As you can guess, my focus has transitioned slightly from this blog over the last few months to some external projects and case reports. I apologize for the lull in content – although not to worry – the sprint-like pace is returning. Thus the need to catch up on some friendly reading, and ski a few more times to stress my meniscal limits. Fortunately, coming up in mid January I jump back onto lower extremity disorders. Yes, I have had a cancel today and catching up on the blog world some interesting trends are: empathy, and meniscal research seems to have some heat behind it. In preparation for the upcoming coursework – why not empathetically talk about the meniscus.
Meniscus – I know how you feel, it’s the holidays – we have all taken a beating. I apologize that the extra 45 cookies I ate probably placed increased pressure on your already strained life. Empathy is a fantastic topic, but has been re-capped very well by the following blog: http://abetternhs.wordpress.com/2013/12/20/empathy/. I will leave that up to them, and we can chat a few common questions with recent literature in regards to the meniscus. This ones gong to be quick folks – and keep in mind – a few cancellations is not enough time for a full literature review.
What are the outcomes of a meniscal tear or repair?
- REPAIR OUTCOMES: Pujol et al (10 month follow up)1
- IKDC scores good in 92% cases
- 23 patients no signs of OA at 10 months
- Initial healing rates did not significantly influence outcomes
- 60% of patients demonstrated complete healing
- 25% of partial healing
- 15% of failure, only 12% required follow up menisectomy
- REPAIR OUTCOMES: Lyman et al:2
- 8.9% frequency of subsequent meniscectomies at a median follow-up of 3 years after meniscal repair
- CONSERVATIVE OUTCOMES
- Rathleff et al: 58% were treated successfully by conservative treatment.
References:
- Pujol N, Tardy N, Boisrenoult P, Beaufils P. Long-Term Outcomes of All Inside Meniscal Repair. Knee Surgery Sports Traumatol Arhtrosc. 2013.
- Lyman, S., Hidaka, C., Valdez, A. S., Hetsroni, I., Pan, T. J., Do, H., … Marx, R. G. (2013). Risk factors for meniscectomy after meniscal repair. The American journal of sports medicine, 41(12), 2772–8. doi:10.1177/0363546513503444
- Camilla Rams Rathleff, Christian Cavallius, Hans Peter Jensen,Ole Højgaard Simonsen, Sten Rasmussen, Søren Kaalund, Svend Erik Østgaard. Successful conservative treatment of patients with MRI-verified meniscal lesions. Knee Surgery, Sports Traumatology, Arthroscopy. 2013.
Best post-operative protocol for meniscal repair?
- Nielsen et al:1
- The following two protocols were compared:
- No STATISTICAL difference noted in repair failure rates. Although, noted that at 1 year follow up 7% failure in free rehabilitation and 25% failure in restricted rehabilitation and at 2 year rates were 28 and 36% respectively.
- No statistical difference in KOOS scores
References:
- Lind, M., Nielsen, T., Faunø, P., Lund, B., & Christiansen, S. E. (2013). Free rehabilitation is safe after isolated meniscus repair: a prospective randomized trial comparing free with restricted rehabilitation regimens.The American journal of sports medicine, 41(12), 2753–8. doi:10.1177/0363546513505079
Is there any literature to state if I don’t get the menisectomy, that it will get worse?
- To the contrary….
- Cohen et al: There was significantly greater cartilage loss in patients post-meniscectomy at follow-up than in those who did not have meniscectomy. Cartilage loss was observed in 38% compared with 76% in patients with meniscectomy.
- To my knowledge no study discusses that if we don’t resect or repair the tissue that the tear worsens over time, intuitively this may make sense and may take a stab at this above statement.
Reference:
- Cohen SB, Short CP, O’Hagan T, Wu HT, Morrison WB, Zoga AC. The Effect of Meniscal Tears on Cartilage Loss of the Knee: Findings on Serial MRIs. Phys Sportsmed. 2012 Sep;40(3):66-76. doi: 10.3810/psm.2012.09.1983.
Original post: December 26, 2013