Editorial Commentary: False-Positive Meniscus Pseudotear on Magnetic Resonance Imaging: A False Sign That Rings True.

The false-positive finding of anterior horn meniscus (pseudo)tear on magnetic resonance imaging (MRI) is an important finding of which to be aware. We have recently seen awareness similarly raised regarding root tears of the meniscus, which, if overlooked, could have detrimental consequences. Manifestations of the MRI finding of meniscus pseudotear arise from the variability of the insertion of the transverse geniculate ligament into the anterior horn of the lateral meniscus.

Meniscus Tear Management: Indications, Technique, and Outcomes.

Meniscus tears are commonly encountered in the clinical and operative setting and vary in presentation, including bucket-handle, radial, and horizontal cleavage tears. Historically, tears were treated with benign neglect or partial meniscectomy. However, a great deal of subsequent research has highlighted the biomechanical consequences of tears and meniscectomy, including increased peak local contact forces, progressive postmeniscectomy arthritis, and subsequent arthroplasty.

Editorial Commentary: A Stitch in Time May Save the Meniscus…but Not the Articular Cartilage?

Early-generation meniscal fixators sometimes caused iatrogenic articular cartilage damage. This resulted in injury to the very structure one tries to preserve when repairing a meniscal tear. Advances in suture-based meniscal implants and all-inside suture devices have allowed us to safely repair meniscal tears, even ones thought previously irreparable, and without the need for a secondary incision.

Meniscus Repair and Replacement.

The importance of preserving the function of the meniscus is seen with renewed interest. There has been an evolution of arthroscopic meniscus repair from inside-out, outside-in, meniscal fixators, to all-inside suturing techniques. Tear patterns once ignored or thought to be irreparable, such as root tears and horizontal cleavage tears, have recently been undergoing repair with promising results.

Meniscus Root Repair vs Meniscectomy or Nonoperative Management to Prevent Knee Osteoarthritis After Medial Meniscus Root Tears: Clinical and Economic Effectiveness.

Background: Medial meniscus root tears are a common knee injury and can lead to accelerated osteoarthritis, which might ultimately result in a total knee replacement.

Purpose: To compare meniscus repair, meniscectomy, and nonoperative treatment approaches among middle-aged patients in terms of osteoarthritis development, total knee replacement rates (clinical effectiveness), and cost-effectiveness.

Study Design: Meta-analysis and cost-effectiveness analysis.

Editorial Commentary: Should I Order Prophylactic Antibiotics for My Next Knee Scope?

Postoperative infections are going to happen. The question of whether prophylactic antibiotics can lower the infection rate in routine knee arthroscopy is investigated. Although a large number of cases were included in the study, the results did not reach statistical significance.

Clinical Application of Scaffolds for Partial Meniscus Replacement.

Meniscal tears are common injuries often treated by partial meniscectomy. This may result in altered joint contact mechanics which in turn may lead to worsening symptoms and an increased risk of osteoarthritis. Meniscal scaffolds have been proposed as a treatment option aimed at reducing symptoms while also potentially reducing progression of degenerative change.

Physical examination and imaging of medial collateral ligament and posteromedial corner of the knee.

The medial collateral ligament (MCL) is the most commonly injured knee ligament. Most will heal well with nonoperative treatment. However, not all medial knee injuries are the same.

Repair of horizontal meniscus tears: a systematic review.

Purpose: Despite the well-documented advantages of meniscal repair over meniscectomy, horizontal cleavage tears (HCTs) are often not repaired. Reported reasons include difficulty performing the repair, potential suture failure due to mechanical stresses, and poor healing rates. In addition, many surgeons have the perception that debriding the tear until the superior and inferior laminae are stable results in a good clinical outcome.

Anterior cruciate ligament reconstruction with Achilles tendon allografts in revisions and in patients older than 30.

We evaluated the results of anterior cruciate ligament (ACL) reconstruction using an Achilles tendon allograft in revisions and in patients older than 30. Results from 23 consecutive patients (mean age, 43 years) who underwent ACL reconstruction with fresh-frozen, irradiated (22/23) Achilles allografts were retrospectively reviewed. Seven cases were revisions.

Magnetic resonance imaging appearance of the shoulder after subacromial injection with corticosteroids can mimic a rotator cuff tear.

Subacromial injections have been used to treat rotator cuff problems. Previous studies have noted the difficulty in performing accurate injections into this area. In addition, one must also question the effects that misplaced corticosteroids could have on the surrounding tissues.

Physical examination and imaging of the medial collateral ligament and posteromedial corner of the knee.

The medial side is one of the most commonly injured areas of the knee. The anatomy, diagnosis, and treatment of medial collateral ligament and posteromedial corner (PMC) injuries can be challenging. Understanding the mechanism of injury and performing a thorough physical examination and radiographic evaluation is essential.

Antibiotic prophylaxis for arthroscopic surgery.

Because the incidence of infection in arthroscopic surgery is very low, one can argue both for and against the use of prophylactic antibiotics. Administering antibiotics adds expense and introduces the potential for both exposure to allergic reactions and selection of resistant organisms. Antibiotics are given to prevent deep infection; such treatment may require further surgery, prolonged use of intravenous antibiotics, high costs, and outcomes that may be less than satisfactory.

Unsatisfactory clinical results of meniscal repair using the meniscus arrow.

Purpose: The all-inside technique using the Meniscus Arrow (Bionx Implants, Malvern, PA) has become a popular method for repairing meniscal tears. The few published clinical studies have been promising. The present study, with longer follow-up and larger numbers, does not show encouraging results.

Electromyographic evaluation after primary repair of massive rotator cuff tears.

Anatomic dissections have suggested that mobilization of the supraspinatus and infraspinatus tendons greater than 1 cm may cause suprascapular nerve injury. This study evaluated rotator cuff function by use of electromyographic (EMG) analysis after primary repair of massive tears in 9 patients. All subjects had massive rotator cuff tears involving at least the entire supraspinatus and entire infraspinatus tendons.

Restoring articular cartilage in the knee.

Following damage or injury, as well as normal wear and tear, articular cartilage in adults has limited healing potential. Repair of cartilage is dependent on the extent and depth of the injury, its location, and the surviving chondrocytes and extracellular matrix. The ultimate goal of cartilage repair is to restore the normal composition and matrix of the cartilage, but for most patients this is not feasible.

Intra-articular hyaluronans in knee osteoarthritis: rationale and practical considerations.

Intra-articular hyaluronans are used to treat pain associated with osteoarthritis of the knee. Many controlled clinical studies have demonstrated their efficacy for this indication. The rationale for the use of hyaluronans therapeutically is based on observations that hyaluronic acid is an important component of the synovial fluid acting as a cushion and lubricant for the joint and also serving as a major component of the extracellular matrix of the cartilage, helping to enhance the ability of cartilage to resist shear and maintain a resiliency to compression.