Search Results (27)

Background: This study evaluated time-dependent changes in anchor hole width (AHW) and their association with postoperative medial meniscus extrusion (MME) in patients undergoing open-wedge high tibial osteotomy (OWHTO) with medial meniscus posterior root tear (MMPRT) repair and meniscal centralization. Methods: Thirty knees treated with combined OWHTO and MMPRT repair using the centralization technique were retrospectively reviewed. MRI, CT, and second-look arthroscopy were performed preoperatively and postoperatively. AHW of the MMPRT anchor and two centralization anchors (midbody and midbody–posterior, M-anchor and MP-anchor) were measured on multiplanar reconstruction CT images at 1, 3, and 6 months, and 1 year, and their correlations with postoperative MME were analyzed. Results: AHW increased up to 3 months and gradually decreased with surrounding sclerosis by 1 year. The M-anchor showed significantly greater mediolateral (ML) expansion than the MP-anchor and demonstrated a moderate positive correlation between 1-year AHW and MME (r ≈ 0.5, p < 0.01). Second-look arthroscopy confirmed a 90% healing rate of the repaired root. Conclusions: Although OWHTO combined with MMPRT repair and centralization achieved favorable root healing, postoperative MME progression was not fully prevented. Time-dependent ML anchor hole expansion around the M-anchor may indicate persistent micromotion, elongation of the meniscotibial ligament, and degenerative stretch of the repaired meniscus following healing, suggesting that even after successful root healing, ML motion remains difficult to control, highlighting the need for biomechanically optimized fixation. Full article

Meniscal preservation is increasingly recognized as a critical determinant of long-term knee joint health, yet successful repair remains challenging due to the meniscus’s limited intrinsic healing capacity. The adult meniscus is characterized by restricted vascularity, low cellularity, a dense extracellular matrix, complex biomechanical loading, and a hostile post-injury intra-articular inflammatory environment—factors that collectively impair meniscus healing, particularly in the avascular zones. Over the past several decades, a wide range of biologic augmentation strategies have been explored to overcome these barriers, including synovial abrasion, fibrin clot implantation, marrow stimulation, platelet-derived biologics, cell-based therapies, scaffold coverage, and emerging biologic and biophysical interventions. This review summarizes the biological basis of meniscal healing, critically evaluates current and emerging biologic augmentation techniques, and integrates these approaches within a unified framework of vascular, cellular, matrix, biomechanical, and immunologic targets. Understanding and modulating the cellular and molecular mechanisms governing meniscal degeneration and repair may enable the development of more effective, mechanism-driven strategies to improve healing outcomes and reduce the risk of post-traumatic osteoarthritis. Full article

Background/Objectives: Meniscal root tears, particularly those of the posterolateral root, are frequently associated with anterior cruciate ligament (ACL) injuries and significantly alter load distribution and knee stability. Surgical repair of the posterolateral meniscal root (PLMR) aims to restore normal biomechanics; however, postoperative rehabilitation strategies remain heterogeneous. The objective of this systematic review was to describe and analyze postoperative weight-bearing (WB) and range-of-motion (ROM) protocols following concomitant PLMR repair and anterior cruciate ligament reconstruction (ACLR), integrating both clinical and biomechanical perspectives. Methods: This systematic review followed PRISMA guidelines and analyzed biomechanical and clinical studies assessing postoperative WB and ROM management following PLMR repair combined with ACLR. Results: Eleven studies were included, describing heterogeneous postoperative rehabilitation protocols for WB and ROM following posterolateral meniscal root repair with ACLR. Biomechanical data consistently showed that root section increased tibial internal rotation and contact pressure on the lateral tibial plateau, whereas repair restored near-native load sharing. Clinically, most authors recommended non-weight-bearing or toe-touch loading for 4–6 weeks and flexion limited to 0–90° during early rehabilitation. Gradual progression to full loading and motion between 8 and 12 weeks was the most consistent strategy. Conclusions: Although the current evidence is limited and mainly based on low-level studies, available data suggest that a cautious and progressive rehabilitation protocol after PLMR repair with ACLR early controlled motion and delayed full loading may optimize repair healing while protecting graft integrity. Full article

Background/Objectives: While arthroscopic repair is established for the treatment of medial meniscus posterior root tears (MMPRT), the relationship between physiotherapy (PT) exposure, meniscal extrusion (ME), and structural healing remains unclear. The aim of this study was to evaluate short-term functional and structural results after transtibial pull-out (TPO) repair of isolated MMPRT and to explore the influence of patient age and postoperative physiotherapy volume. Methods: A retrospective single-center case series with 14 adults (64% women, age 59 years, body mass index (BMI) 31.0 kg/m²) who underwent TPO repair (April 2022–June 2024). Mean follow-up was 18.4 months. Outcomes included range of motion (ROM), pain levels using visual analog scale (VAS), International Knee Documentation Committee (IKDC), the Western Ontario Meniscal Evaluation Tool (WOMET), the 36-Item Short Form Survey (SF-36), and MRI-based ME, cartilage grade, and root-healing status. Postoperative PT volume was assessed with a self-developed, custom questionnaire. Correlations and subgroup analyses (<60 vs. ≥60 years) were performed. Results: Mean postoperative ROM was 121° and IKDC 63.4. Median PT exposure was 25.9 h, and the mean duration from symptom to repair was 215 days. MRI demonstrated complete healing in 70% of cases. A positive correlation was observed between postoperative ME and ROM (p = 0.008), while higher PT volume was associated with greater pain scores. Conclusions: TPO repair appears to be a viable treatment option for selected patients with MMPRT, showing acceptable early outcomes, even in older individuals with higher BMIs or delayed repair. Meniscal healing was frequent, although extrusion progression remained common and may influence the function. The observed links between ME, ROM, and PT-related pain highlight the need for standardized rehabilitation assessment. Larger, prospective studies are warranted to validate these exploratory findings and refine postoperative management. Full article

Meniscal injuries are common and often lead to chronic pain, joint instability, and an increased risk of osteoarthritis. Traditional treatments, such as partial meniscectomy, may accelerate joint degeneration. In recent years, biologically active therapies, including platelet-rich plasma (PRP), mesenchymal stem cells (MSCs), hyaluronic acid (HA), bone marrow aspirate concentrate (BMAC), collagen, growth factors (GFs), and silk fibroin (SF), have emerged as promising strategies to enhance meniscal healing. This review evaluates the efficiency of these biological agents in promoting meniscal repair, with a particular focus on their potential integration into injectable hydrogel systems for targeted, minimally invasive delivery. Recent literature from 2015 to 2025 has provided growing insights into the role of biologically active agents and biomaterials in meniscal repair. Among the agents studied, PRP, MSCs, and HA have shown particular promise in modulating inflammation and supporting tissue regeneration. While biological therapies alone may not replace surgery for complex tears, they offer promising, less invasive alternatives that support tissue preservation. However, variability in study design, agent quality, and treatment protocols remains challenging. Further long-term research will be essential to confirm clinical benefits and optimize hydrogel-based delivery methods. Full article

Background and Objectives: The menisci are crucial fibrocartilaginous structures of the knee joint and have to be repaired in case of a tear. However, not all meniscal tears heal, even in young patients. Fibrin clot (FC) started to be used to reduce the failure rates following meniscus repair. The purpose of this study is to evaluate and compare outcomes after isolated arthroscopic meniscal repair augmented with FC versus without FC. Materials and Methods: Fifty-nine patients aged under 19 with isolated meniscal tears were randomized into two groups: one group underwent the meniscal repair with FC (FC-augmented), and the other group did not receive FC (control). The evaluation and comparison between the groups based on FC augmentation included secondary arthroscopy rates, patient-reported outcome measures (Pedi-IKDC, Lysholm, and Tegner), and clinical and radiological (MRI) assessments at a median follow-up of 12 months. Results: No statistically significant difference was observed between FC-augmented and control groups in Pedi-IKDC, Lysholm, and TAG scores, or following clinical and radiological (MRI) evaluation. Patients in the FC-augmented group reported fewer clinical symptoms at the final follow-up across unstable and demanding (bucket-handle and complex) tear type subgroups (p = 0.012 and 0.041, respectively). Overall, nine revision arthroscopies occurred in both groups (2 and 7, respectively), all across bucket-handle and complex tears with no significant difference between the FC-augmented and control groups (p = 0.072). Conclusions: This pilot study found that FC usage during meniscal repair reduces clinical symptoms for patients with unstable, bucket-handle, or complex meniscal tears at the final follow-up of 12 months postoperatively. Nonetheless, no statistically significant differences were observed within the other outcome measures between the FC-augmented and control groups and subgroups based on meniscal tear types. Level of evidence: Level II. Full article

The proper function and longevity of the knee joint are ensured by the knee menisci. Their susceptibility to damage and injury is one of the main risk factors for rapid cartilage loss and the development of osteoarthritis. The vascularization pattern and nutritional status of a torn meniscus determine its potential for healing and the success of meniscus surgery. Blood supply is a crucial factor in assessing healing potential. Knee cartilage volume loss and its modification often result from meniscal damage or excision, leading to osteoarthritis. Modern methods for preserving meniscal tissue are currently the treatment of choice. Magnetic resonance imaging (MRI) is the gold standard for assessing meniscus lesions. It provides a comprehensive evaluation of tear stability and progression risk. Additionally, it offers high sensitivity and specificity. Arthrography combined with computed tomography (CT) can be used for patients who are unable to undergo MRI. Other methods, such as X-ray and ultrasound, are not useful for the typical diagnosis of meniscal lesions. Minimally invasive surgery has become the gold standard for both treatment and diagnosis. Modern techniques, such as all-inside compression sutures and other suturing techniques, are also considered. In contrast, in the past, open total meniscectomy was routinely performed as the gold standard, based on the mistaken belief that the menisci were functionless. Currently, new treatment methods for meniscal lesions are being explored, including mesenchymal stem cells, synthetic implants, and platelet-rich plasma (PRP). The crucial role of the menisci in knee biomechanics drives the development of modern solutions focused on preserving meniscal tissue. Full article

Since the role of the menisci in knee stability, proprioception, and homeostasis has been well established, significant efforts have been made to repair meniscal tears, resulting in excellent clinical outcomes and a reduction in the progression of knee osteoarthritis (OA). However, varying failure rates have been reported, raising questions regarding the healing potential in cases of complex injuries, poorly vascularized and degenerated areas, and generally in the presence of unfavorable biological characteristics. Therefore, over the last few decades, different strategies have been described to increase the chances of meniscal healing. Biological augmentation of meniscal repair through various techniques represents a safe and effective strategy with proven clinical benefits. This approach could reduce the failure rate and expand the indications for meniscal repair. In the present study, we thoroughly reviewed the available evidence on meniscal repair surgery and summarized the main techniques that can be employed to enhance the biological healing potential of a meniscal lesion. Our aim was to provide an overview of the state of the art on meniscal repair and suggest the best techniques to reduce their failure rate. Full article

This systematic review aims to evaluate critically and synthesize the existing literature on the outcomes of meniscectomy versus meniscal repair for posterior medial meniscus injuries, with a focus on osteoarthritis (OA) development. We sought to assess the incidence of OA following both treatment modalities, compare functional outcomes post-treatment, and identify factors influencing treatment choice, providing evidence-based recommendations for clinical decision-making. A comprehensive search strategy was employed across PubMed, Scopus, and Embase up until December 2023, adhering to PRISMA guidelines. The primary outcomes included OA development, functional knee outcomes, and quality of life measures. Six studies met the inclusion criteria, encompassing 298 patients. The systematic review revealed a significant association between meniscal repair and decreased progression of OA compared to meniscectomy. Meniscectomy patients demonstrated a 51.42% progression rate towards OA, significantly higher than the 21.28% observed in meniscal repair patients. Functional outcomes, as measured by the International Knee Documentation Committee (IKDC) and Lysholm scores, were notably better in the repair group, with average scores of 74.68 (IKDC) and 83.78 (Lysholm) compared to 67.55 (IKDC) and 74.56 (Lysholm) in the meniscectomy group. Furthermore, the rate of complete healing in the repair group was reported at 71.4%, as one study reported, indicating a favorable prognosis for meniscal preservation. However, these pooled data should be interpreted with consideration to the heterogeneity of the analyzed studies. Meniscal repair for posterior medial meniscus injuries is superior to meniscectomy in preventing OA development and achieving better functional outcomes and quality of life post-treatment. These findings strongly suggest the adoption of meniscal repair as the preferred treatment modality for such injuries, emphasizing the need for a paradigm shift in clinical practice towards preserving meniscal integrity to optimize patient outcomes. Full article

This review provides insights at the molecular level into the current and old methods for treating meniscal injuries. Meniscal injuries have been found to have a substantial impact on the progression of osteoarthritis. In line with the “save the meniscus” approach, meniscectomy is considered a last-resort treatment. Nevertheless, it is important to note that mechanical repair alone may not achieve the complete restoration of the meniscus. A deep understanding of the healing pathways could lead to future improvements in meniscal healing. The inclusion of cytokines and chemokines has the potential to facilitate the process of tear repair or impede the inflammatory catabolic cascade. MicroRNA (miRNA) could serve as a potential biomarker for meniscal degeneration, and RNA injections might promote collagen and growth factor production. The critical aspect of the healing process is angiogenesis within the inner zone of the meniscus. The use of collagen scaffolds and the implantation of autologous meniscus fragments have been successfully integrated into clinical settings. These findings are encouraging and underscore the need for well-designed clinical trials to explore the most effective factors that can enhance the process of meniscal repair. Full article

The menisci increase the contact area of load bearing in the knee and thus disperse the mechanical stress via their circumferential tensile fibers. Traumatic meniscus injuries cause mechanical symptoms in the knee, and are more prevalent amongst younger, more active patients, compared to degenerative tears amongst the elderly population. Traumatic meniscus tears typically result from the load-and-shear mechanism in the knee joint. The treatment depends on the size, location, and pattern of the tear. For non-repairable tears, partial or total meniscal resection decreases its tensile stress and increases joint contact stress, thus potentiating the risk of arthritis. A longitudinal vertical tear pattern at the peripheral third red-red zone leads to higher healing potential after repair. The postoperative rehabilitation protocols after repair range from immediate weight-bearing with no range of motion restrictions to non-weight bearing and delayed mobilization for weeks. Pediatric and adolescent patients may require special considerations due to their activity levels, or distinct pathologies such as a discoid meniscus. Further biomechanical and biologic evidence is needed to guide surgical management, postoperative rehabilitation protocols, and future technology applications for traumatic meniscus injuries. Full article

The knee is one of the most frequently affected joints in sports trauma, and anterior cruciate ligament (ACL) injury and meniscal tears are the most common lesions. ACL reconstruction (ACLR) remains the treatment of choice for patients willing to return to their previous activity. There are different surgical techniques and different possible usable grafts. The graft used for ACLR surgery undergoes a bone incorporation process and an intra-articular remodelling named ligamentization until it reaches characteristics similar to the native ligament. After the first incorporation stage, the remodelling process is divided into an early stage that could last 4 weeks, a proliferative stage that lasts 4 to 12 weeks, and a final stage of ligamentization that could last over 1 year. The period of return to sport (RTS) after ACLR, which is becoming shorter and shorter, can be a high-risk period for athletes due to the risk of graft failure. This systematic review aims to define the phases of the ligamentization process considering graft type and fixation techniques, as well as the graft’s anatomopathological and biomechanical characteristics, to evaluate a criterion-based rehab progression and maximize patient outcomes for an RTS respecting graft biology. The rehabilitative program has to promote and optimize the graft remodelling and incorporation processes; moreover, it has to accommodate physiological graft healing and avoid overloading. An early RTS and noncompliance with the biological characteristics of the graft in the various phases are associated with a high incidence of re-injury. Full article

Osteoarthritis (OA) is a low-grade inflammatory disorder of the joints that causes deterioration of the cartilage, bone remodeling, formation of osteophytes, meniscal damage, and synovial inflammation (synovitis). The synovium is the primary site of inflammation in OA and is frequently characterized by hyperplasia of the synovial lining and infiltration of inflammatory cells, primarily macrophages. Macrophages play a crucial role in the early inflammatory response through the production of several inflammatory cytokines, chemokines, growth factors, and proteinases. These pro-inflammatory mediators are activators of numerous signaling pathways that trigger other cytokines to further recruit more macrophages to the joint, ultimately leading to pain and disease progression. Very few therapeutic alternatives are available for treating inflammation in OA due to the condition’s low self-healing capacity and the lack of clear diagnostic biomarkers. In this review, we opted to explore the immunomodulatory properties of mesenchymal stem cells (MSCs) and their paracrine mediators-dependent as a therapeutic intervention for OA, with a primary focus on the practicality of polarizing macrophages as suppression of M1 macrophages and enhancement of M2 macrophages can significantly reduce OA symptoms. Full article

Bone marrow aspirate (BMA) is an excellent source of cells and growth factors and has been used successfully for bone, cartilage, and soft-tissue healing. This study aimed to investigate the histological and biomechanical properties of autogenous tendon graft by injecting BMA and its protective effect against degenerative changes in a rabbit model of meniscal defects. Adult white rabbits were divided into untreated, tendon, and tendon + BMA groups, and meniscal defects were created in the knees. The tendon graft and articular cartilage status were evaluated by macroscopic and histological analysis at 4, 12, and 24 weeks postoperatively among the three groups. The tendon graft in the tendon and tendon + BMA groups were used for biomechanical evaluation at 4, 12, and 24 weeks postoperatively. The meniscal covering ratio in the tendon + BMA group was better than that in the tendon and untreated groups at 12 and 24 weeks postoperatively. The matrix around the central portion of cells in the tendon + BMA group was positively stained by safranin O and toluidine blue staining with metachromasia at 24 weeks. The histological score of the tendon graft in the tendon + BMA group was significantly higher than that in the untreated and tendon groups at 12 and 24 weeks postoperatively. In the tendon + BMA group, cartilage erosion was not shown at 4 weeks, developed slowly, and was better preserved at 12 and 24 weeks compared to the untreated and tendon groups. Histological scores for the articular cartilage were significantly better in the tendon + BMA group at 24 weeks. The compressive stress on the tendon graft in the tendon + BMA group was significantly higher than that in the tendon group at 12 weeks postoperatively. Transplantation of autogenous tendon grafts by injecting BMA improved the histologic score of the regenerated meniscal tissue and was more effective than the tendon and untreated group for preventing cartilage degeneration in a rabbit model of massive meniscal defects. Full article

The meniscus is a critical component of a healthy knee joint. It is a complex and vital fibrocartilaginous tissue that maintains appropriate biomechanics. Injuries of the meniscus, particularly in the inner region, rarely heal and usually progress into structural breakdown, followed by meniscus deterioration and initiation of osteoarthritis. Conventional therapies range from conservative treatment, to partial meniscectomy and even meniscus transplantation. All the above have high long-term failure rates, with recurrence of symptoms. This communication presents a brief account of in vitro and in vivo studies and describes recent developments in the field of 3D-printed scaffolds for meniscus tissue engineering. Current research in meniscal tissue engineering tries to combine polymeric biomaterials, cell-based therapy, growth factors, and 3D-printed scaffolds to promote the healing of meniscal defects. Today, 3D-printing technology represents a big opportunity in the orthopaedic world to create more specific implants, enabling the rapid production of meniscal scaffolds and changing the way that orthopaedic surgeons plan procedures. In the future, 3D-printed meniscal scaffolds are likely to be available and will also be suitable substitutes in clinical applications, in an attempt to imitate the complexity of the native meniscus. Full article