dilutions of pooled tears from normal individuals were assayed to determine the linear range of detectability. MUC1, MUC4, MUC16, MUC5AC and low levels of MUC2 were consistently detected in human tear fluid, while MUC5B and MUC7 were not. Use of several antibodies recognizing different epitopes on the same mucin confirmed these findings. The antibodies to mucins bound to serial dilutions of tears in a linear fashion (r2 >0.9), indicating the feasibility of semi-quantitation. MUC5AC in tear fluid had an increased electrophoretic mobility compared to MUC5AC isolated from conjunctival tissue. This study provides clear evidence that the mucin component of tears is a mixture of secreted and shed membrane-associated mucins, and for the first time demonstrates MUC16 in tear fluid. Immunoblots of tears using agarose gel electrophoresis and chemiluminescence detection provide a semi-quantitative assay for mucin protein that will be useful for comparisons with tears from diseased eyes or after pharmacological intervention. PMID:17399701

  7. Tear exchange and contact lenses: a review.

    PubMed

    Muntz, Alex; Subbaraman, Lakshman N; Sorbara, Luigina; Jones, Lyndon

    2015-01-01

    Tear exchange beneath a contact lens facilitates ongoing fluid replenishment between the ocular surface and the lens. This exchange is considerably lower during the wear of soft lenses compared with rigid lenses. As a result, the accumulation of tear film debris and metabolic by-products between the cornea and a soft contact lens increases, potentially leading to complications. Lens design innovations have been proposed, but no substantial improvement in soft lens tear exchange has been reported. Researchers have determined post-lens tear exchange using several methods, notably fluorophotometry. However, due to technological limitations, little remains known about tear hydrodynamics around the lens and, to-date, true tear exchange with contact lenses has not been shown. Further knowledge regarding tear exchange could be vital in aiding better contact lens design, with the prospect of alleviating certain adverse ocular responses. This article reviews the literature to-date on the significance, implications and measurement of tear exchange with contact lenses. Copyright © 2014 Spanish General Council of Optometry. Published by Elsevier Espana. All rights reserved.

  8. Quantitative histological grading methods to assess subchondral bone and synovium changes subsequent to medial meniscus transection in the rat

    PubMed Central

    Kloefkorn, Heidi E.; Allen, Kyle D.

    2017-01-01

    Aim of the Study The importance of the medial meniscus to knee health is demonstrated by studies which show meniscus injuries significantly increase the likelihood of developing osteoarthritis (OA), and knee OA can be modeled in rodents using simulated meniscus injuries. Traditionally, histological assessments of OA in these models have focused on damage to the articular cartilage; however, OA is now viewed as a disease of the entire joint as an organ system. The aim of this study was to develop quantitative histological measures of bone and synovial changes in a rat medial meniscus injury model of knee OA. Materials and Methods To initiate OA, a medial meniscus transection (MMT) and a medial collateral ligament transection (MCLT) were performed in 32 male Lewis rats (MMT group). MCLT alone served as the sham procedure in 32 additional rats (MCLT sham group). At weeks 1, 2, 4, and 6 post-surgery, histological assessment of subchondral bone and synovium was performed (n = 8 per group per time point). Results Trabecular bone area and the ossification width at the osteochondral interface increased in both the MMT and MCLT groups. Subintimal synovial cell morphology also changed in MMT and MCLT groups relative to naïve animals. Conclusions OA affects the joint as an organ system, and quantifying changes throughout an entire joint can improve our understanding of the relationship between joint destruction and painful OA symptoms following meniscus injury. PMID:27797605

  9. Knee arthroscopy in Chinese children and adolescents: an eight-year prospective study.

    PubMed

    Maffulli, N; Chan, K M; Bundoc, R C; Cheng, J C

    1997-02-01

    In the period January 1985 to December 1992, 69 Chinese boys and 20 Chinese girls (average 14.6 years, age range 6 to 16 years) with a total of 92 involved knees underwent examination under anaesthesia and knee arthroscopy. Two thirds of the patients were engaged in sports activities. A haemarthrosis was present in 51 patients. In one patient, Staphylococcus aureus was shown, and in two children a serous-purulent aspirate grew Mycobacterium tuberculosis. The lateral meniscus was torn in four knees and the medial meniscus in six. An intact discoid lateral meniscus was found in five girls. Three partial anterior cruciate ligament (ACL) tears, three complete ACL tears and two posterior cruciate ligament tears were diagnosed. One child had an osteochondral defect of the lateral femoral condyle accompanying an ACL and a lateral meniscal tear. Nonspecific synovitis of unknown etiology was diagnosed in six patients who had presented subacutely with at least a 2-month history of a symptomatic monoarticular knee effusion with low grade local inflammation and no history of major trauma. The synovitis gradually resolved over a 6- to 10-month period after arthroscopy. Knee arthroscopy in children and adolescent patients is safe, gives a high diagnostic accuracy, and allows treatment of a variety of intraarticular conditions. This study also demonstrates that the range of intraarticular knee problems found in Chinese children and adolescents differs from that described in their Western counterparts.

  10. Quality of Vision in Eyes With Epiphora Undergoing Lacrimal Passage Intubation.

    PubMed

    Koh, Shizuka; Inoue, Yasushi; Ochi, Shintaro; Takai, Yoshihiro; Maeda, Naoyuki; Nishida, Kohji

    2017-09-01

    To investigate visual function and optical quality in eyes with epiphora undergoing lacrimal passage intubation. Prospective case series. Thirty-four eyes of 30 patients with lacrimal passage obstruction were enrolled. Before and 1 month after lacrimal passage intubation, functional visual acuity (FVA), higher-order aberrations (HOAs), lower tear meniscus, and tear clearance were assessed. An FVA measurement system was used to examine changes in continuous visual acuity (VA) over time, and visual function parameters such as FVA, visual maintenance ratio, and blink frequency were obtained. Sequential ocular HOAs were measured for 10 seconds after the blink using a wavefront sensor. Aberration data were analyzed in the central 4 mm for coma-like, spherical-like, and total HOAs. Fluctuation and stability indices of the total HOAs over time were calculated. Lower tear meniscus was assessed by anterior segment optical coherence tomography. After lacrimal passage intubation, visual function significantly improved, as indicated by improved FVA (P = .003) and visual maintenance ratio (P < .001). Blink frequency decreased significantly after treatment (P = .01). Optical quality significantly improved, as indicated by a decrease in coma-like aberrations (P = .003), spherical-like aberrations (P = .018), and total HOAs (P = .001). Stability index increased (P < .001) and fluctuation index decreased (P = .019), and tear meniscus dimension decreased (P < .001). Lacrimal passage intubation for eyes with epiphora significantly improved visual function and optical quality via patency of the lacrimal passage. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Reduced tear production in three canine endocrinopathies.

    PubMed

    Williams, D L; Pierce, V; Mellor, P; Heath, M F

    2007-05-01

    Previous reports have suggested that hypothyroid and diabetic patients can be predisposed to keratoconjunctivitis sicca. This study aimed to measure tear production in dogs with diabetes, hypothyroidism and hyperadrenocorticism using the Schirmer tear test and to compare these results with Schirmer tear test values for a group of normal dogs. Schirmer tear tests were performed on 16 dogs with hyperadrenocorticism, 18 with diabetes and 12 with hypothyroidism together with 100 control dogs. Corneal sensitivity was also measured in 12 of the 18 diabetic dogs with a Cochet Bonnet aesthesiometer and compared with age- and breed-matched normal dogs. Schirmer tear test values in dogs with hypothyroidism, hyperadrenocorticism and diabetes were 12.3+/-3.2, 14.0+/-4.0 and 12.3+/-5.3 mm/minutes, respectively. Schirmer tear test values were significantly lower than that for the control group (19.6+/-4.2 mm/minutes) in all dogs with an endocrinopathy. Only in two hypothyroid dogs and three diabetics, this was manifested as profound keratoconjunctivitis sicca with Schirmer tear test value lower than 5 mm/minutes. Diabetic dogs had significantly reduced corneal sensitivity compared with a matched set of control dogs. This study shows a significant reduction in tear production in animals with diabetes mellitus, hypothyroidism and hyperadrenocorticism. Further research is needed to elucidate the mechanisms by which this reduction in tear production occurs. Assessment of tear production should be undertaken in animals diagnosed with these endocrinopathies, as these animals may progress to clinical keratoconjunctivitis sicca.

  12. Interferometric characterization of tear film dynamics

    NASA Astrophysics Data System (ADS)

    Primeau, Brian Christopher

    The anterior refracting surface of the eye is the thin tear film that forms on the surface of the cornea. When a contact lens is on worn, the tear film covers the contact lens as it would a bare cornea, and is affected by the contact lens material properties. Tear film irregularity can cause both discomfort and vision quality degradation. Under normal conditions, the tear film is less than 10 microns thick and the thickness and topography change in the time between blinks. In order to both better understand the tear film, and to characterize how contact lenses affect tear film behavior, two interferometers were designed and built to separately measure tear film behavior in vitro and in vivo. An in vitro method of characterizing dynamic fluid layers applied to contact lenses mounted on mechanical substrates has been developed using a phase-shifting Twyman-Green interferometer. This interferometer continuously measures light reflected from the surface of the fluid layer, allowing precision analysis of the dynamic fluid layer. Movies showing this fluid layer behavior can be generated. The fluid behavior on the contact lens surface is measured, allowing quantitative analysis beyond what typical contact angle or visual inspection methods provide. The in vivo interferometer is a similar system, with additional modules included to provide capability for human testing. This tear film measurement allows analysis beyond capabilities of typical fluorescein visual inspection or videokeratometry and provides better sensitivity and resolution than shearing interferometry methods.

  13. Effects of medial meniscus posterior horn avulsion and repair on tibiofemoral contact area and peak contact pressure with clinical implications.

    PubMed

    Marzo, John M; Gurske-DePerio, Jennifer

    2009-01-01

    Avulsion of the posterior horn attachment of the medial meniscus can compromise load-bearing ability, produce meniscus extrusion, and result in tibiofemoral joint-space narrowing, articular cartilage damage, and osteoarthritis. Avulsion of the posterior horn of the medial meniscus will increase peak contact pressure and decrease contact area in the medial compartment of the knee, and posterior horn repair will restore contact area and peak contact pressures to values of the control knee. Controlled laboratory study. Eight fresh-frozen human cadaveric knees had tibiofemoral peak contact pressures and contact area measured in the control state. The posterior horn of the medial meniscus was avulsed from its insertion and knees were retested. The meniscal avulsion was repaired by suture through a transosseous tunnel and the knees were tested a third time. Avulsion of the posterior horn attachment of the medial meniscus resulted in a significant increase in medial joint peak contact pressure (from 3841 kPa to 5084 kPa) and a significant decrease in contact area (from 594 mm(2) to 474 mm(2)). Repair of the avulsion resulted in restoration of the loading profiles to values equal to the control knee, with values of 3551 kPa for peak pressure and 592 mm(2) for contact area. Posterior horn medial meniscal root avulsion leads to deleterious alteration of the loading profiles of the medial joint compartment and results in loss of hoop stress resistance, meniscus extrusion, abnormal loading of the joint, and early knee medial-compartment degenerative changes. The repair technique described restores the ability of the medial meniscus to absorb hoop stress and eliminate joint-space narrowing, possibly decreasing the risk of degenerative disease.

  14. The Use of Blood Vessel–Derived Stem Cells for Meniscal Regeneration and Repair

    PubMed Central

    OSAWA, AKI; HARNER, CHRISTOPHER D.; GHARAIBEH, BURHAN; MATSUMOTO, TOMOYUKI; MIFUNE, YUTAKA; KOPF, SEBASTIAN; INGHAM, SHEILA J. M.; SCHREIBER, VERENA; USAS, ARVYDAS; HUARD, JOHNNY

    2015-01-01

    Purpose Surgical repairs of tears in the vascular region of the meniscus usually heal better than repairs performed in the avascular region; thus, we hypothesized that this region might possess a richer supply of vascular-derived stem cells than the avascular region. Methods In this study, we analyzed 6 menisci extracted from aborted human fetuses and 12 human lateral menisci extracted from adult human subjects undergoing total knee arthroplasty. Menisci were immunostained for CD34 (a stem cell marker) and CD146 (a pericyte marker) in situ, whereas other menisci were dissected into two regions (peripheral and inner) and used to isolate meniscus-derived cells by flow cytometry. Cell populations expressing CD34 and CD146 were tested for their multi-lineage differentiation potentials, including chondrogenic, osteogenic, and adipogenic lineages. Fetal peripheral meniscus cells were transplanted by intracapsular injection into the knee joints of an athymic rat meniscal tear model. Rat menisci were extracted and histologically evaluated after 4 wk posttransplantation. Results Immunohistochemistry and flow cytometric analyses demonstrated that a higher number of CD34- and CD146-positive cells were found in the peripheral region compared with the inner region. The CD34- and CD146-positive cells isolated from the vascular region of both fetal and adult menisci demonstrated multilineage differentiation capacities and were more potent than cells isolated from the inner (avascular) region. Fetal CD34- and CD146-positive cells transplanted into the athymic rat knee joint were recruited into the meniscal tear sites and contributed to meniscus repair. Conclusions The vascularized region of the meniscus contains more stem cells than the avascular region. These meniscal-derived stem cells were multi-potent and contributed to meniscal regeneration. PMID:23247715

  15. Assessment of tear film osmolarity using the TearLab™ osmometer in normal dogs and dogs with keratoconjunctivitis sicca.

    PubMed

    Sebbag, Lionel; Park, Shin Ae; Kass, Philip H; Maggs, David J; Attar, Mayssa; Murphy, Christopher J

    2017-07-01

    To evaluate repeatability and reproducibility of tear osmolarity measured using the TearLab ™ osmometer in normal dogs and to assess its diagnostic potential in dogs with keratoconjunctivitis sicca (KCS). Beagle dogs; six normal and five with KCS. Tear osmolarity and Schirmer tear test-1 (STT-1) values were obtained at various times. Normal dogs were assessed for diurnal variation and repeatability and reproducibility of measurements. Dogs with KCS were evaluated before and after 5 months' topical twice-daily therapy with 2% cyclosporine. Mean ± SD tear osmolarity (mOsm/L) was significantly higher in normal dogs (337.4 ± 16.2) than in dogs with KCS before therapy (306.2 ± 18.0; P < 0.0001), but not following therapy with 2% cyclosporine (330.5 ± 13.7; P = 1.00). Osmolarity readings lower than 325.5 mOsm/L were suggestive of KCS (84.8% sensitivity and 87.1% specificity). In normal dogs, tear osmolarity readings were stable during the daytime (P = 0.99). Repeated measurements revealed high variability and typically poor-to-moderate repeatability and reproducibility, although this was improved by taking three successive measurements at each session. Considering combined data from all dogs, a positive correlation existed between STT-1 and tear osmolarity measurements (Pearson's correlation test, P = 0.04, r = 0.62). Canine tear osmolarity as determined by TearLab ™ osmometer was variable, required multiple readings to be informative, and differed from values reported for humans. Dogs with KCS had a lower tear osmolarity than did normal dogs, and this increased following cyclosporine therapy. © 2016 American College of Veterinary Ophthalmologists.

  16. Tibial coverage, meniscus position, size and damage in knees discordant for joint space narrowing – data from the Osteoarthritis Initiative

    PubMed Central

    Bloecker, K.; Guermazi, A.; Wirth, W.; Benichou, O.; Kwoh, C.K.; Hunter, D.J.; Englund, M.; Resch, H.; Eckstein, F.

    2013-01-01

    SUMMARY Introduction Meniscal extrusion is thought to be associated with less meniscus coverage of the tibial surface, but the association of radiographic disease stage with quantitative measures of tibial plateau coverage is unknown. We therefore compared quantitative and semi-quantitative measures of meniscus position and morphology in individuals with bilateral painful knees discordant on medial joint space narrowing (mJSN). Methods A sample of 60 participants from the first half (2,678 cases) of the Osteoarthritis Initiative cohort fulfilled the inclusion criteria: bilateral frequent pain, Osteoarthritis Research Society International (OARSI) mJSN grades 1–3 in one, no-JSN in the contra-lateral (CL), and no lateral JSN in either knee (43 unilateral mJSN1; 17 mJSN2/3; 22 men, 38 women, body mass index (BMI) 31.3 ± 3.9 kg/m2). Segmentation and three-dimensional quantitative analysis of the tibial plateau and meniscus, and semi-quantitative evaluation of meniscus damage (magnetic resonance imaging (MRI) osteoarthritis knee score – MOAKS) was performed using coronal 3T MR images (MPR DESSwe and intermediate-weighted turbo spin echo (IW-TSE) images). CL knees were compared using paired t-tests (between-knee, within-person design). Results Medial tibial plateau coverage was 36 ± 9% in mJSN1 vs 45 ± 8% in CL no-JSN knees, and was 31 ± 9% in mJSN2/3 vs 46 ± 6% in no-JSN knees (both P < 0.001). mJSN knees showed greater meniscus extrusion and damage (MOAKS), but no significant difference in meniscus volume. No significant differences in lateral tibial coverage, lateral meniscus morphology or position were observed. Conclusions Knees with medial JSN showed substantially less medial tibial plateau coverage by the meniscus. We suggest that the less meniscal coverage, i.e., less mechanical protection may be a reason for greater rates of cartilage loss observed in JSN knees. PMID:23220556

  17. Quantitative evaluation of hyaline articular cartilage T2 maps of knee and determine the relationship of cartilage T2 values with age, gender, articular changes.

    PubMed

    Cağlar, E; Şahin, G; Oğur, T; Aktaş, E

    2014-11-01

    To identify changes in knee joint cartilage transverse relaxation values depending on the patient's age and gender and to investigate the relationship between knee joint pathologies and the transverse relaxation time. Knee MRI images of 107 symptomatic patients with various pathologic knee conditions were analyzed retrospectively. T2 values were measured at patellar cartilage, posteromedial and posterolateral femoral cartilage adjacent to the central horn of posterior meniscus. 963 measurements were done for 107 knees MRI. Relationship of T2 values with seven features including subarticular bone marrow edema, subarticular cysts, marginal osteophytes, anterior-posterior cruciate and collateral ligament tears, posterior medial and posterior lateral meniscal tears, synovial thickening and effusion were analyzed. T2 values in all three compartments were evaluated according to age and gender. A T2 value increase correlated with age was present in all three compartments measured in the subgroup with no knee joint pathology and in all patient groups. According to the ROC curve, an increase showing a statistically significant difference was present in the patient group aged over 40 compared to the patient group aged 40 and below in all patient groups. There is a statistically difference at T2 values with and without subarticular cysts, marginal osteophytes, synovial thickening and effusion. T2 relaxation time showed a statistically significant increase in the patients with a medial meniscus tear compared to those without a tear and no statistically significant difference was found in T2 relaxation times of patients with and without a posterior lateral meniscus tear. T2 cartilage mapping on MRI provides opportunity to exhibit biochemical and structural changes related with cartilage extracellular matrix without using invasive diagnostic methods.

  18. [Shoulder instability and rotator cuff tear].

    PubMed

    Voigt, C; Lill, H

    2009-01-01

    A rotator cuff tear as a complication of anterior shoulder dislocation is well known in patients over 40 years old. The incidence of this accompanying injury correlates with the patient's age and the number of redislocations. The tear localization and dimension depend on the patient's age. To what extent these tears are a complication of shoulder dislocation is often unclear, as rotator cuff tears and glenohumeral instability interact. Reports on this combined injury pattern are rare, but based on the patient's age, activity level, and functional demand, therapeutic concepts have been devised. In active patients younger than 60 years and in cases of redislocation, both the rotator cuff tear and the capsule-labrum-ligament lesion should be reconstructed arthroscopically. In lesser active patients age 60 years or older, an isolated rotator cuff reconstruction is often sufficient to stabilize the glenohumeral joint. This treatment concept shows a predominantly good outcome.As a special form of anterior shoulder dislocation, a rotator cuff tear and a plexus brachialis lesion--the"terrible triad of the shoulder"--is described here.

  19. Evaporation-driven instability of the precorneal tear film.

    PubMed

    Peng, Cheng-Chun; Cerretani, Colin; Braun, Richard J; Radke, C J

    2014-04-01

    Tear-film instability is widely believed to be a signature of eye health. When an interblink is prolonged, randomly distributed ruptures occur in the tear film. "Black spots" and/or "black streaks" appear in 15 to 40 s for normal individuals. For people who suffer from dry eye, tear-film breakup time (BUT) is typically less than a few seconds. To date, however, there is no satisfactory quantitative explanation for the origin of tear rupture. Recently, it was proposed that tear-film breakup is related to locally high evaporative thinning. A spatial variation in the thickness of the tear-film lipid layer (TFLL) may lead to locally elevated evaporation and subsequent tear-film breakup. We examine the local-evaporation-driven tear-film-rupture hypothesis in a one-dimensional (1-D) model for the evolution of a thin aqueous tear film overriding the cornea subject to locally elevated evaporation at its anterior surface and osmotic water influx at its posterior surface. Evaporation rate depends on mass transfer both through the coating lipid layer and through ambient air. We establish that evaporation-driven tear-film breakup can occur under normal conditions but only for higher aqueous evaporation rates. Predicted roles of environmental conditions, such as wind speed and relative humidity, on tear-film stability agree with clinical observations. More importantly, locally elevated evaporation leads to hyperosmolar spots in the tear film and, hence, vulnerability to epithelial irritation. In addition to evaporation rate, tear-film instability depends on the strength of healing flow from the neighboring region outside the breakup region, which is determined by the surface tension at the tear-film surface and by the repulsive thin-film disjoining pressure. This study provides a physically consistent and quantitative explanation for the formation of black streaks and spots in the human tear film during an interblink. Copyright © 2013 Elsevier B.V. All rights reserved.

  20. Topical anaesthetic and tear film stability.

    PubMed

    Mengher, L S; Pandher, K S; Bron, A J

    1986-02-01

    The effect of unpreserved topical anaesthetic on tear film stability (0.4% oxybuprocaine hydrochloride) was investigated in a double masked randomised study in 12 healthy volunteers, using a noninvasive tear film break up technique (NIBUT). It was found that the topical anaesthetic did not reduce the pre-corneal tear film stability, contrary to the electron microscopic evidence.

  1. Thermodynamics of Capillary Rise: Why Is the Meniscus Curved?

    ERIC Educational Resources Information Center

    Henriksson, Ulf; Eriksson, Jan Christer

    2004-01-01

    The thermodynamics of capillary rise is explained as the gravitational elevation of the whole column of liquid caused by the positive connection between the liquid, and the solid wall of the capillary tube. The curvature of the meniscus is ascribed to the maintenance of a physiochemical balance throughout the gravitational column of liquid.

  2. The relief of dry eye signs and symptoms using a combination of lubricants, lid hygiene and ocular nutraceuticals.

    PubMed

    Ngo, William; Srinivasan, Sruthi; Houtman, Diane; Jones, Lyndon

    To determine the combined effect of TheraTears ® Lubricant Eye Drops, TheraTears ® SteriLid Eyelid Cleanser, and TheraTears ® Nutrition on dry eye signs and symptoms. This prospective study enrolled 28 dry eye participants. Participants were instructed to use the Lubricant Eye Drops at least 2-4× a day, SteriLid 1-2× a day, and Nutrition 3 gel caps once a day. Participants were followed up at baseline, 1 month and 3 months. Outcome variables were the Ocular Surface Disease Index (OSDI), Symptom Assessment iN Dry Eye (SANDE) questionnaire, non-invasive tear break-up time (NIBUT), osmolarity, number of meibomian glands blocked (#MG blocked), meibum quality, eyelid margin features, Schirmer's test, tear film lipid layer thickness (LLT), meniscus height, corneal and conjunctival staining. Twenty participants (mean age=43, from 23 to 66, 17F, 3M) completed the study. Participants reported having used, on average, the Lubricant Eye Drop 2.4×/day, the SteriLid 1.1×/day, and the Nutrition 3 gel caps 1×/day. There was a significant change over time (p<0.05) for OSDI (-21.2 points), SANDE (-32.4 points), NIBUT (+0.43s), eyelid margin features (-1.1 grade), meibum quality (-1.0 grade), and #MG blocked (-4.0 glands). By using a combination of TheraTears ® Lubricant Eye Drop, SteriLid, and Nutrition, patients experience significant relief in both dry eye symptoms and signs. Copyright © 2016 Spanish General Council of Optometry. Published by Elsevier España, S.L.U. All rights reserved.

  3. Increased Tear Film Osmolarity in Systemic Lupus Erythematosus.

    PubMed

    Duru, Necati; Altinkaynak, Hasan; Uysal, Betul Seher; Duru, Zeynep; Can, Mehmet Erol; Erten, Sukran; Yuksel, Nilay; Kalkan Akcay, Emine

    2017-01-01

    To evaluate tear film osmolarity in patients with systemic lupus erythematosus (SLE). A total of 55 eyes from 55 patients with SLE and 47 eyes from 47 age- and gender-matched healthy individuals were included in this study. Tear film osmolarity was evaluated with a lab-on-a-chip technique (TearLab; TearLab Corporation, San Diego, CA) in SLE patients in comparison with healthy individuals, and results were correlated to clinically available diagnostic tests for dry eye, such as tear film break-up time (BUT), Schirmer's test, and Ocular Surface Disease Index (OSDI). The mean tear film osmolarity in the SLE patients and healthy individuals was 306.02 ± 13.27 mOsm/L and 300.74 ± 9.11 mOsm/L, respectively, which made for a statistically significant difference (p = 0.020). In the SLE group, tear film osmolarity was negatively correlated with the Schirmer's test score and the BUT value (r = -0.295 p = 0.029 and r = 0.347 p = 0.009, respectively), whereas tear film osmolarity was not correlated with OSDI score (r = -0.182 p = 0.183). This study revealed that tear film hyperosmolarity and abnormal tear film function are associated with SLE.

  4. The knee meniscus: structure-function, pathophysiology, current repair techniques, and prospects for regeneration

    PubMed Central

    Makris, Eleftherios A.; Hadidi, Pasha; Athanasiou, Kyriacos A.

    2011-01-01

    Extensive scientific investigations in recent decades have established the anatomical, biomechanical, and functional importance that the meniscus holds within the knee joint. As a vital part of the joint, it acts to prevent the deterioration and degeneration of articular cartilage, and the onset and development of osteoarthritis. For this reason, research into meniscus repair has been the recipient of particular interest from the orthopedic and bioengineering communities. Current repair techniques are only effective in treating lesions located in the peripheral vascularized region of the meniscus. Healing lesions found in the inner avascular region, which functions under a highly demanding mechanical environment, is considered to be a significant challenge. An adequate treatment approach has yet to be established, though many attempts have been undertaken. The current primary method for treatment is partial meniscectomy, which commonly results in the progressive development of osteoarthritis. This drawback has shifted research interest towards the fields of biomaterials and bioengineering, where it is hoped that meniscal deterioration can be tackled with the help of tissue engineering. So far, different approaches and strategies have contributed to the in vitro generation of meniscus constructs, which are capable of restoring meniscal lesions to some extent, both functionally as well as anatomically. The selection of the appropriate cell source (autologous, allogeneic, or xenogeneic cells, or stem cells) is undoubtedly regarded as key to successful meniscal tissue engineering. Furthermore, a large variation of scaffolds for tissue engineering have been proposed and produced in experimental and clinical studies, although a few problems with these (e.g., byproducts of degradation, stress shielding) have shifted research interest towards new strategies (e.g., scaffoldless approaches, self-assembly). A large number of different chemical (e.g., TGF-β1, C-ABC) and

  5. Glenohumeral Instability Related to Special Conditions: SLAP Tears, Pan-labral Tears, and Multidirectional Instability.

    PubMed

    Van Blarcum, Gregory S; Svoboda, Steven J

    2017-09-01

    Glenohumeral instability is one of the more common conditions seen by sports medicine physicians, especially in young, active athletes. The associated anatomy of the glenohumeral joint (the shallow nature of the glenoid and the increased motion it allows) make the shoulder more prone to instability events as compared with other joints. Although traumatic dislocations or instability events associated with acute labral tears (ie, Bankart lesions) are well described in the literature, there exists other special shoulder conditions that are also associated with shoulder instability: superior labrum anterior/posterior (SLAP) tears, pan-labral tears, and multidirectional instability. SLAP tears can be difficult to diagnose and arthroscopic diagnosis remains the gold standard. Surgical treatment as ranged from repair to biceps tenodesis with varying reports of success. Along the spectrum of SLAP tears, pan-labral tears consist of 360-degree injuries to the labrum. Patients can present complaining of either anterior or posterior instability alone, making the physical examination and advanced imaging a crucial component of the work up of the patients. Arthroscopic labral repair remains a good initial option for surgical treatment of these conditions. Multidirectional instability remains one of the more difficult conditions for the sports medicine physician to diagnose and treat. Symptoms may only be reported as vague pain versus frank instability making the diagnoses particularly challenging, especially in a patient with overall joint laxity. Conservative management to include physical therapy is the mainstay initial treatment in patients without an identifiable structural abnormality. Surgical management of this condition has evolved from open to arthroscopic capsular shifts with comparable results.

  6. Tear gas: an epidemiological and mechanistic reassessment

    PubMed Central

    Rothenberg, Craig; Achanta, Satyanarayana; Svendsen, Erik R.

    2016-01-01

    Deployments of tear gas and pepper spray have rapidly increased worldwide. Large amounts of tear gas have been used in densely populated cities, including Cairo, Istanbul, Rio de Janeiro, Manama (Bahrain), and Hong Kong. In the United States, tear gas was used extensively during recent riots in Ferguson, Missouri. Whereas tear gas deployment systems have rapidly improved—with aerial drone systems tested and requested by law enforcement—epidemiological and mechanistic research have lagged behind and have received little attention. Case studies and recent epidemiological studies revealed that tear gas agents can cause lung, cutaneous, and ocular injuries, with individuals affected by chronic morbidities at high risk for complications. Mechanistic studies identified the ion channels TRPV1 and TRPA1 as targets of capsaicin in pepper spray, and of the tear gas agents chloroacetophenone, CS, and CR. TRPV1 and TRPA1 localize to pain‐sensing peripheral sensory neurons and have been linked to acute and chronic pain, cough, asthma, lung injury, dermatitis, itch, and neurodegeneration. In animal models, transient receptor potential inhibitors show promising effects as potential countermeasures against tear gas injuries. On the basis of the available data, a reassessment of the health risks of tear gas exposures in the civilian population is advised, and development of new countermeasures is proposed. PMID:27391380

  7. In vivo transport of Gd-DTPA2- into human meniscus and cartilage assessed with delayed gadolinium-enhanced MRI of cartilage (dGEMRIC)

    PubMed Central

    2014-01-01

    Background Impaired stability is a risk factor in knee osteoarthritis (OA), where the whole joint and not only the joint cartilage is affected. The meniscus provides joint stability and is involved in the early pathological progress of OA. Delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) has been used to identify pre-radiographic changes in the cartilage in OA, but has been used less commonly to examine the meniscus, and then using only a double dose of the contrast agent. The purpose of this study was to enable improved early OA diagnosis by investigate the temporal contrast agent distribution in the meniscus and femoral cartilage simultaneously, in healthy volunteers, using 3D dGEMRIC at two different doses of the contrast agent Gd-DTPA2-. Methods The right knee in 12 asymptomatic volunteers was examined using a 3D Look-Locker sequence on two occasions after an intravenous injection of a double or triple dose of Gd-DTPA2- (0.2 or 0.3 mmol/kg body weight). The relaxation time (T1) and relaxation rate (R1 = 1/T1) were measured in the meniscus and femoral cartilage before, and 60, 90, 120 and 180 minutes after injection, and the change in relaxation rate (ΔR1) was calculated. Paired t-test and Analysis of Variance (ANOVA) were used for statistical evaluation. Results The triple dose yielded higher concentrations of Gd-DTPA2- in the meniscus and cartilage than the double dose, but provided no additional information. The observed patterns of ΔR1 were similar for double and triple doses of the contrast agent. ΔR1 was higher in the meniscus than in femoral cartilage in the corresponding compartments at all time points after injection. ΔR1 increased until 90-180 minutes in both the cartilage and the meniscus (p < 0.05), and was lower in the medial than in the lateral meniscus at all time points (p < 0.05). A faster increase in ΔR1 was observed in the vascularized peripheral region of the posterior medial meniscus, than in the avascular central

  8. Tear and decohesion of bovine pericardial tissue.

    PubMed

    Tobaruela, Almudena; Elices, Manuel; Bourges, Jean Yves; Rojo, Francisco Javier; Atienza, José Miguel; Guinea, Gustavo

    2016-10-01

    The aim of this study was to evaluate quantitatively the fracture-by tear and delamination-of bovine pericardium tissues which are usually employed for the manufacture of bioprosthetic valves. A large number of samples (77) were tested in root-to-apex and circumferential directions, according to a standardised tear test (ASTM D 1938). Before performing the tear test, some samples were subjected to 1000 cycles of fatigue to a maximum stress of 3MPa. Fracture toughness of tearing and delamination were computed by following a simple fracture model. The study showed significantly lower values of delamination toughness compared with tear delamination. Moreover, tear forces were different in each test direction, revealing a clear orthotropic behaviour. All these results, as well as the testing procedure, could be of value for future research in the physiological function of pericardium tissues and clinical applications. Copyright © 2016 Elsevier Ltd. All rights reserved.

  9. Photon correlation spectroscopy applied to tear analysis.

    PubMed

    Picarazzi, S; Lecchi, M; Pastori, V; D'Arienzo, M; Scotti, R; Tavazzi, S

    2017-09-01

    This study aims to deepen the knowledge on tear film properties by the development of a protocol for analyses of Photon Correlation Spectroscopy (PCS) on human tears and by the comparison between PCS results obtained on tears of contact lens wearers and non-wearers. Tears (5μL) were collected by a glass capillary. The analyses provide the hydrodynamic diameter of tear components by analyzing intensity fluctuations in time of scattered light. PCS appears a promising technique for studying tear features and for shedding light on specific eye conditions, such as on the clinical effects of CL wear. In fact, statistical difference (p<0.001) was found between the measured mean hydrodynamic diameter of tear components of wearers and non-wearers, the resulting value significantly higher for CL wearers. The scenario does not substantially change after (25±5)min from the CL removal. The difference is attributed to changes in the interactions between tear constituents due to CL wear. In order to get deeper insights on the influence of CL wear on aggregation and structure of tear components, a preliminary Electron Spin Resonance (ESR) investigation was performed, monitoring Fe 3+ species. ESR spectra on tears of both CL wearers and non-wearers showed the presence of intense signals, probably associated to iron (III) centers in proteins such as lactoferrin, and a weaker resonance attributable to Fe 3+ species interacting with S-S bridges of lysozyme. Differences in ESR spectra between CL wearers and non-wearers were detected and tentatively ascribed to changes in coordination or in local environment of Fe 3+ centers connected to aggregation phenomena induced by CL wear, which promote their interaction with other neighboring iron species. Copyright © 2017. Published by Elsevier B.V.

  10. Influence of meniscus on cartilage and subchondral bone features of knees from older individuals: A cadaver study

    PubMed Central

    Touraine, Sébastien; Bouhadoun, Hamid; Engelke, Klaus; Laredo, Jean Denis; Chappard, Christine

    2017-01-01

    Objective Cartilage and subchondral bone form a functional unit. Here, we aimed to examine the effect of meniscus coverage on the characteristics of this unit in knees of older individuals. Methods We assessed the hyaline cartilage, subchondral cortical plate (SCP), and subchondral trabecular bone in areas covered or uncovered by the meniscus from normal cadaver knees (without degeneration). Bone cores harvested from the medial tibial plateau at locations uncovered (central), partially covered (posterior), and completely covered (peripheral) by the meniscus were imaged by micro-CT. The following were measured on images: cartilage volume (Cart.Vol, mm3) and thickness (Cart.Th, mm); SCP thickness (SCP.Th, μm) and porosity (SCP.Por, %); bone volume to total volume fraction (BV/TV, %); trabecular thickness (Tb.Th, μm), spacing (Tb.Sp, μm), and number (Tb.N, 1/mm); structure model index (SMI); trabecular pattern factor (Tb.Pf); and degree of anisotropy (DA). Results Among the 28 specimens studied (18 females) from individuals with mean age 82.8±10.2 years, cartilage and SCP were thicker at the central site uncovered by the meniscus than the posterior and peripheral sites, and Cart.Vol was greater. SCP.Por was highest in posterior samples. In the upper 1–5 mm of subchondral bone, central samples were characterized by higher values for BV/TV, Tb.N, Tb.Th, and connectivity (Tb.Pf), a more plate-like trabecular structure and lower anisotropy than with other samples. Deeper down, at 6–10 mm, the differences were slightly higher for Tb.Th centrally, DA peripherally and SMI posteriorly. Conclusions The coverage or not by meniscus in the knee of older individuals is significantly associated with Cart.Th, SCP.Th, SCP.Por and trabecular microarchitectural parameters in the most superficial 5 mm and to a lesser extent the deepest area of subchondral trabecular bone. These results suggest an effect of differences in local loading conditions. In subchondral bone uncovered by

  11. The potential of optical coherence tomography for diagnosing meniscal pathology

    NASA Astrophysics Data System (ADS)

    Hang-Yin Ling, Carrie; Pozzi, Antonio; Thieman, Kelley M.; Tonks, Catherine A.; Guo, Shuguang; Xie, Huikai; Horodyski, MaryBeth

    2010-04-01

    Meniscal tears are often associated with anterior cruciate ligament (ACL) injury and may lead to pain and discomfort in humans. Maximal preservation of meniscal tissue is highly desirable to mitigate the progression of osteoarthritis. Guidelines of which meniscal tears are amenable to repair and what part of damaged tissues should be removed are elusive and lacking consensus. Images of microstructural changes in meniscus would potentially guide the surgeons to manage the meniscal tears better, but the resolution of current diagnostic techniques is limited for this application. In this study, we demonstrated the feasibility of using optical coherence tomography (OCT) for the diagnosis of meniscal pathology. Torn medial menisci were collected from dogs with ACL insufficiency. The torn meniscus was divided into three tissue samples and scanned by OCT and scanning electron microscopy (SEM). OCT and SEM images of torn menisci were compared. Each sample was evaluated for gross and microstructural abnormalities and reduction or loss of birefringence from the OCT images. The abnormalities detected with OCT were described for each type of tear. OCT holds promise in non-destructive and fast assessment of microstructural changes and tissue birefringence of meniscal tears. Future development of intraoperative OCT may help surgeons in the decision making of meniscal treatment.

  12. Magnetic Resonance Imaging Findings in Symptomatic Patients After Arthroscopic Partial Meniscectomy for Torn Discoid Lateral Meniscus.

    PubMed

    Lee, Chang-Rack; Bin, Seong-Il; Kim, Jong-Min; Kim, Nam-Ki

    2016-11-01

    To evaluate the change in the thickness and width of the residual meniscus using magnetic resonance imaging (MRI) in patients who underwent arthroscopic partial meniscectomy for discoid lateral meniscus (DLM), to assess whether the degeneration of the articular cartilage in the lateral compartment of the knee progressed, and to evaluate clinical results. Among the patients who underwent arthroscopic partial meniscectomy for DLM between January 1997 and December 2011, those who were aged 40 or below at surgery were followed up for at least 3 years, and received at least 2 follow-up MRIs that were retrospectively reviewed. MRIs were done in symptomatic knees. Using MRI, the relative thickness and width were measured in the anterior horn, midportion, and posterior horn. To determine whether the degeneration of the lateral compartment would progress, the articular cartilage was graded based on the Outerbridge classification in MRIs. The clinical results were evaluated using the Lysholm score. A total of 20 patients (21 knees) were included. The average follow-up period was 6.8 years. In residual meniscus, the relative thickness of the midportion decreased from 9.0% ± 2.4% to 7.3% ± 2.3% (P < .001), the relative thickness of the anterior horn decreased from 15.6% ± 4.3% to 14.3% ± 6.7% (P = .030), and the relative thickness of the posterior horn decreased from 20.0% ± 4.4% to 16.7% ± 6.7% (P = .019). A decrease in the relative width was observed in the midportion (12.4% ± 4.8% to 10.9% ± 4.9%, P = .003). No significant changes in size were observed in the medial meniscus. A progression of degeneration in the lateral compartment was observed. However, the clinical results did not present significant changes. In symptomatic patients after arthroscopic partial meniscectomy for DLM, the thickness and width of the residual meniscus decreases over time. The arthritic change of the lateral compartment of the knee progressed. However, the change in the size of

  13. Hot Tearing in Aluminium — Copper Alloys

    NASA Astrophysics Data System (ADS)

    Viano, David; StJohn, David; Grandfield, John; Cáceres, Carlos

    For many aluminium alloys, hot tearing susceptibility follows a lambda curve relationship when hot tearing severity is plotted as a function of solute content. In the past, there has been some difficulty quantifying hot tearing. Traditional methods rely upon measuring electrical resistivity or the number and/or length of cracks in tests such as the ring test. In this experimental program, a hot tear test rig was used to investigate a series of binary Al-Cu alloys. This device measures the load imposed on the mushy zone during solidification. Hot tearing susceptibility was quantified in two ways. The first method involved measuring the load at the solidus temperature (548°C). The second method was to radiograph the hot spot and measure the image density of the cracks. Both methods had advantages and disadvantages. It was found that the results from the hot tear rig correlates with other published data using different experimental methods.

  14. Chemosignalling effects of human tears revisited: Does exposure to female tears decrease males' perception of female sexual attractiveness?

    PubMed

    Gračanin, Asmir; van Assen, Marcel A L M; Omrčen, Višnja; Koraj, Ivana; Vingerhoets, Ad J J M

    2017-01-01

    Gelstein et al. reported the results of three experiments suggesting a dampening influence of inhalation of female emotional tears on males' arousal and perception of female sexual attractiveness, specifically in non-sexual situations. This prompted the hypothesis that crying exerts its influence on others not only via the auditory and visual mode but also via chemosignals. In three studies, we attempted to replicate and extend Gelstein et al.'s findings by including an additional condition with irritant tears, by using pictures of sexually attractive women, and by testing related hypotheses on the pro-social effects of exposure to tears. All three studies, separately or combined in a meta-analysis, failed to replicate the original inhibitory effects of tears. In addition, sniffing tears did not affect measures of connectedness, aggression and pro-social behaviour. It is concluded that the effects of female tears on male arousal and perception of female sexual attractiveness, if any, are very weak at best. Rather, it seems that crying exerts its strong inter-personal effects through the visual and auditory sensory channels.

  15. [Comparison of the Arthroscopic Finding in the Knee Joint and the MRI - Retrospective Study].

    PubMed

    Šimeček, K; Látal, P; Duda, J; Šimeček, M

    2017-01-01

    PURPOSE OF THE STUDY Our retrospective study presents the comparison of the preoperative magnetic resonance imaging of the knee joint - MRI - and the arthroscopic finding - ASC. Its aim is to find out how a positive or a negative finding of MRI corresponds with the operative finding and how much the experience of radiologist contributes to the conformity. MATERIAL AND METHODS The MRI findings of knee joints treated surgically at two departments in 2013 and 2014 were assessed. The MRI was performed in a total of 470 patients who subsequently underwent an arthroscopic surgery. A conformity or a non-conformity in anterior, posterior horn and complete rupture of both menisci and in partial or complete tear of anterior cruciate ligament - LCA was searched for. The sensitivity, specificity and accuracy of MRI were established. The difference between experienced and less experienced radiologists was evaluated. The analysis of the radiology report, surgical protocol of ASC and medical history in the documentation was performed. The cartilage was not subject to evaluation. The finding of Grade 1 meniscus tear on MRI was evaluated as negative. Grade 2 and Grade 3 were evaluated as positive. RESULTS Comparison of the preoperative MRI and the arthroscopic finding 1. The group with MRI reported 3 % of diagnostic arthroscopies. The control group without MRI (551 ASC) reported 15 % diagnostic arthroscopies. 2. Low sensitivity of MRI (0.67) in negative findings of ASC. It concerned 7 cases in which a pathological finding was identified on a MRI scan, but not by ASC. In two cases the repeated arthroscopy confirmed that a pathology inside the knee joint was overlooked by the arthroscopist. In the remaining five cases, the clinical finding improved without a repeated surgery. 3. High sensitivity of MRI is shown in the most frequent finding - posterior horn of medial meniscus (0.94). 4. Lower sensitivity (0.76) in partial and (0.83) in complete ACL tear. It increases to 0.93 if

  16. 49 CFR 173.340 - Tear gas devices.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 2 2010-10-01 2010-10-01 false Tear gas devices. 173.340 Section 173.340... SHIPMENTS AND PACKAGINGS Gases; Preparation and Packaging § 173.340 Tear gas devices. (a) Packagings for tear gas devices must be approved prior to initial transportation by the Associate Administrator. (b...

  17. Tear clearance implications for ocular surface health.

    PubMed

    de Paiva, Cintia Sade; Pflugfelder, Stephen C

    2004-03-01

    Tear clearance/turnover provides a global assessment of the function of the lacrimal functional unit and of tear exchange on the ocular surface. It is an indirect measure of dry eye induced inflammation on the ocular surface. It shows better correlation with the severity of ocular irritation symptoms and corneal epithelial disease in dry eye than the Schirmer 1 test. Delayed tear clearance may prove to be the best measure for identifying patients with tear film disorders who may respond to anti-inflammatory therapy.

  18. Tear Film Osmolarity in Subjects with Acute Allergic Rhinoconjunctivitis

    PubMed Central

    NITODA, EIRINI; LAVARIS, ANASTASIOS; LAIOS, KONSTANTINOS; ANDROUDI, SOPHIA; KALOGEROPOULOS, CHRIS D; TSATSOS, MICHAEL; DAMASKOS, CHRISTOS; GARMPIS, NIKOLAOS; MOSCHOS, MARILITA M

    2018-01-01

    Background/Aim: Acute allergic rhinoconjuctivitis is the most common form of ocular allergies. The pathogenetic mechanisms are based on an immunoglobulin E (IgE)-mediated hypersensitivity reaction. On the other hand, tear osmolarity has been suggested to be an index of ocular surface damage and inflammation. These data were the motive to investigate the levels of tear osmolarity in subjects with acute allergic rhinoconjuctivitis, before and after administration of artificial tears. Patients and Methods: Forty-five subjects with acute allergic rhinoconjuctivitis were randomly divided into three groups, based on the type of artificial tears that they received: Group A (Thera tears), Group B (Wet therapy) and Group C (Tears Naturale free). The eye drops were administered six times a day for 60 days and all subjects underwent grading of subjective symptoms and clinical examination at baseline and at the end of the treatment. Results: The diagnosis of severe eye disease, which was based on ocular surface disease index (OSDI; Allergan, Inc, Irvine, CA, USA) and tear osmolarity values, concerned all patients at baseline. Although the administration of artificial tears significantly ameliorated the symptoms and the ocular variables in all groups, the results were better in the first group. Tear osmolarity was strongly and negatively correlated with tear film breakup time (BUT) and Schirmer I test at 2 months. Contrariwise, symptoms were eliminated, when tear osmolarity was decreased. Conclusion: Acute allergic rhinoconjuctivitis is characterized by tear hyperosmolarity, which can be rehabilitated with the administration of hypotonic artificial tears. PMID:29475928

  19. Tear Film Osmolarity in Subjects with Acute Allergic Rhinoconjunctivitis.

    PubMed

    Nitoda, Eirini; Lavaris, Anastasios; Laios, Konstantinos; Androudi, Sophia; Kalogeropoulos, Chris D; Tsatsos, Michael; Damaskos, Christos; Garmpis, Nikolaos; Moschos, Marilita M

    2018-01-01

    Acute allergic rhinoconjuctivitis is the most common form of ocular allergies. The pathogenetic mechanisms are based on an immunoglobulin E (IgE)-mediated hypersensitivity reaction. On the other hand, tear osmolarity has been suggested to be an index of ocular surface damage and inflammation. These data were the motive to investigate the levels of tear osmolarity in subjects with acute allergic rhinoconjuctivitis, before and after administration of artificial tears. Forty-five subjects with acute allergic rhinoconjuctivitis were randomly divided into three groups, based on the type of artificial tears that they received: Group A (Thera tears), Group B (Wet therapy) and Group C (Tears Naturale free). The eye drops were administered six times a day for 60 days and all subjects underwent grading of subjective symptoms and clinical examination at baseline and at the end of the treatment. The diagnosis of severe eye disease, which was based on ocular surface disease index (OSDI; Allergan, Inc, Irvine, CA, USA) and tear osmolarity values, concerned all patients at baseline. Although the administration of artificial tears significantly ameliorated the symptoms and the ocular variables in all groups, the results were better in the first group. Tear osmolarity was strongly and negatively correlated with tear film breakup time (BUT) and Schirmer I test at 2 months. Contrariwise, symptoms were eliminated, when tear osmolarity was decreased. Acute allergic rhinoconjuctivitis is characterized by tear hyperosmolarity, which can be rehabilitated with the administration of hypotonic artificial tears. Copyright© 2018, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

  20. Optical spectroscopic characterization of human meniscus biomechanical properties

    NASA Astrophysics Data System (ADS)

    Ala-Myllymäki, Juho; Danso, Elvis K.; Honkanen, Juuso T. J.; Korhonen, Rami K.; Töyräs, Juha; Afara, Isaac O.

    2017-12-01

    This study investigates the capacity of optical spectroscopy in the visible (VIS) and near-infrared (NIR) spectral ranges for estimating the biomechanical properties of human meniscus. Seventy-two samples obtained from the anterior, central, and posterior locations of the medial and lateral menisci of 12 human cadaver joints were used. The samples were subjected to mechanical indentation, then traditional biomechanical parameters (equilibrium and dynamic moduli) were calculated. In addition, strain-dependent fibril network modulus and permeability strain-dependency coefficient were determined via finite-element modeling. Subsequently, absorption spectra were acquired from each location in the VIS (400 to 750 nm) and NIR (750 to 1100 nm) spectral ranges. Partial least squares regression, combined with spectral preprocessing and transformation, was then used to investigate the relationship between the biomechanical properties and spectral response. The NIR spectral region was observed to be optimal for model development (83.0%≤R2≤90.8%). The percentage error of the models are: Eeq (7.1%), Edyn (9.6%), Eɛ (8.4%), and Mk (8.9%). Thus, we conclude that optical spectroscopy in the NIR range is a potential method for rapid and nondestructive evaluation of human meniscus functional integrity and health in real time during arthroscopic surgery.

  1. Does high location and thickness of the Wrisberg ligament affect discoid lateral meniscus tear type based on peripheral detachment?

    PubMed

    Ahn, Jin Hwan; Wang, Joon Ho; Kim, Dong Uk; Lee, Do Kyung; Kim, Jun Ho

    2017-12-01

    The aim of this study was to evaluate the relationship between discoid lateral meniscus (DLM) types based on peripheral detachment and anatomic features of Wrisberg ligament (WL) such as location and thickness based on magnetic resonance image (MRI). A total of 322 knees in 292 patients were reviewed. Patients were divided into four DLM types according to peripheral detachment: no shift (type 1), anterocentral shift (type 2), posterocentral shift (type 3) and central shift (type 4). We reviewed all MRI concentrating on the presence, location (high or low location), running angle, thickness of WL, and WL/posterior cruciate ligament (PCL) thickness ratio. The relationship between DLM types and anatomic features of WL were analyzed using one-way analysis of variance and chi-square test. According to DLM types based on peripheral detachment, 149 knees were type 1, 38 were type 2, 79 were type 3, and 56 were type 4. Among the 322 knees, 302 (93.8%) had WL on MRI. In DLM patients, type 3 showed a statistically significant (P<0.001) relationship with high location of WL. In addition, type 3 had significantly larger (P<0.0001) running angle of WL, thicker (P<0.0001) WL, and higher (P<0.0001) WL/PCL ratio compared to other types. A high location and thick WL are related to posterocentral shift type of DLM based on peripheral detachment. Based on our results, the high location and thick WL might provide information to surgeons in predicting the direction of peripheral detachment in symptomatic DLM patients. Copyright © 2017 Elsevier B.V. All rights reserved.

  2. Physical Therapy to Treat Torn Meniscus Comparable to Surgery for Many Patients

    MedlinePlus

    ... to Surgery for Many Patients Spotlight on Research Physical Therapy to Treat Torn Meniscus Comparable to Surgery ... to avoid surgery and achieve comparable relief from physical therapy, according to a recent, multisite study funded ...

  3. Chondrogenically primed tonsil-derived mesenchymal stem cells encapsulated in riboflavin-induced photocrosslinking collagen-hyaluronic acid hydrogel for meniscus tissue repairs.

    PubMed

    Koh, Rachel H; Jin, Yinji; Kang, Byung-Jae; Hwang, Nathaniel S

    2017-04-15

    Current meniscus tissue repairing strategies involve partial or total meniscectomy, followed by allograft transplantation or synthetic material implantation. However, allografts and synthetic implants have major drawbacks such as the limited supply of grafts and lack of integration into host tissue, respectively. In this study, we investigated the effects of conditioned medium (CM) from meniscal fibrochondrocytes and TGF-β3 on tonsil-derived mesenchymal stem cells (T-MSCs) for meniscus tissue engineering. CM-expanded T-MSCs were encapsulated in riboflavin-induced photocrosslinked collagen-hyaluronic acid (COL-RF-HA) hydrogels and cultured in chondrogenic medium containing TGF-β3. In vitro results indicate that CM-expanded cells followed by TGF-β3 exposure stimulated the expression of fibrocartilage-related genes (COL2, SOX9, ACAN, COL1) and production of extracellular matrix components. Histological assessment of in vitro and subcutaneously implanted in vivo constructs demonstrated that CM-expanded cells followed by TGF-β3 exposure resulted in highest cell proliferation, GAG accumulation, and collagen deposition. Furthermore, when implanted into meniscus defect model, CM treatment amplified the potential of TGF-β3 and induced complete regeneration. Conditioned medium derived from chondrocytes have been reported to effectively prime mesenchymal stem cells toward chondrogenic lineage. Type I collagen is the main component of meniscus extracellular matrix and hyaluronic acid is known to promote meniscus regeneration. In this manuscript, we investigated the effects of conditioned medium (CM) and transforming growth factor-β3 (TGF-β3) on tonsil-derived mesenchymal stem cells (T-MSCs) encapsulated in riboflavin-induced photocrosslinked collagen-hyaluronic acid (COL-RF-HA) hydrogel. We employed a novel source of conditioned medium, derived from meniscal fibrochondrocytes. Our in vitro and in vivo results collectively illustrate that CM-expanded cells followed by

  4. On the tear resistance of skin

    DOE PAGES

    Yang, Wen; Sherman, Vincent R.; Gludovatz, Bernd; ...

    2015-03-27

    Tear resistance is vitally important for the various functions of skin, especially protection from predatorial attack. Here, we mechanistically quantify the extreme tear resistance of skin and identify the underlying structural features, which lead to its sophisticated failure mechanisms. Here we explain why it is virtually impossible to propagate a tear in rabbit skin, chosen as a model material for the dermis of vertebrates. Finally, we express the deformation in terms of four mechanisms of collagen fibril activity in skin under tensile loading that virtually eliminate the possibility of tearing in pre-notched samples: fibril straightening, fibril reorientation towards the tensilemore » direction, elastic stretching and interfibrillar sliding, all of which contribute to the redistribution of the stresses at the notch tip.« less

  5. Diadenosine tetraphosphate contributes to carbachol-induced tear secretion.

    PubMed

    Fonseca, Begoña; Martínez-Águila, Alejandro; Díaz-Hernández, Miguel; Pintor, Jesús

    2015-03-01

    The purpose of this study is to investigate if the cholinergic stimulation by carbachol on tear secretion is a direct process or if it is also mediated by purinergic mechanisms. Experiments were performed in New Zealand male rabbits. The amount of tear secretion was measured with Schirmer's test and then analyzed by a HPLC protocol in order to study the nucleotide levels. Animal eyes were instilled with carbachol (a cholinergic agonist), pirenzepine, gallamine and 4-DAMP (muscarinic antagonists), PPADS, suramin and reactive blue 2 (purinergic antagonists), and a P2Y2 receptor small interfering RNA (siRNA). Tear secretion increased with the instillation of carbachol, approximately 84 % over control values 20 min after the instillation and so did Ap4A and ATP release. When we applied carbachol in the presence of muscarinic antagonists, tear volume only increased to 4 % with atropine, 12 % in the case of pirenzepine, 3 % with gallamine, and 8 % with 4-DAMP. In the presence of carbachol and purinergic antagonists, tear secretion was increased to 12 % (all values compared to basal tear secretion). By analyzing tear secretion induced with carbachol in presence of a P2Y2 receptor siRNA, we found that tear secretion was diminished to 60 %. The inhibition of tear secretion in the presence of carbachol and purinergic antagonists or P2Y2 siRNA occurred with no apparent change in the tear amount of Ap4A. These experiments demonstrated the participation of Ap4A in lacrimal secretion process.

  6. [Alterations in tears aqueous layer during cytostatics treatment].

    PubMed

    Wojciechowska, Katarzyna; Wieckowska-Szakiel, Marzena; Rózalska, Barbara; Jurowski, Piotr

    2013-01-01

    The aim of the study was to evaluate tears secretion, pH and lysozyme activity in tears aqueous layer during chemotherapy in lung, breast and bowel cancer. 36 patients were enrolled to the study. Depending on the type of cancer and type of chemotherapy patients were divided into three groups. Group I (12 patients) diagnosed with non-small-cell lung cancer treated with PE schema (cisplatin, etoposide), Group II (12 patients) with breast cancer treated with FAC schema (fluorouracil, doxorubicin, cyclophosphamide), Group III (12 patients) with bowel cancer treated with FU/LV schema (fluorouracil, leucovorin). In all the patients: Schirmer's I test, pH measurements and lysozyme test were performed. Patients were examined before chemotherapy, after 2nd, 4th, 6th cycle. In group I and II lowering of tears secretion (p < 0.001) was revealed. In group III there was higher tears secretion (p < 0.001). PH was lowered after 2nd chemotherapy course in group I and II. In further treatment pH value were in the same lower level as after the second course. In group III there was higher pH--more alkaline (p < 0.001) after 2nd cycle of treatment and it was on the same level to the end of the examination process. Lowering of lysozyme activity in the tears film in all groups (p < 0.001) was established. The higher alterations of the lysozyme activity were observed in group treated with FAC schema. Cytostatic treatment has major influence on tears aqueous layer causing alterations of tears secretions. PH alterations depending on type of chemotherapy was observed. Lowering of lysozyme activity in tears was observed. All the deteriorations aggravate with duration of chemotherapy. Alterations of tears film parameters during chemotherapy may influence upon eye surface homeostasis and infectious complication. tears aqueous layer, Schirmer's test, lysozyme activity, tears pH.

  7. Influence of Ophthalmic Solutions on Tear Components.

    PubMed

    Shigeyasu, Chika; Yamada, Masakazu; Akune, Yoko

    2016-11-01

    Tear fluids are a mixture of secretions derived from lacrimal glands, accessory lacrimal glands, conjunctiva, and meibomian glands. Compositional changes to tears occur in the normal state and during ocular surface disease, such as dry eye conditions. We have investigated compositional changes to tears after topical application of ophthalmic solutions, with regard to tear-specific proteins (secretory immunoglobulin A, lactoferrin, lipocalin-1, and lysozyme) and ocular surface mucin in normal and dry eye conditions using high-performance liquid chromatography. After application of saline solution (0.9% sodium chloride) in normal subjects, transient but significant decreases in all tear components were observed. The recovery of protein concentrations took up to 30 minutes and lasted longer when the saline solution was applied more frequently. When applying ophthalmic solutions, a balance between washout and dilutional effects should be considered in addition to the therapeutic effect. Investigation of the effect of diquafosol solution (3%) in normal subjects revealed a significant increase in sialic acid concentration, a marker of ocular mucin, at 5 minutes after application, whereas a significant decrease was observed with saline. This result indicates the accelerated secretion of mucin from ocular tissues induced by diquafosol. A clinical study to determine the efficacy of diquafosol in patients with dry eye revealed improvements in tear breakup time, keratoconjunctival staining scores, and Schirmer test score, accompanied by an increase in sialic acid concentration in tears. Investigating normal and dry eye conditions through tear analysis may clarify the pathophysiology of dry eye conditions and support the efficacy of treatments.

  8. Formation of Hot Tear Under Controlled Solidification Conditions

    NASA Astrophysics Data System (ADS)

    Subroto, Tungky; Miroux, Alexis; Bouffier, Lionel; Josserond, Charles; Salvo, Luc; Suéry, Michel; Eskin, Dmitry G.; Katgerman, Laurens

    2014-06-01

    Aluminum alloy 7050 is known for its superior mechanical properties, and thus finds its application in aerospace industry. Vertical direct-chill (DC) casting process is typically employed for producing such an alloy. Despite its advantages, AA7050 is considered as a "hard-to-cast" alloy because of its propensity to cold cracking. This type of cracks occurs catastrophically and is difficult to predict. Previous research suggested that such a crack could be initiated by undeveloped hot tears (microscopic hot tear) formed during the DC casting process if they reach a certain critical size. However, validation of such a hypothesis has not been done yet. Therefore, a method to produce a hot tear with a controlled size is needed as part of the verification studies. In the current study, we demonstrate a method that has a potential to control the size of the created hot tear in a small-scale solidification process. We found that by changing two variables, cooling rate and displacement compensation rate, the size of the hot tear during solidification can be modified in a controlled way. An X-ray microtomography characterization technique is utilized to quantify the created hot tear. We suggest that feeding and strain rate during DC casting are more important compared with the exerted force on the sample for the formation of a hot tear. In addition, we show that there are four different domains of hot-tear development in the explored experimental window—compression, microscopic hot tear, macroscopic hot tear, and failure. The samples produced in the current study will be used for subsequent experiments that simulate cold-cracking conditions to confirm the earlier proposed model.

  9. Assessment, prevention and management of skin tears.

    PubMed

    Benbow, Maureen

    2017-04-28

    Skin tears are common in older people. They are acute wounds that are at high risk of becoming complex, chronic wounds due to the interplay between the physiological changes in the skin and trauma from the external environment. Skin tears have been reported to have prevalence rates equal to, or greater than, those for pressure ulcers. A comprehensive risk assessment should include assessment of the individual's general health (chronic/critical disease, polypharmacy and cognitive, sensory and nutritional status); mobility (history of falls, impaired mobility, dependent activities of daily living, and mechanical trauma); and skin (extremes of age, fragile skin and previous skin tears). A recognised classification system should be used to identify and document skin tears and guide treatment decisions in line with local wound management protocols. Nurses and carers are in a prime position to prevent, assess and manage skin tears.

  10. Phospholipid transfer protein is present in human tear fluid.

    PubMed

    Jauhiainen, Matti; Setälä, Niko L; Ehnholm, Christian; Metso, Jari; Tervo, Timo M T; Eriksson, Ove; Holopainen, Juha M

    2005-06-07

    The human tear fluid film consists of a superficial lipid layer, an aqueous middle layer, and a hydrated mucin layer located next to the corneal epithelium. The superficial lipid layer protects the eye from drying and is composed of polar and neutral lipids provided by the meibomian glands. Excess accumulation of lipids in the tear film may lead to drying of the corneal epithelium. In the circulation, phospholipid transfer protein (PLTP) and cholesteryl ester transfer protein (CETP) mediate lipid transfers. To gain insight into the formation of tear film, we investigated whether PLTP and CETP are present in human tear fluid. Tear fluid samples were collected with microcapillaries. The presence of PLTP and CETP was studied in tear fluid by Western blotting, and the PLTP concentration was determined by ELISA. The activities of the enzymes were determined by specific lipid transfer assays. Size-exclusion and heparin-affinity chromatography assessed the molecular form of PLTP. PLTP is present in tear fluid, whereas CETP is not. Quantitative assessment of PLTP by ELISA indicated that the PLTP concentration in tear fluid, 10.9 +/- 2.4 microg/mL, is about 2-fold higher than that in human plasma. PLTP-facilitated phospholipid transfer activity in tears, 15.1 +/- 1.8 micromol mL(-)(1) h(-)(1), was also significantly higher than that measured in plasma. Inactivation of PLTP by heat treatment (+58 degrees C, 60 min) or immunoinhibition abolished the phospholipid transfer activity in tear fluid. Size-exclusion chromatography of tear fluid indicated that PLTP eluted in a position corresponding to a size of 160-170 kDa. Tear fluid PLTP was quantitatively bound to Heparin-Sepharose and could be eluted as a single peak by 0.5 M NaCl. These data indicate that human tear fluid contains catalytically active PLTP protein, which resembles the active form of PLTP present in plasma. The results suggest that PLTP may play a role in the formation of the tear film by supporting phospholipid

  11. Antioxidant content and ultraviolet absorption characteristics of human tears.

    PubMed

    Choy, Camus Kar Man; Cho, Pauline; Benzie, Iris F F

    2011-04-01

    Dry eye syndrome is a common age-related disorder, and decreased antioxidant/ultraviolet (UV) radiation protection in tears may be part of the cause. This study aimed to compare the tear antioxidant content and flow rate in young and older adults. The total antioxidant content and UV absorbing properties of various commercially available ophthalmic solutions used to alleviate dry eye symptoms were also examined. Minimally stimulated tears were collected from 120 healthy Chinese adults with no ocular pathology. Two age groups were studied: 19 to 29 years (n = 58) and 50 to 75 years (n = 62). Tear samples from each subject and 13 ophthalmic solutions were analyzed for total antioxidant content (as the Ferric Reducing/Antioxidant Power value). Tear flow rates were estimated from time taken to collect a fixed volume of tear fluid. UV absorbance spectra of pooled fresh reflex tear fluid and the ophthalmic solutions were determined. Results showed that the antioxidant content of minimally stimulated tears from older subjects (398 ± 160 μmol/l) was not significantly lower than that of younger subjects (348 ± 159 μmol/l; p = 0.0915). However, there was a significant difference in the tear flow rates between the two groups (p < 0.0001), with the younger group having three to four fold higher flow rate. None of the commercial preparations tested had detectable antioxidant content, and none showed the UV absorption characteristics of natural reflex tears. The effect of low flow rate on the dynamic antioxidant supply to the corneal surface indicates that older subjects have poorer overall defense against photooxidative and other oxidative processes. This could predispose older persons to corneal stress and development of dry eye syndrome. The commercially available artificial tears tested lack both the antioxidant content and UV absorbing characteristics of natural tears. Artificial tears formulations that help restore natural antioxidant and UV absorbing properties to the

  12. Impact of oral vitamin D supplementation on the ocular surface in people with dry eye and/or low serum vitamin D.

    PubMed

    Yang, Chih-Huang; Albietz, Julie; Harkin, Damien G; Kimlin, Michael G; Schmid, Katrina L

    2018-02-01

    To determine the possible association between serum vitamin D levels and dry eye symptoms, and the impact of an oral vitamin D supplement. Three linked studies were performed. (i) 29 older adult participants, (ii) 29 dry eyed participants, and (iii) 2-month vitamin D supplementation for 32 dry eyed/low serum vitamin D levelled participants. All participants were assessed by the Ocular Surface Diseases Index (OSDI) to determine dry eye symptoms, and the phenol red thread test (PRT) and/or Schirmer's tear test, tear meniscus height, non-invasive tear break up time, grading ocular surface redness and fluorescein staining of the cornea to detect the tear quality and ocular surface conditions. Blood samples were collected for serum vitamin D analysis and interleukin-6 (IL-6) levels. Among older adult participants, vitamin D levels were negatively correlated with dry eye symptoms, the severity of dry eye, and associated with tired eye symptom. Vitamin D levels of people with dry eye diagnosis were not correlated with OSDI scores and IL-6 levels; while IL-6 levels showed correlation with tear production. In supplement study, vitamin D levels increased by 29mol/l, while dry eye symptoms and grading of corneal staining appeared significant reductions. No significant changes in IL-6 levels. Low vitamin D levels (<50nmol/l) were associated with dry eye symptoms in older individuals but not those diagnosed with dry eye. Vitamin D supplement increased the vitamin D levels, and improved dry eye symptoms, the tear quality and ocular surface conditions. Copyright © 2017 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.

  13. Reverse shoulder arthroplasty for massive irreparable rotator cuff tears and cuff tear arthropathy: a systematic review.

    PubMed

    Petrillo, S; Longo, U G; Papalia, R; Denaro, V

    2017-08-01

    To report the outcomes and complications of reverse shoulder arthroplasty (RSA) in massive irreparable rotator cuff tears (MIRCT) and cuff tear arthropathy (CTA). A systematic review of the literature contained in Medline, Cochrane, EMBASE, Google Scholar and Ovid databases was conducted on May 1, 2016, according to PRISMA guidelines. The key words "reverse total shoulder arthroplasty" or "reverse total shoulder prostheses" with "rotator cuff tears"; "failed rotator cuff surgery"; "massive rotator cuff tears"; "irreparable rotator cuff tears"; "cuff tear arthropathy"; "outcomes"; "complications" were matched. All articles reporting outcomes and complications of RSA for the management of MIRCT or CTA were included. The comparison between preoperative and postoperative clinical scores, as well as range of motion (ROM), was performed using the Wilcoxon-Mann-Whitney test. P values lower than 0.05 were considered statistically significant. Seven articles were included in our qualitative synthesis. A statistically significant improvement in all clinical scores and ROM was found comparing the preoperative value with the postoperative value. The degrees of retroversion of the humeral stem of the RSA do not influence the functional outcomes in a statistically significant fashion. There were 17.4% of complications. The most frequent was heterotopic ossification, occurring in 6.6% of patients. Revision surgery was necessary in 7.3% of patients. RSA restores pain-free ROM and improves function of the shoulder in patients with MIRCT or CTA. However, complications occur in a high percentage of patients. The lack of level I studies limits the real understanding of the potentials and limitations of RSA for the management of MIRCT and CTA.

  14. Physiologically Distributed Loading Patterns Drive the Formation of Zonally Organized Collagen Structures in Tissue-Engineered Meniscus.

    PubMed

    Puetzer, Jennifer L; Bonassar, Lawrence J

    2016-07-01

    The meniscus is a dense fibrocartilage tissue that withstands the complex loads of the knee via a unique organization of collagen fibers. Attempts to condition engineered menisci with compression or tensile loading alone have failed to reproduce complex structure on the microscale or anatomic scale. Here we show that axial loading of anatomically shaped tissue-engineered meniscus constructs produced spatial distributions of local strain similar to those seen in the meniscus when the knee is loaded at full extension. Such loading drove formation of tissue with large organized collagen fibers, levels of mechanical anisotropy, and compressive moduli that match native tissue. Loading accelerated the development of native-sized and aligned circumferential and radial collagen fibers. These loading patterns contained both tensile and compressive components that enhanced the major biochemical and functional properties of the meniscus, with loading significantly improved glycosaminoglycan (GAG) accumulation 200-250%, collagen accumulation 40-55%, equilibrium modulus 1000-1800%, and tensile moduli 500-1200% (radial and circumferential). Furthermore, this study demonstrates local changes in mechanical environment drive heterogeneous tissue development and organization within individual constructs, highlighting the importance of recapitulating native loading environments. Loaded menisci developed cartilage-like tissue with rounded cells, a dense collagen matrix, and increased GAG accumulation in the more compressively loaded horns, and fibrous collagen-rich tissue in the more tensile loaded outer 2/3, similar to native menisci. Loaded constructs reached a level of organization not seen in any previous engineered menisci and demonstrate great promise as meniscal replacements.

  15. Human tears reveal insights into corneal neovascularization.

    PubMed

    Zakaria, Nadia; Van Grasdorff, Sigi; Wouters, Kristien; Rozema, Jos; Koppen, Carina; Lion, Eva; Cools, Nathalie; Berneman, Zwi; Tassignon, Marie-José

    2012-01-01

    Corneal neovascularization results from the encroachment of blood vessels from the surrounding conjunctiva onto the normally avascular cornea. The aim of this study is to identify factors in human tears that are involved in development and/or maintenance of corneal neovascularization in humans. This could allow development of diagnostic tools for monitoring corneal neovascularization and combination monoclonal antibody therapies for its treatment. In an observational case-control study we enrolled a total of 12 patients with corneal neovascularization and 10 healthy volunteers. Basal tears along with reflex tears from the inferior fornix, superior fornix and using a corneal bath were collected along with blood serum samples. From all patients, ocular surface photographs were taken. Concentrations of the pro-angiogenic cytokines interleukin (IL)-6, IL-8, Vascular Endothelial Growth Factor (VEGF), Monocyte Chemoattractant Protein 1 (MCP-1) and Fas Ligand (FasL) were determined in blood and tear samples using a flow cytometric multiplex assay. Our results show that the concentration of pro-angiogenic cytokines in human tears are significantly higher compared to their concentrations in serum, with highest levels found in basal tears. Interestingly, we could detect a significantly higher concentration of IL- 6, IL-8 and VEGF in localized corneal tears of patients with neovascularized corneas when compared to the control group. This is the first study of its kind demonstrating a significant difference of defined factors in tears from patients with neovascularized corneas as compared to healthy controls. These results provide the basis for future research using animal models to further substantiate the role of these cytokines in the establishment and maintenance of corneal neovascularization.

  16. Human Tears Reveal Insights into Corneal Neovascularization

    PubMed Central

    Wouters, Kristien; Rozema, Jos; Koppen, Carina; Lion, Eva; Cools, Nathalie; Berneman, Zwi; Tassignon, Marie-José

    2012-01-01

    Corneal neovascularization results from the encroachment of blood vessels from the surrounding conjunctiva onto the normally avascular cornea. The aim of this study is to identify factors in human tears that are involved in development and/or maintenance of corneal neovascularization in humans. This could allow development of diagnostic tools for monitoring corneal neovascularization and combination monoclonal antibody therapies for its treatment. In an observational case-control study we enrolled a total of 12 patients with corneal neovascularization and 10 healthy volunteers. Basal tears along with reflex tears from the inferior fornix, superior fornix and using a corneal bath were collected along with blood serum samples. From all patients, ocular surface photographs were taken. Concentrations of the pro-angiogenic cytokines interleukin (IL)-6, IL-8, Vascular Endothelial Growth Factor (VEGF), Monocyte Chemoattractant Protein 1 (MCP-1) and Fas Ligand (FasL) were determined in blood and tear samples using a flow cytometric multiplex assay. Our results show that the concentration of pro-angiogenic cytokines in human tears are significantly higher compared to their concentrations in serum, with highest levels found in basal tears. Interestingly, we could detect a significantly higher concentration of IL- 6, IL-8 and VEGF in localized corneal tears of patients with neovascularized corneas when compared to the control group. This is the first study of its kind demonstrating a significant difference of defined factors in tears from patients with neovascularized corneas as compared to healthy controls. These results provide the basis for future research using animal models to further substantiate the role of these cytokines in the establishment and maintenance of corneal neovascularization. PMID:22590547

  17. Rotator cuff tear and sarcopenia: are these related?

    PubMed

    Chung, Seok Won; Yoon, Jong Pil; Oh, Kyung-Soo; Kim, Hyung Sup; Kim, Young Gun; Lee, Hyun-Joo; Jeong, Won-Ju; Kim, Dong-Hyun; Lee, Jong Soo; Yoon, Jee Wook

    2016-09-01

    Sarcopenia is the loss of muscle mass and consequent loss of muscle function with aging. Its prevalence among the general population is 12% to 30% in those aged >60 years. We evaluated (1) the difference in the prevalence of sarcopenia between patients with rotator cuff tear and controls and (2) the sarcopenia severity according to the size of the rotator cuff tear. Group 1 included 48 consecutive patients with chronic symptomatic full-thickness rotator cuff tears (mean age, 60.1 ± 6.5 years; range, 46-76 years), and group 2 included 48 age- and sex-matched patients. The sarcopenic index was evaluated by using the grip strength of the asymptomatic contralateral side and the skeletal muscle mass. No significant differences were found in the baseline data and demographic factors between the groups. The sarcopenic index was significantly inferior in the rotator cuff tear group than in the age- and sex-matched control groups (P = .041, .007, and .05, respectively). Patients with large to massive tears had a significantly inferior sarcopenic index than those with small and medium tears. The results showed that sarcopenia was more severe in patients with a chronic symptomatic full-thickness rotator cuff tear than in the age- and sex-matched control population and was correlated with the size of the tear, with the numbers available. Despite the individual variance in the underlying medical condition and physical activities, this study suggests that clinicians should consider the sarcopenic condition of patients with a rotator cuff tear, especially in elderly patients with large to massive tears. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  18. Failure strength of a new meniscus arrow repair technique: biomechanical comparison with horizontal suture.

    PubMed

    Albrecht-Olsen, P; Lind, T; Kristensen, G; Falkenberg, B

    1997-04-01

    A new method for arthroscopic all-inside repair of vertical meniscus lesions by use of a biodegradable fixation device ("meniscus arrow") has been developed, including a set of cannulas for easy insertion via standard arthroscopic portals. The technique is described. A study to test the fixation properties was performed in the laboratory. Twenty-four fresh frozen bovine medial menisci were defreezed and divided into three groups. In all menisci an artificial vertical lesion was created with a scalpel 3mm from the peripheral rim. Repair in group I was done with a single horizontal Maxon-O suture using an Acufex double-barrel cannula (Acufex Meniscal Stitcher; Acufex Microsurgical, Norwood, MA). A knot was tied on the capsular side. Repair in group II was made with one 13 mm Biofix Meniscus arrow (Bioscience Ltd, Tampere, Finland). In group III repair was performed like in group II but the menisci were incubated in isotonic saline at 21 degrees C for 24 hours before testing. Menisci in group I and II were tested within 3 hours after defreezing. Prior to testing total separation of central and peripheral part of meniscus was performed. Thus only the repair site was tested. Pull-out tests to failure were made in a computer-based Nene M5 testing machine with a cross-head speed of 5 mm/min. Median failure load in group I: 49 N (range 43 to 77 N), in group II: 53 N (range 42 to 65 N) and in group III: 54 N (range 35 to 74 N). No statistically significant differences in failure load was found between the groups. Thus initial failure strength for arrow-repaired bovine menisci is comparable to that of a horizontal suture.

  19. Polyimide Film of Increased Tear Strength

    NASA Technical Reports Server (NTRS)

    St. Clair, A. K.; Hinkley, J. A.; Ezzell, S. A.

    1986-01-01

    High-temperature linear aromatic polyimide with improved resistance to tearing made by new process that incorporates elastomer into polyimide. Linear aromatic condensation polyimides are materials of prime choice for use as films and coatings on advanced spacecraft and aircraft where durability at temperatures in range of 200 to 300 degree C required. Elastomer-containing polyimide film with improved toughness proves useful for applications where resistance to tearing and long-term thermal stability necessary. Desired resistance to tearing achieved by careful control of amount and chemical composition of added elastomer.

  20. Age-related changes in the signal value of tears.

    PubMed

    Zeifman, Debra M; Brown, Sarah A

    2011-08-12

    Emotional tears may be uniquely human and are an effective signal of distress in adults. The present study explored whether tears signal distress in younger criers and whether the effect of tears on observers is similar in magnitude across the life span. Participants rated photographs of crying infants, young children, and adults, with tears digitally removed or added. The effectiveness of tears in conveying sadness and eliciting sympathy was greatest for images of adults, intermediate for images of children, and least potent for images of infants. These findings suggest that the signal value of tears varies with the age of the crier. The results may shed light on the functional significance of crying at different stages of human development.

  1. Neurostimulation of the Lacrimal Nerve for Enhanced Tear Production

    PubMed Central

    Kossler, Andrea L.; Wang, Jianhua; Feuer, William; Tse, David T.

    2014-01-01

    Purpose To design a proof-of-concept study to assess the effect of lacrimal nerve stimulation (LNS) with an implantable pulse generator (IPG) to increase aqueous tear production. Methods Experimental animal study design of six Dutch Belted rabbits. Ultra high-resolution optical coherence tomography (UHR-OCT) quantified tear production by measuring the baseline tear volume of each rabbit’s right and left eye. A neurostimulator was implanted adjacent to the right lacrimal nerve. After two minutes of LNS (100 μs, 1.6 mAmp, 20 Hz, 5–8 volts), the tear volumes were measured with UHR-OCT. The change in tear volume was quantified and compared to the non-stimulated left eye. Three rabbits underwent chronic LNS (100 μS, 1.6 mAmp, 10 Hz, 2 volts) and their lacrimal glands were harvested for histopathologic analysis. Results UHR-OCT imaging of the right eyes tear volume showed a 441% average increase in tear production after LNS as a percent of baseline. After stimulation, right eyes had statistically significant greater increase in tear volumes than left eyes (p=0.028, Wilcoxon test). Post-stimulation right eye tear volumes were significantly greater compared to baseline (p=0.028, Wilcoxon test). Histopathologic examination of the lacrimal glands showed no discernible tissue damage from chronic neurostimulation. Additionally, there were no gross adverse effects on the general well-beings of the animals due to chronic stimulation. Conclusions Lacrimal nerve stimulation with an implantable pulse generator appears to increase aqueous tear production. Chronic LNS showed no histopathologic lacrimal gland damage. This study suggests LNS is a promising new treatment strategy to increase aqueous tear production. PMID:25126767

  2. Cartilage Delamination Flap Mimicking a Torn Medial Meniscus

    PubMed Central

    Bin Abd Razak, Hamid Rahmatullah; Amit Kanta, Mitra

    2016-01-01

    We report a case of a chondral delamination lesion due to medial parapatellar plica friction syndrome involving the medial femoral condyle. This mimicked a torn medial meniscus in clinical and radiological presentation. Arthroscopy revealed a chondral delamination flap, which was debrided. Diagnosis of chondral lesions in the knee can be challenging. Clinical examination and MRI have good accuracy for diagnosis and should be used in tandem. Early diagnosis and treatment of chondral lesions are important to prevent progression to early osteoarthritis. PMID:28070434

  3. Duplex Tear Film Evaporation Analysis.

    PubMed

    Stapf, M R; Braun, R J; King-Smith, P E

    2017-12-01

    Tear film thinning, hyperosmolarity, and breakup can cause irritation and damage to the human eye, and these form an area of active investigation for dry eye syndrome research. Recent research demonstrates that deficiencies in the lipid layer may cause locally increased evaporation, inducing conditions for breakup. In this paper, we explore the conditions for tear film breakup by considering a model for tear film dynamics with two mobile fluid layers, the aqueous and lipid layers. In addition, we include the effects of osmosis, evaporation as modified by the lipid, and the polar portion of the lipid layer. We solve the system numerically for reasonable parameter values and initial conditions and analyze how shifts in these cause changes to the system's dynamics.

  4. Meniscus maturation in the swine model: changes occurring along with anterior to posterior and medial to lateral aspect during growth

    PubMed Central

    Di Giancamillo, Alessia; Deponti, Daniela; Addis, Alessandro; Domeneghini, Cinzia; Peretti, Giuseppe M

    2014-01-01

    The meniscus plays important roles in knee function and mechanics and is characterized by a heterogeneous matrix composition. The changes in meniscus vascularization observed during growth suggest that the tissue-specific composition may be the result of a maturation process. This study has the aim to characterize the structural and biochemical variations that occur in the swine meniscus with age. To this purpose, menisci were collected from young and adult pigs and divided into different zones. In study 1, both lateral and medial menisci were divided into the anterior horn, the body and the posterior horn for the evaluation of glycosaminoglycans (GAGs), collagen 1 and 2 content. In study 2, the menisci were sectioned into the inner, the intermediate and the outer zones to determine the variations in the cell phenotype along with the inner–outer direction, through gene expression analysis. According to the results, the swine meniscus is characterized by an increasing enrichment in the cartilaginous component with age, with an increasing deposition in the anterior horn (GAGs and collagen 2; P < 0.01 both); moreover, this cartilaginous matrix strongly increases in the inner avascular and intermediate zone, as a consequence of a specific differentiation of meniscal cells towards a cartilaginous phenotype (collagen 2, P < 0.01). The obtained data add new information on the changes that accompany meniscus maturation, suggesting a specific response of meniscal cells to the regional mechanical stimuli in the knee joint. PMID:25216283

  5. Numerical simulation for meniscus shape and optical performance of a MEMS-based liquid micro-lens.

    PubMed

    Lee, Shong-Leih; Yang, Chao-Fu

    2008-11-24

    It is very difficult to fabricate tunable optical systems having an aperture below 1000 micrometers with the conventional means on macroscopic scale. Krogmann et al. (J. Opt. A 8, S330-S336, 2006) presented a MEMS-based tunable liquid micro-lens system with an aperture of 300 micrometers. The system exhibited a tuning range of back focal length between 2.3mm and infinity by using the electrowetting effect to change the contact angle of the meniscus shape on silicon with a voltage of 0-45 V. However, spherical aberration was found in their lens system. In the present study, a numerical simulation is performed for this same physical configuration by solving the Young-Laplace equation on the interface of the lens liquid and the surrounding liquid. The resulting meniscus shape produces a back focal length that agrees with the experimental observation excellently. To eliminate the spherical aberration, an electric field is applied on the lens. The electric field alters the Young-Laplace equation and thus changes the meniscus shape and the lens quality. The numerical result shows that the spherical aberration of the lens can be essentially eliminated when a proper electric field is applied.

  6. Sphincter tears in primiparous women: Is age a factor?

    PubMed Central

    BOWLING, C. Bryce; WHEELER, Thomas L.; GERTEN, Kimberly A.; CHAPMAN, Victoria R.; BURGIO, Kathryn L.; RICHTER, Holly E.

    2011-01-01

    Introduction and Hypothesis Anal sphincter tears during vaginal delivery may result in serious sequelae. We examined whether younger primiparous patients were at increased risk for sphincter tears during vaginal delivery. Methods Data from an obstetric automated record were analyzed. Primiparous women delivering term infants (n = 5,937) were included to test for an association between age and sphincter tear rates. Three age groups were considered: young adolescents (≤16 years), older adolescents (17-20 years) and adults (≥21 years). Results No significant difference was found in tear rates among age cohorts (9.2%, 8.0%, and 9.6% respectively; p = 0.12). Logistic regression modeling revealed that young adolescents were not more likely to have sphincter tears compared to older cohorts. Conclusions Younger adolescents may not be at increased risk of anal sphincter tears. Decisions regarding interventions to decrease sphincter tears during vaginal delivery should not be made on the basis of maternal age alone. PMID:18985267

  7. Saturated fatty acid palmitate negatively regulates autophagy by promoting ATG5 protein degradation in meniscus cells.

    PubMed

    Mallik, Aritra; Yammani, Raghunatha R

    2018-07-20

    Obesity and associated metabolic factors are major risk factors for the development of osteoarthritis. Previously, we have shown that the free fatty acid palmitate induces endoplasmic reticulum (ER) stress and induces apoptosis in meniscus cells. However, the molecular mechanisms involved in these effects are not clearly understood. In our current study, we found that palmitate inhibits autophagy by modulating the protein levels of autophagy-related genes-5 (ATG5) that is associated with decreased lipidation of LC3 and increased activation of cleaved caspase 3. Pretreatment of meniscus cells with 4-phenyl butyric acid, a small molecule chemical chaperone that alleviates ER stress, or with MG-132, a proteasome inhibitor, restored normal levels of ATG5 and autophagosome formation, and decreased expression of cleaved caspase 3. Thus, our data suggest that palmitate downregulates autophagy in meniscus cells by degrading ATG5 protein via ER-associated protein degradation, and thus promotes apoptosis. This is the first study to demonstrate that palmitate-induced endoplasmic reticulum stress negatively regulates autophagy. Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

  8. What tissue bankers should know about the use of allograft meniscus in orthopaedics.

    PubMed

    McDermott, Ian D

    2010-02-01

    The menisci of the knee are two crescent shaped cartilage shock absorbers sitting between the femur and the tibia, which act as load sharers and shock absorbers. Loss of a meniscus leads to a significant increase in the risk of developing arthritis in the knee. Replacement of a missing meniscus with allograft tissue can reduce symptoms and may potentially reduce the risk of future arthritis. Meniscal allograft transplantation is a complex surgical procedure with many outstanding issues, including 'what techniques should be used for processing and storing grafts?', 'how should the allografts be sized?' and 'what surgical implantation techniques might be most appropriate?' Further clinical research is needed and close collaboration between the users (surgeons) and the suppliers (tissue banks) is essential. This review explores the above subject in detail.

  9. Diet, nutraceuticals and the tear film.

    PubMed

    Jalbert, Isabelle

    2013-12-01

    Nutrition disorders and their correlates such as obesity are increasingly prevalent worldwide. A number of studies to date have suggested numerous potential associations between diet and tear film health; this paper will provide a summary of the available literature. The tear film is characterized through its protein and lipid content and through clinical measurements of characteristics such as osmolarity, volume and stability. Malnutrition, protein and vitamin-A deficiencies are extremely deleterious to tear film health and supplementation with oral vitamin A in this setting is of clear benefit. The relative impact of diet on tear film within what would be considered normal ranges of consumption is less clear. A number of population studies have suggested that hyperlipidemia and a diet low in omega-3 fatty acids are risks factor for dry eye disease. Numerous studies have investigated the effectiveness of oral supplementation with antioxidants, omega-3 (e.g. fish oil and linseed oil) and omega-6 (e.g. evening primrose oil) fatty acids in the last 10 years. Taken together, these suggest a small benefit of oral supplementation on tear film volume, stability and decreased ocular symptoms in patients previously diagnosed with diseases involving the ocular surface (e.g. Sjögren's syndrome, meibomian gland dysfunction, dry eye disease) and contact lens wearers suffering from dry eye. More research is required to determine the exact composition, dosage and indications for their use and to fully characterize how these nutraceuticals modulate the tear film. Copyright © 2013 Elsevier Ltd. All rights reserved.

  10. Effects of tip-substrate gap, deposition temperature, holding time, and pull-off velocity on dip-pen lithography investigated using molecular dynamics simulation

    NASA Astrophysics Data System (ADS)

    Wu, Cheng-Da; Fang, Te-Hua; Lin, Jen-Fin

    2012-05-01

    The process parameters in the dip-pen nanolithography process, including tip-substrate gap, deposition temperature, holding time, and pull-off velocity are evaluated in terms of the mechanism of molecular transference, alkanethiol meniscus characteristic, surface adsorbed energy, and pattern formation using molecular dynamics simulations. The simulation results clearly show that the optimum deposition occurs at a smaller tip-substrate gap, a slower pull-off velocity, a higher temperature, and a longer holding time. The pattern area increases with decreasing tip-substrate gap and increasing deposition temperature and holding time. With an increase in deposition temperature, the molecular transfer ability significantly increases. Pattern height is a function of meniscus length. When the pull-off velocity is decreased, the pattern height increases. The height of the neck in meniscus decreases and the neck width increases with holding time. Meniscus size increases with increasing deposition temperature and holding time.

  11. Effects of tear film dynamics on quality of vision.

    PubMed

    Koh, Shizuka; Tung, Cynthia I; Inoue, Yasushi; Jhanji, Vishal

    2018-06-15

    The precorneal tear film is maintained by blinking and exhibits different phases in the tear cycle. The tear film serves as the most anterior surface of the eye and plays an important role as a first refractive component of the eye. Alterations in tear film dynamics may cause both vision-related and ocular surface-related symptoms. Although the optical quality associated with the tear film dynamics previously received little attention, objective measurements of optical quality using wavefront sensors have enabled us to quantify optical aberrations induced by the tear film. This has provided an objective method for assessing reduced optical quality in dry eye; thus, visual disturbances were included in the definition of dry eye disease in the 2007 Dry Eye Workshop report. In addition, sequential measurements of wavefront aberrations have provided us with valuable insights into the dynamic optical changes associated with tear film dynamics. This review will focus on the current knowledge of the mechanisms of wavefront variations that are caused by different aspects of tear film dynamics: specifically, quality, quantity and properties of the tear film, demonstrating the respective effects of dry eye, epiphora and instillation of eye drops on the quality of vision. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  12. Lipid peroxidation is increased in tears from the elderly.

    PubMed

    Benlloch-Navarro, Soledad; Franco, Ilenia; Sánchez-Vallejo, Violeta; Silvestre, Dolores; Romero, Francisco Javier; Miranda, María

    2013-10-01

    We describe a procedure in which tears, obtained from Schirmer strips, are used to measure a marker of lipid peroxidation, malondialdehyde (MDA). We also compared the levels of proteins and MDA in tears from two groups of people: young adults (18-30 years old) and elderly adults (65-85 years old), because the data related to total protein concentration of human tears vary widely and because the majority of people over the age of 65 experience some symptoms of dry eyes and this condition has been recognized as an oxidative stress-induced disease. Our results show a significant difference in the protein concentration of the tears taken from the two age categories, younger adults (18-30 years old) and older adults (65-85 years old). Herein, we report for the first time an increase in MDA concentrations determined by HPLC in human tears based on age. It is possible that alterations in the tear lipid layer may lead to an increase in lipid peroxidation. Further studies are needed to understand the nature and function of tear film and stability in order to obtain new methods to analyze tears in patients with different diseases. In this sense, it would be interesting to compare MDA concentration in tears from control subjects and from people with meibomian gland dysfunction. Copyright © 2013 Elsevier Ltd. All rights reserved.

  13. Relationship of ABO Blood Type on Rotator Cuff Tears.

    PubMed

    Lee, Doo-Hyung; Lee, Han-Dong; Yoon, Seung-Hyun

    2015-11-01

    ABO blood groups are associated with various diseases. A relationship between Achilles tendon ruptures and blood type O has been reported, although its pathogenesis was not clear. To the best of our knowledge, there is no published study describing the relationship between blood type and rotator cuff tendon tears. To determine whether patients with rotator cuff tear had a greater prevalence of blood type O than those without rotator cuff tear. A cross-sectional study. Research hospital outpatient evaluation. A total of 316 subjects with shoulder pain were included and divided into "tear" and "no-tear" groups according to ultrasonographic examination. ABO blood group, gender, dominant arm, smoking history, trauma history, and age were compared between the 2 groups and the odds ratios of these factors were evaluated by logistic regression. The tear group (38.6%) had more instances of blood type O than the healthy population (27.2%; P = .002). The adjusted odds ratio for rotator cuff tear for blood type O to non-O was 2.38 (95% confidence interval 1.28-4.42). The odds ratios for rotator cuff tears for smoking, major trauma history, minor trauma history, and age were 2.08, 3.11, 2.29, and 1.06, respectively. Patients with rotator cuff tears were more likely to have blood type O. The odds ratios of factors for rotator cuff tears were high in the following order: major trauma history, blood type O, minor trauma history, and age. Copyright © 2015 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

  14. Effect of Ambient Temperature on the Human Tear Film.

    PubMed

    Abusharha, Ali A; Pearce, E Ian; Fagehi, Raied

    2016-09-01

    During everyday life, the tear film is exposed to a wide range of ambient temperatures. This study aims to investigate the effect of ambient temperature on tear film physiology. A controlled environment chamber was used to create different ambient temperatures (5, 10, 15, 20, and 25°C) at a constant relative humidity of 40%. Subjects attended for two separate visits and were exposed to 25, 20, and 15°C at one visit and to 10 and 5°C at the other visit. The subjects were exposed to each room temperature for 10 min before investigating tear film parameters. The order of the visits was random. Tear physiology parameters assessed were tear evaporation rate, noninvasive tear break-up time (NITBUT), lipid layer thickness (LLT), and ocular surface temperature (OST). Each parameter was assessed under each condition. A threefold increase in tear evaporation rate was observed as ambient temperature increased to 25°C (P=0.00). The mean evaporation rate increased from 0.056 μL/min at 5°C to 0.17 μL/min at 25°C. The mean NITBUT increased from 7.31 sec at 5°C to 12.35 sec at 25°C (P=0.01). A significant change in LLT was also observed (P=0.00), LLT median ranged between 20 and 40 nm at 5 and 10°C and increased to 40 and 90 nm at 15, 20, and 25°C. Mean reduction of 4°C OST was observed as ambient temperature decreased from 25 to 5°C. Ambient temperature has a considerable effect on human tear film characteristics. Tear evaporation rate, tear LLT, tear stability, and OST were considerably affected by ambient temperature. Chronic exposure to low ambient temperature would likely result in symptoms of dry eye and ultimately ocular surface disorders.

  15. Protruding anterior medial meniscus-An indirect sign of posterior cruciate ligament deficiency.

    PubMed

    Parkar, Anagha P; Bleskestad, Kristiane; Løken, Susanne; Adriaensen, Miraude E A P M; Solheim, Eirik

    2018-02-01

    to examine if PROTruding of the Anterior Medial Meniscus (PROTAMM) could be an indirect sign of PCL deficiency by comparing PROTAMM to passive posterior tibial sagging (PSS) for chronic PCL rupture on routine MRI. Patients with PCL reconstruction between 2011 and 2016 were included in a case control study. Primarily cases with combined ACL/PCL injury were excluded. Secondary exclusion criteria were bony fractures, medial meniscus pathology and poor quality MRIs. Three (blinded) observers reviewed the pre-operative MRIs according to a pre-defined protocol. After applying the inclusion and primary exclusion criteria 16 patients were identified in the PCL rupture group. The control group consisted of 15 patients. After reviewing the MRIs, 6 were excluded due to secondary exclusion criteria. Mean PPS measured 4.8 mm (± 4.4 mm) in the PCL rupture group and 1.8 mm (±2.9 mm) in the control group, p = 0.05. Mean PROTAMM was 3.6 mm (±0.6 mm) in the PCL rupture group and 0.7 mm (±0.9 mm) in the control group, p = 0.004. We found a mean PROTAMM of 3.6 mm in patients with PCL rupture. We suggest that this sign, after knee injury in an otherwise normal medial meniscus, is a promising indirect sign of PCL deficiency compared to PPS. Implementation of this sign in clinical practice may improve the sensitivity of routine non-weight bearing MRI in identifying PCL deficient knees. Copyright © 2018 Elsevier B.V. All rights reserved.

  16. Tear dysfunction and the cornea: LXVIII Edward Jackson Memorial Lecture.

    PubMed

    Pflugfelder, Stephen C

    2011-12-01

    To describe the cause and consequence of tear dysfunction-related corneal disease. Perspective on effects of tear dysfunction on the cornea. Evidence is presented on the effects of tear dysfunction on corneal morphology, function, and health, as well as efficacy of therapies for tear dysfunction-related corneal disease. Tear dysfunction is a prevalent eye disease and the most frequent cause for superficial corneal epithelial disease that results in corneal barrier disruption, an irregular optical surface, light scattering, optical aberrations, and exposure and sensitization of pain-sensing nerve endings (nociceptors). Tear dysfunction-related corneal disease causes irritation and visual symptoms such as photophobia and blurred and fluctuating vision that may decrease quality of life. Dysfunction of 1 or more components of the lacrimal functional unit results in changes in tear composition, including elevated osmolarity and increased concentrations of matrix metalloproteinases, inflammatory cytokines, and chemokines. These tear compositional changes promote disruption of tight junctions, alter differentiation, and accelerate death of corneal epithelial cells. Corneal epithelial disease resulting from tear dysfunction causes eye irritation and decreases visual function. Clinical and basic research has improved understanding of the pathogenesis of tear dysfunction-related corneal epithelial disease, as well as treatment outcomes. Copyright © 2011 Elsevier Inc. All rights reserved.

  17. Immunoglobulin Concentration in Tears of Contact Lens Wearers

    PubMed Central

    Maurya, Rajendra P.; Bhushan, Prashant; Singh, Virendra P.; Singh, Mahendra K.; Kumar, Prakash; Bhatia, Ravindra P.S.; Singh, Usha

    2014-01-01

    Purpose: To evaluate changes in the concentration of tear immunoglobulins in contact lens wearers. Methods: A total of 45 cases including 23 contact lens wearers (43 eyes) and 22 age and sex matched healthy controls having no ocular pathology were studied for immunoglobulins (IgA, IgG, IgM) in their tears by single radial immunodiffusion method. Results: Most of the cases used soft (56.6%) and semi-soft gas permeable (30.4%) contact lenses. Tear IgM was detected in only 17.4% and tear IgG in 43.6% of contact lens wearers, while in controls IgG was detected in 9.1% but none of the controls had IgM. There was a significant rise in total tear IgA (13.17 ± 4.44 mg/dl) in contact lens wearer as compared to controls (8.93 ± 3.79 mg/dl). Rise of tear IgA was more in symptomatic patients (15.38 ± 5.28 mg/dl) and in those wearing hard (19.73 ± 5.43 mg/dl) and semi-soft contact lenses (13.31 ± 5.43 mg/dl). A significant increase in tear IgA was noticed in subjects wearing lenses for >3 years (15.69 ± 5.39 mg/dl). About 43.4% of lens wearers were symptomatic and 80% of their lenses showed deposits and/or haziness. All cases with IgM in tear were symptomatic. Conclusion: The relation of immunoglobulin concentration with increasing duration of wear and material of contact lens shows that tear immunoglobulin rise accrues due to mechanical stimulation, hence contact lenses should not be used for a long period and lenses of hard nature should be discouraged. The maintenance, cleaning and deproteinization of the lenses are of high importance to avoid immunostimulation. PMID:25667732

  18. Tearfulness: a psychoanalytic interpretation.

    PubMed

    Wood, E C; Wood, C D

    1984-01-01

    In our view, the tearful feeling state is occasioned by the ego temporarily threatened with being inundated by complex memories and affects. For the moment, the ego cannot provide appropriate satisfying and integrated verbal expression. Words and verbal thinking are delayed. In this brief period, a controlled regression occurs during which the ego relates the current "precipitating experience" to temporally older conflictual experiences in the presence of the current object as a transference object and with a series of relationships so closely connected to that experience that they are interchanged in whole or part by the less selective, regressed, ego operations. The conscious experience may be sadness, gratitude, love, pride, or joy. But beneath these, there is the controlled regression, which interrupts verbal expression while the ego works through the earlier related conflicts,now remembered. The tearful feeling, a step in the direction of overt weeping, primitively expresses the frustration of an early wish for relief from pain, the pain of the imbalance of a complex conflict. The tearful feeling both expresses the wish for relief of pain and, at the same time, interrupts current verbal expression until the needed defense operations reduce the threat of ego disruption by working through old conflicts once again. Our thesis, then, is that within the analytic or psychotherapeutic hour the patient's feeling of tearfulness is a "too much" ego phenomenon that leads to a psychophysiological outlet.

  19. Towards Multiscale Interactions Between Tearing Modes and Microturbulence

    NASA Astrophysics Data System (ADS)

    Williams, Z. R.; Pueschel, M. J.; Terry, P. W.

    2017-10-01

    Work on the Madison Symmetric Torus Reversed-Field Pinch (RFP) has shown that large-scale tearing modes present in standard operation are highly detrimental to confinement. These tearing modes, even when reduced in improved confinement regimes of operation, significantly affect zonal flow activity and play a large role in setting microturbulent-induced transport levels. Previous gyrokinetic work has shown that a small but finite tearing fluctuation amplitude is necessary to produce transport values in agreement with experimental observation. This has previously been implemented via an ad-hoc, constant-in-time A∥ perturbation. This work details self-consistent modeling of tearing fluctuations in the RFP using the Gene code via the inclusion of a current gradient drive incorporated into the background distribution function. Tearing mode growth rates calculated from gyrokinetic simulations are benchmarked with results from fluid theory. Additionally, first results from multiscale Gene simulations describing tearing mode interactions with RFP microturbulence are presented. This work is supported by the U.S. Department of Energy, Grant No. DE-FG02-85ER-53121.

  20. Comparison of Medpor coated tear drainage tube versus silicon tear drainage tube in conjunctivodacryocystorhinostomy: problems and solutions.

    PubMed

    Sendul, Selam Yekta; Cagatay, Halil Huseyin; Dirim, Burcu; Demir, Mehmet; Yıldız, Ali Atakhan; Acar, Zeynep; Cinar, Sonmez; Guven, Dilek

    2014-01-01

    This study aims at comparing two different types of drainage tubes in conjunctivodacryocystorhinostomy, which are used for upper lacrimal system obstruction or damage, with respect to their respective postoperative problems and solutions. Nineteen eyes of 17 patients who underwent conjunctivodacryocystorhinostomy (CDCR) or conjunctivorhinostomy (CR) surgery with a Medpor coated tear drainage tube or silicon tube placement between October, 2010, and February, 2014, were included in this retrospective comparative study. In the initial surgery, Medpor coated tear drainage tubes were used in 11 eyes by CDCR, whereas silicon tear drainage tubes were implanted into 2 eyes by CR and 6 eyes by CDCR. In group 1, proximal and distal obstructions developed postoperatively in 4 eyes, while 1 eye showed tube malposition and 3 eyes developed luminal obstruction by debris 3 times. In group 2, tube extrusion developed in 4 eyes, whereas tube malposition developed in 6 eyes and luminal obstruction by debris developed in 6 eyes at different times, for a total of 20 times. In our study, the most significant complication we observed in the use of silicon tear drainage tubes was tube extrusion,whereas the leading complication related to the use of Medpor coated tear drainage tubes was tube obstruction.