Beaufils / Verdonk The Meniscus

1. Auflage 2010
ISBN: 978-3-642-02450-4
Verlag: Springer
Format: PDF
Kopierschutz: 1 - PDF Watermark

E-Book, Englisch, 407 Seiten

Reihe: Medicine (R0)

Autoren/Hrsg.

Beaufils, Philippe

Verdonk, René

Inhaltsverzeichnis

1;151522_1_En_BookFrontmatter_OnlinePDF;1
2;151522_1_En_1_PartFrontmatter_OnlinePDF;14
3;151522_1_En_1_Chapter_OnlinePDF;15
3.1;1.1;15
3.1.1;Ontogeny-Phylogeny;15
3.1.1.1;Introduction;15
3.1.1.2;Meniscal Phylogeny;15
3.1.1.3;Meniscal Ontogeny;18
3.1.1.4;The Particular Case of Discoid Meniscus;19
3.1.1.5;Conclusion;20
3.1.2;References;21
4;151522_1_En_2_Chapter_OnlinePDF;22
4.1;1.2;22
4.1.1;Anatomy;22
4.1.1.1;Morphology;22
4.1.1.2;The Tibial Insertional Ligaments;24
4.1.1.3;The Intermeniscal Ligaments;24
4.1.1.4;The Meniscofemoral Ligaments;25
4.1.1.5;The Composition of Meniscal Tissue;25
4.1.1.6;The Fine Structure of Menisci;26
4.1.1.7;Blood Supply and Innervation;26
4.1.1.8;Meniscal Motion During Knee Flexion;27
4.1.1.9;Summary;28
4.1.2;References;28
5;151522_1_En_3_Chapter_OnlinePDF;30
5.1;1.3;30
5.1.1;Histology-Ultrastructure-Biology;30
5.1.1.1;Embryology;30
5.1.1.2;Chemical Composition and Organization of Normal Meniscal Tissue;30
5.1.1.3;Cellular Composition of Meniscal Tissue;31
5.1.1.3.1;Fibrochondrocyte;32
5.1.1.3.2;Fibroblast-Like Cells;32
5.1.1.3.3;Cells of the Superficial Zone;33
5.1.1.4;Healing Response in the Injured Meniscus;33
5.1.1.4.1;Model I: Transection of the Anterior Cruciate Ligament;33
5.1.1.4.2;Model II: Plug Model;34
5.1.1.4.3;Model III: Tear Model;34
5.1.1.5;Rationale for Meniscal Replacement;35
5.1.2;References;37
6;151522_1_En_4_Chapter_OnlinePDF;39
6.1;1.4;39
6.1.1;Biomechanics;39
6.1.1.1;Introduction;39
6.1.1.2;Material Properties of Meniscal Tissue;39
6.1.1.2.1;Tensile Material Properties;39
6.1.1.2.2;Compressive Material Properties;40
6.1.1.3;Functional Biomechanics of the Menisci;40
6.1.1.4;Biomechanics of the Meniscal Ligaments;43
6.1.1.4.1;Insertional Ligaments;43
6.1.1.4.2;The Deep Medial Collateral Ligament;43
6.1.1.4.3;The Anterior Intermeniscal Ligament;43
6.1.1.4.4;The Meniscofemoral Ligaments;44
6.1.1.5;The Consequences of Loss of Function of the Meniscus-Meniscal Ligament construct;44
6.1.1.6;Conclusions;45
6.1.2;References;45
7;151522_1_En_5_Chapter_OnlinePDF;48
7.1;1.5;48
7.1.1;Synthesis;48
7.1.1.1;Conclusion;49
7.1.2;References;50
8;151522_1_En_2_PartFrontmatter_OnlinePDF;51
9;151522_1_En_6_Chapter_OnlinePDF;52
9.1;2.1;52
9.1.1;Traumatic Lesions: Stable Knee, ACL Knee;52
9.1.1.1;Introduction;52
9.1.1.2;Classification of Meniscal Tears by Morphology: ISAKOS;52
9.1.1.2.1;Tear Length;52
9.1.1.2.2;Tear Depth;52
9.1.1.2.3;Location (Fig. .2.1.1a, b.);52
9.1.1.2.4;Tear Pattern .[5,..6]. (Fig. .2.1.2.);53
9.1.1.2.4.1;Longitudinal-Vertical Tear;53
9.1.1.2.4.2;Horizontal Tear;53
9.1.1.2.4.3;Radial Tear;53
9.1.1.2.4.4;Flap Tear;53
9.1.1.2.4.5;Complex Tear;53
9.1.1.2.4.6;Discoid Meniscus;54
9.1.1.3;Classification of Meniscal Tears by Symptomatology;54
9.1.1.4;Pathogenesis;54
9.1.1.4.1;Longitudinal Tears;54
9.1.1.4.2;Transverse, Radial, or Oblique Tears;54
9.1.1.5;Classification of Meniscal Tears by Reparability;55
9.1.1.6;Classification of Meniscal Tears by Type of Injury;55
9.1.2;References;56
10;151522_1_En_7_Chapter_OnlinePDF;57
10.1;2.2;57
10.1.1;Degenerative Lesions-Meniscal Cyst;57
10.1.1.1;Pathology;57
10.1.1.2;Frequency of Degenerative Meniscal Lesions;57
10.1.1.3;Arthroscopic Classification;58
10.1.1.4;MRI Classification;59
10.1.1.5;Correlation Between MRI and Histology;60
10.1.1.6;Correlation Between MRI and Arthroscopy;60
10.1.1.7;Clinical Aspects;60
10.1.1.7.1;Horizontal Cleavage Tear and Meniscal Cyst;61
10.1.1.7.2;Non-Traumatic Degenerative Tear of the Medial Meniscus or Type IV DML;61
10.1.1.7.2.1;Epidemiology;61
10.1.1.7.2.1.1;Age;61
10.1.1.7.2.1.2;Gender;61
10.1.1.7.2.1.3;Triggering Conditions;62
10.1.1.7.2.2;Clinical Symptoms;62
10.1.1.7.2.3;Radiological Evaluation;62
10.1.1.7.2.4;Treatment of Degenerative Meniscal Lesions;63
10.1.1.7.3;Meniscal Extrusion;64
10.1.1.7.4;Complex Meniscal Lesions (Type V);65
10.1.1.8;Conclusion;65
10.1.2;References;65
11;151522_1_En_8_Chapter_OnlinePDF;67
11.1;2.3;67
11.1.1;Meniscus and Osteoarthritis;67
11.1.1.1;Introduction;67
11.1.1.2;Osteoarthritis;67
11.1.1.2.1;X-Rays;67
11.1.1.2.2;MRI;68
11.1.1.2.2.1;Cartilage Thickness;68
11.1.1.2.2.2;Bone Marrow Oedema;68
11.1.1.2.3;Arthroscopy;68
11.1.1.3;Degenerative Meniscal Lesions;68
11.1.1.3.1;Arthroscopic Classification;68
11.1.1.3.2;MRI Classification .(Fig. .2.3.2.);68
11.1.1.4;Meniscus and OA;69
11.1.1.5;Conclusion;70
11.1.2;References;70
12;151522_1_En_9_Chapter_OnlinePDF;72
12.1;2.4;72
12.1.1;Synthesis;72
12.1.1.1;Traumatic Meniscal Lesions;72
12.1.1.2;Degenerative Meniscal Lesions;72
13;151522_1_En_3_PartFrontmatter_OnlinePDF;74
14;151522_1_En_10_Chapter_OnlinePDF;75
14.1;3.1;75
14.1.1;Clinical Examination: Standard X-Rays;75
14.1.1.1;Introduction;75
14.1.1.2;Physical Examination;75
14.1.1.2.1;Tests Commonly Used to Assess Meniscal Lesions;75
14.1.1.2.1.1;McMurray Test .[13];75
14.1.1.2.1.2;Apley Test .[4];76
14.1.1.2.1.3;Joint Line Palpation;76
14.1.1.2.2;Level of Evidence of Clinical Tests;76
14.1.1.3;Standard X-Rays;76
14.1.1.4;Conclusion;80
14.1.2;References;80
15;151522_1_En_11_Chapter_OnlinePDF;81
15.1;3.2;81
15.1.1;MRI, MR-arthrography and CT-arthrography;81
15.1.1.1;Introduction;81
15.1.1.2;Standard Radiography and Arthrography;81
15.1.1.3;CT and CT Arthrography;81
15.1.1.4;MR and MR Arthrography;82
15.1.1.4.1;Imaging Technique;83
15.1.1.4.2;Normal Meniscus Anatomy;84
15.1.1.4.3;Abnormal Meniscal Signals;84
15.1.1.4.4;Detection of Meniscal Lesions;85
15.1.1.5;Meniscal Lesions;85
15.1.1.5.1;Classification of Meniscal Tears;85
15.1.1.5.1.1;Longitudinal/Vertical Tears;85
15.1.1.5.1.2;Horizontal Tears;86
15.1.1.5.1.3;Radial Tears;86
15.1.1.5.1.4;Oblique Tears;87
15.1.1.5.1.5;Complex Tears;88
15.1.1.5.2;Meniscal Cysts;88
15.1.1.6;MR Imaging Pitfalls;88
15.1.1.7;Postoperative Imaging;89
15.1.1.7.1;MR Imaging of the Operated Meniscus;89
15.1.1.7.2;Imaging of the Sutured Meniscus;90
15.1.1.7.3;MR Imaging After Meniscus Transplantation;91
15.1.1.7.4;MR Imaging of the Artificial Meniscus;91
15.1.2;References;92
16;151522_1_En_12_Chapter_OnlinePDF;95
16.1;3.3;95
16.1.1;Bone Scan;95
16.1.1.1;Envelope of Function;96
16.1.1.2;Recommendations for Use of Bone Scans;97
16.1.2;References;99
17;151522_1_En_13_Chapter_OnlinePDF;100
17.1;3.4;100
17.1.1;Synthesis;100
17.1.1.1;History of Knee Injury;100
17.1.1.1.1;Physical Examination;100
17.1.1.1.2;Associated Lesions;100
17.1.1.1.3;Radiological Findings;101
17.1.1.2;History of Spontaneous Knee Pain;101
17.1.1.3;Conclusion;101
18;151522_1_En_4_PartFrontmatter_OnlinePDF;102
19;151522_1_En_14_Chapter_OnlinePDF;103
19.1;4.1;103
19.1.1;Meniscectomy: Medial-Lateral;103
19.1.1.1;Introduction;103
19.1.1.2;Treatment by Arthroscopic Meniscectomy;103
19.1.1.2.1;Introduction;103
19.1.1.2.2;Arthroscopic Medial Meniscectomy;103
19.1.1.2.3;Arthroscopic Lateral Meniscectomy;104
19.1.1.2.4;Specific Cases;105
19.1.1.2.5;Rehabilitation;105
19.1.1.2.6;Complications;105
19.1.1.3;Treatment by Open Meniscectomy;106
19.1.1.3.1;Introduction;106
19.1.1.3.2;Surgical Technique;106
19.1.1.3.2.1;Open Medial Meniscectomy;106
19.1.1.3.2.2;Open Lateral Meniscectomy;106
19.1.1.4;Conclusion;106
19.1.2;References;107
20;151522_1_En_15_Chapter_OnlinePDF;108
20.1;4.2;108
20.1.1;Meniscal Repair: Biomechanics;108
20.1.1.1;Introduction;108
20.1.1.2;Indications;108
20.1.1.3;Laboratory Testing of Meniscal Repair Techniques;109
20.1.1.4;Testing of the Initial Repair (Time-Zero Studies);109
20.1.1.5;Testing Simulating the Early Healing Phase (0–12 Weeks);111
20.1.1.5.1;Hydrolysis;111
20.1.1.5.2;Cyclic Loading;111
20.1.1.5.3;Shear Forces;112
20.1.1.5.4;Compression Forces;112
20.1.1.6;Testing Simulating the Late Healing Phase (.=.12 Weeks);112
20.1.1.7;Forces Acting In Vivo;116
20.1.1.8;Conclusions;116
20.1.2;References;117
21;151522_1_En_16_Chapter_OnlinePDF;119
21.1;4.3;119
21.1.1;Meniscal Repair: Technique;119
21.1.1.1;Principles;119
21.1.1.1.1;Arthroscopic Set-Up;119
21.1.1.1.2;Debridement;120
21.1.1.1.3;Fixation;120
21.1.1.2;Technique;120
21.1.1.2.1;First Generation: Open Technique;120
21.1.1.2.2;Second Generation: Arthroscopically Assisted Inside-Out or Outside-In Technique;121
21.1.1.2.3;Third Generation: Devices;122
21.1.1.2.4;Fourth Generation: All-Inside Technique with Sutures;123
21.1.1.2.4.1;RapidLoc (Fig. .4.3.6.);123
21.1.1.2.4.2;FasT-Fix (Fig. .4.3.7.);124
21.1.1.2.4.3;Meniscal Cinch (Fig. .4.3.11.);125
21.1.1.3;Specific Cases;126
21.1.1.3.1;Anterior Segment Tear (Fig. .4.3.12.);126
21.1.1.3.2;Bucket-Handle Tear;127
21.1.1.3.3;Horizontal Cleavage Tear;127
21.1.1.4;Conclusion;128
21.1.2;References;128
22;151522_1_En_17_Chapter_OnlinePDF;129
22.1;4.4;129
22.1.1;Meniscal Repair: Enhancement of Healing Process;129
22.1.1.1;Introduction;129
22.1.1.2;Prerequisites of Meniscal Healing;129
22.1.1.3;Enhancement Techniques;130
22.1.1.3.1;Mechanical Trephination .(Fig. .4.4.1.);130
22.1.1.3.2;Abrasion (Fig. .4.4.2.);130
22.1.1.3.3;Synovial Flaps .(Fig. .4.4.3.);130
22.1.1.3.4;High-Frequency Current .(Fig. .4.4.4.);130
22.1.1.3.5;Gluing .(Fig. .4.4.5.);131
22.1.1.3.6;Exogenous Fibrin Clot .(Fig. .4.4.6.);131
22.1.1.3.7;Fascia Sheath Coverage and Fibrin Clot .(Fig. .4.4.7.);131
22.1.1.3.8;Meniscus Wrap Technique .(Fig. .4.4.8.);132
22.1.1.3.9;Unloading the Meniscus .(Fig. .4.4.9.);133
22.1.1.3.10;Cell-Based Therapy and Gene Therapy;133
22.1.1.4;Conclusion;134
22.1.2;References;134
23;151522_1_En_18_Chapter_OnlinePDF;136
23.1;4.5;136
23.1.1;Meniscal Cysts;136
23.1.1.1;Introduction;136
23.1.1.2;Clinical Evaluation;136
23.1.1.2.1;History: Physical Examination;136
23.1.1.2.2;Diagnosis;137
23.1.1.3;Treatment Options;138
23.1.1.3.1;Conservative Treatment;138
23.1.1.3.2;Meniscal Tear Extending to the Joint (Grade 3);138
23.1.1.3.2.1;Arthroscopic Meniscectomy Combined with Cyst Treatment;138
23.1.1.3.2.1.1;Technique;139
23.1.1.3.2.1.2;Results;140
23.1.1.3.2.2;Cyst Excision Combined with Meniscal Repair;140
23.1.1.3.3;Meniscal Tear Not Extending to the Articular Surface (Grade 2);140
23.1.1.3.3.1;Technique;141
23.1.1.3.3.2;Results;141
23.1.1.4;Clinical and Surgical Algorithm for Treatment of Meniscal Cysts;141
23.1.1.5;Conclusion;142
23.1.2;References;143
24;151522_1_En_19_Chapter_OnlinePDF;145
24.1;4.6;145
24.1.1;Rehabilitation;145
24.1.1.1;Rehabilitation After Meniscectomy;145
24.1.1.1.1;Introduction;145
24.1.1.1.2;Rehabilitation Protocol;145
24.1.1.1.3;Early Postoperative Rehabilitation Phase;145
24.1.1.1.4;Second Phase;147
24.1.1.1.5;Third Phase;148
24.1.1.2;Rehabilitation After Meniscus Repair;148
24.1.1.2.1;Introduction;148
24.1.1.2.2;Healing of the Meniscus;148
24.1.1.2.2.1;Healing Rate After Meniscus Repair;148
24.1.1.2.2.2;Extrinsic Factors Influencing Meniscus Healing After Meniscus Repair;149
24.1.1.2.2.2.1;Immobilization;149
24.1.1.2.2.2.2;Weightbearing;149
24.1.1.2.2.3;Intrinsic Factors Influencing Meniscus Healing After Meniscus Repair;149
24.1.1.2.3;Protocol;149
24.1.1.2.3.1;Conventional Rehabilitation Protocol;149
24.1.1.2.3.2;Accelerated Rehabilitation Protocol;150
24.1.1.2.3.3;Individualized Rehabilitation Protocol;150
24.1.1.2.4;Conclusion;150
24.1.2;References;151
25;151522_1_En_20_Chapter_OnlinePDF;153
25.1;4.7;153
25.1.1;Synthesis;153
26;151522_1_En_5_PartFrontmatter_OnlinePDF;154
27;151522_1_En_21_Chapter_OnlinePDF;155
27.1;5.1;155
27.1.1;Functional and Objective Scores. Quality of Life;155
27.1.1.1;Summary of knee function/symptoms scoring systems;155
27.1.2;References;160
28;151522_1_En_22_Chapter_OnlinePDF;162
28.1;5.2;162
28.1.1;Postoperative Imaging: X-Rays, Arthro CT, Arthro MRI;162
28.1.1.1;Introduction;162
28.1.1.2;Current Concepts in Postoperative Imaging of the Meniscus;162
28.1.1.3;Postoperative Imaging After Meniscectomy;162
28.1.1.3.1;Radiography;162
28.1.1.3.2;Double-Contrast Arthrography;163
28.1.1.3.3;Magnetic Resonance Imaging;163
28.1.1.3.4;Arthro CT Scan (Fig. .5.2.3.);164
28.1.1.3.5;Imaging of Cartilage After Meniscectomy;164
28.1.1.4;Postoperative Imaging After Meniscus Repair;164
28.1.1.4.1;Arthrography;164
28.1.1.4.2;Magnetic Resonance Imaging;165
28.1.1.4.3;Arthro MRI;166
28.1.1.4.4;Arthro CT Scan;166
28.1.1.5;Postoperative Imaging of Meniscus Allografts or Meniscal Substitutes;167
28.1.1.5.1;Radiography;167
28.1.1.5.2;MRI and Arthro MRI;167
28.1.1.6;When and Why to Perform Imaging After Meniscus Surgery?;167
28.1.1.6.1;After Meniscectomy;167
28.1.1.6.2;Meniscus Repair and Meniscus Transplantation;168
28.1.1.7;Conclusion;168
28.1.2;References;168
29;151522_1_En_6_PartFrontmatter_OnlinePDF;170
30;151522_1_En_23_Chapter_OnlinePDF;171
30.1;6.1;171
30.1.1;Meniscectomy: ...Global Results-Complications;171
30.1.1.1;History;171
30.1.1.2;Outcome Evaluation;172
30.1.1.2.1;Medial Meniscus;172
30.1.1.2.2;Lateral Meniscus;173
30.1.1.2.2.1;Subjective Results;173
30.1.1.2.2.2;Functional Results;174
30.1.1.2.2.3;Radiological Results;174
30.1.1.3;Meniscectomy in Stable Knees;173
30.1.1.3.1;Traumatic vs. Degenerative Tears;174
30.1.1.4;Meniscectomy in the ACL-Deficient Knee;175
30.1.1.4.1;Isolated Meniscectomy;175
30.1.1.4.1.1;Effect on Sports Level;175
30.1.1.4.1.2;Subjective Results;176
30.1.1.4.1.3;Functional Results;176
30.1.1.4.1.4;Radiological Results;176
30.1.1.4.2;Meniscectomy Associated with ACL Reconstruction;177
30.1.1.4.2.1;Subjective Results;177
30.1.1.4.2.2;Functional Results;178
30.1.1.4.2.3;Degenerative Changes;178
30.1.1.5;Complications;178
30.1.1.5.1;Short Term;179
30.1.1.5.1.1;Infections;179
30.1.1.5.1.2;Intraoperative Material Breakage;179
30.1.1.5.1.3;Ligament Injuries;179
30.1.1.5.1.4;Vascular Lesions;179
30.1.1.5.1.5;Neural Lesions;179
30.1.1.5.1.6;Synovial Fistula;180
30.1.1.5.1.7;Embolic Events;180
30.1.1.5.2;Medium Term;180
30.1.1.5.2.1;Early Chondrolysis;180
30.1.1.6;Conclusion;181
30.1.2;References;181
31;151522_1_En_24_Chapter_OnlinePDF;185
31.1;6.2;185
31.1.1;Meniscal Repair: Intra- and Postoperative Complications;185
31.1.1.1;Introduction;185
31.1.1.2;Neurovascular and Soft-Tissue Complications;185
31.1.1.3;Complications Related to Meniscal Devices and Implants;189
31.1.1.4;Nonspecific Complications;190
31.1.1.5;Conclusion;191
31.1.2;References;191
32;151522_1_En_25_Chapter_OnlinePDF;193
32.1;6.3;193
32.1.1;Meniscal Repair: Results;193
32.1.1.1;Introduction;193
32.1.1.2;Clinical Results;193
32.1.1.2.1;Subsequent Meniscectomy;193
32.1.1.2.2;Functional Results;194
32.1.1.2.3;Contributing Factors;194
32.1.1.2.3.1;ACL Status;194
32.1.1.2.3.2;Location of the Tear;195
32.1.1.2.3.3;Lateral/Medial Meniscus;195
32.1.1.2.3.4;Age;195
32.1.1.2.3.5;Time from Tear to Surgery;195
32.1.1.3;Anatomical Results;195
32.1.1.3.1;Assessment of Meniscal Healing Process;195
32.1.1.3.2;Healing Process and Clinical Outcomes;195
32.1.1.3.3;Meniscal Shortening;197
32.1.1.4;Secondary Arthritis;198
32.1.1.5;Conclusion;198
32.1.2;References;199
33;151522_1_En_7_PartFrontmatter_OnlinePDF;201
34;151522_1_En_26_Chapter_OnlinePDF;202
34.1;7.1;202
34.1.1;Traumatic Meniscal Lesions in a Stable Knee: Masterly Neglect, Meniscectomy, Repair;202
34.1.1.1;Introduction;202
34.1.1.2;Evaluation and Decision Making in the Treatment of a Traumatic Meniscus Tear;202
34.1.1.2.1;History;202
34.1.1.2.2;Physical Examination;203
34.1.1.2.3;Imaging;203
34.1.1.2.4;Arthroscopy;203
34.1.1.3;Indications for Treatment Options for Traumatic Tears in a Stable Knee;203
34.1.1.3.1;Conservative Treatment: Masterly neglect;203
34.1.1.3.2;Surgical Treatment;204
34.1.1.3.2.1;Meniscectomy;204
34.1.1.3.2.2;(Sub)Total or Partial Meniscectomy;204
34.1.1.3.2.3;Repair of Traumatic Tears;205
34.1.1.3.2.4;Suitability and Indications for Repair;205
34.1.1.4;Conclusion;206
34.1.2;References;206
35;151522_1_En_27_Chapter_OnlinePDF;208
35.1;7.2;208
35.1.1;Traumatic Lesions, ACL Knee: Masterly Neglect, Meniscectomy, Repair;208
35.1.1.1;Introduction;208
35.1.1.2;Does the Co-Existence of a Meniscal Lesion Influence the Indications for an ACL Reconstruction?;208
35.1.1.2.1;Indications for ACL Reconstruction in Case of a Co existent Meniscal Lesion and Modifications of the Procedure;208
35.1.1.2.2;Type of ACL Graft;209
35.1.1.2.3;Association of a Lateral Peripheral Tenodesis: Double-Bundle ACL Reconstruction;209
35.1.1.2.4;Rehabilitation After ACL Reconstruction;209
35.1.1.2.5;Secondary Meniscal Lesions in an Unstable Knee;209
35.1.1.2.6;Occurrence of Meniscal Lesions in an ACL-Reconstructed Knee;210
35.1.1.3;Does the Co-Existence of a Ligamentous Lesion Influence the Indications for Meniscal Surgery?;210
35.1.1.3.1;Isolated or Associated Meniscectomy;210
35.1.1.3.2;Meniscal Repair;210
35.1.1.3.3;Masterly Neglect;210
35.1.1.3.4;Meniscal Grafts and Substitutes;214
35.1.1.4;Conclusion;214
35.1.2;References;215
36;151522_1_En_28_Chapter_OnlinePDF;216
36.1;7.3;216
36.1.1;Degenerative Meniscal Lesions in a Stable Knee;216
36.1.1.1;Introduction;216
36.1.1.2;Evaluation and Decision Making in the Treatment of a Degenerative Meniscus Tear;216
36.1.1.2.1;History;217
36.1.1.2.2;Physical Examination;217
36.1.1.2.3;Imaging;217
36.1.1.3;Indications for Treatment Options for Degenerative Tears in a Stable Knee;218
36.1.1.3.1;Conservative Treatment- Masterly Neglect;218
36.1.1.3.2;Surgical Treatment;218
36.1.1.3.2.1;Meniscectomy;218
36.1.1.3.2.2;Repair;218
36.1.1.3.2.3;Horizontal Tears;219
36.1.1.3.2.4;Meniscal Cysts;220
36.1.1.4;Conclusion;220
36.1.2;References;220
37;151522_1_En_29_Chapter_OnlinePDF;222
37.1;7.4;222
37.1.1;Lavage, Debridement, and Osteoarthritis;222
37.1.1.1;Introduction;222
37.1.1.2;Diagnosis;222
37.1.1.2.1;Bone Marrow Edema;223
37.1.1.2.2;Effusion, Synovial Hypertrophy;223
37.1.1.2.3;Degenerative Meniscal Tear: Symptomatic or Not?;223
37.1.1.3;Medical Treatment;223
37.1.1.3.1;Manual Physical Therapy and Exercise;223
37.1.1.3.2;Hyaluronic Acid/Steroids;223
37.1.1.3.2.1;Lavage;224
37.1.1.4;Arthroscopic Lavage-Debridement-Meniscectomy-Chondroplasty;224
37.1.1.4.1;Debridement;224
37.1.1.4.2;Abrasion Arthroplasty;224
37.1.1.4.3;Level One Study;224
37.1.1.4.4;Other Studies: Review;225
37.1.1.5;Patient Selection for Arthroscopic Debridement;225
37.1.1.5.1;Grade of OA;225
37.1.1.5.2;Type and Location of Meniscal Tear, Mechanical Symptoms;225
37.1.1.5.3;Location of OA;225
37.1.1.5.4;Others Factors;225
37.1.1.6;Conclusion;225
37.1.2;References;226
38;151522_1_En_30_Chapter_OnlinePDF;228
38.1;7.5;228
38.1.1;Synthesis;228
38.1.1.1;Longitudinal Vertical Lesion in a Stable Knee;228
38.1.1.2;Traumatic Meniscal Lesion in an ACL-Deficient Knee;229
38.1.1.2.1;Meniscal Repair or Let the Meniscus Alone;229
38.1.1.3;“Primary” Degenerative Meniscal Lesion and Meniscal Lesion in an Osteoarthritic Knee (Meniscarthrosis);229
39;151522_1_En_8_PartFrontmatter_OnlinePDF;232
40;151522_1_En_31_Chapter_OnlinePDF;233
40.1;8.1;233
40.1.1;Classification: Discoid Meniscus, Traumatic Lesions;233
40.1.1.1;Introduction;233
40.1.1.2;Traumatic Meniscal Lesions Without Congenital Abnormality;233
40.1.1.3;Meniscal Lesions with Congenital Meniscal Abnormality;234
40.1.1.4;Classification;234
40.1.1.4.1;Radiological Classifications;236
40.1.1.4.2;Correlation Between Type of Discoid Lateral Meniscus and Tear Pattern;237
40.1.2;References;237
41;151522_1_En_32_Chapter_OnlinePDF;239
41.1;8.2;239
41.1.1;Discoid Meniscus: Histology;239
41.1.2;References;241
42;151522_1_En_33_Chapter_OnlinePDF;242
42.1;8.3;242
42.1.1;Technique of Meniscoplasty and Meniscal Repair in Children;242
42.1.1.1;Introduction;242
42.1.1.2;Pre-Operative Planning;242
42.1.1.3;Patient Positioning, Equipment and Arthroscopic Portals;243
42.1.1.4;Discoid Meniscus;244
42.1.1.4.1;Introduction;244
42.1.1.4.2;Technical Considerations;245
42.1.1.4.3;Complications;248
42.1.1.5;Meniscal Lesions in Stable Knees;248
42.1.1.5.1;Introduction;248
42.1.1.5.2;Treatment of Horizontal Cleavage Tears with or Without Cyst;249
42.1.1.6;Meniscal Lesions Combined with ACL Tears;250
42.1.1.7;Post-Operative Management: Rehabilitation;250
42.1.1.8;Conclusion;250
42.1.2;References;251
43;151522_1_En_34_Chapter_OnlinePDF;252
43.1;8.4;252
43.1.1;Meniscus Lesions in Children-Indications and Results;252
43.1.1.1;Indications;252
43.1.1.1.1;Symptoms;252
43.1.1.1.2;Differential Diagnosis;252
43.1.1.1.3;Imaging Procedures;252
43.1.1.1.4;Surgical Findings;252
43.1.1.1.5;Treatment Options and Criteria for Repair;253
43.1.1.2;Results;255
43.1.2;References;257
44;151522_1_En_35_Chapter_OnlinePDF;259
44.1;8.5;259
44.1.1;Synthesis;259
44.1.2;References;262
45;151522_1_En_9_PartFrontmatter_OnlinePDF;263
46;151522_1_En_36_Chapter_OnlinePDF;264
46.1;9.1;264
46.1.1;Postoperative Osteonecrosis of the Condyle: Diagnosis and Management;264
46.1.1.1;Introduction;264
46.1.1.2;Epidemiology of ONPK;265
46.1.1.3;Etiology;267
46.1.1.4;Patient History, Physical Examination and Differential Diagnosis;267
46.1.1.5;Diagnosis of ONPK and Imaging Findings;268
46.1.1.5.1;Absence of Osteonecrosis on Preoperative Imaging;268
46.1.1.5.2;Temporal Association Between MRI Signal Changes Following Arthroscopy;268
46.1.1.5.3;Imaging Findings and Classification;269
46.1.1.5.4;Histologic Findings;272
46.1.1.6;Natural History and Prognostic Factors of ONPK;272
46.1.1.7;Treatment Options;274
46.1.1.8;Conclusion and Medicolegal Implications;274
46.1.2;References;275
47;151522_1_En_37_Chapter_OnlinePDF;277
47.1;9.2;277
47.1.1;Management of Early and Late Failure of Lateral Meniscus;277
47.1.1.1;Defining the Problem;277
47.1.1.2;Short and Medium-Term Complications;278
47.1.1.3;Long-Term Complications;278
47.1.1.3.1;Sec4_9.2;279
47.1.1.3.2;Tibial Varus Osteotomy;280
47.1.1.3.3;Choice of Osteotomy;280
47.1.1.4;Surgical Techniques;281
47.1.1.4.1;Tibial Varus Osteotomy .(Fig. .9.2.3.);281
47.1.1.4.2;Femoral Varus Osteotomy;282
47.1.1.5;Conclusions;283
47.1.2;References;283
48;151522_1_En_38_Chapter_OnlinePDF;285
48.1;9.3;285
48.1.1;Synthesis;285
48.1.1.1;Early Complications;285
48.1.1.2;Late Complications;286
48.1.1.3;Conclusion;287
49;151522_1_En_10_PartFrontmatter_OnlinePDF;288
50;151522_1_En_39_Chapter_OnlinePDF;289
50.1;10.1;289
50.1.1;Basic Science;289
50.1.1.1;History of Meniscal Transplantation and Replacement;289
50.1.1.2;Animal Models;289
50.1.1.2.1;Type of Animal Models;289
50.1.1.2.2;Evaluation of Transplanted Meniscal Allografts in Animal Models;289
50.1.1.2.2.1;Macroscopic Assessment;289
50.1.1.2.2.2;Histological Assessment;290
50.1.1.2.2.3;Microangiography;290
50.1.1.2.3;Evaluation of Cartilage After Meniscal Transplantation;290
50.1.1.2.3.1;Macroscopic Assessment;290
50.1.1.2.3.2;Histological Assessment;291
50.1.1.2.3.3;Radiographic Evaluation;291
50.1.1.2.3.4;Effects of Nonanatomic Positioning and Incongruent Meniscal Transplants on Articular Cartilage;292
50.1.1.2.3.5;Effects of Intraoperative Pretensioning of Meniscal Transplants;292
50.1.1.3;Preservation Techniques;292
50.1.1.4;Biomechanical Studies;294
50.1.1.4.1;Biomechanical Evaluation of the Transplanted Meniscus in Animal Models;294
50.1.1.4.2;Biomechanical Testing of Cartilage;295
50.1.1.4.3;Contact Mechanics After Meniscal Allograft Transplantation;295
50.1.1.4.3.1;Effects of Positioning and Size Matching;295
50.1.1.4.3.2;Effects of Fixation;295
50.1.1.5;Conclusion;297
50.1.2;References;297
51;151522_1_En_40_Chapter_OnlinePDF;300
51.1;10.2;300
51.1.1;Organization: Type of Grafts, Conservation, Regulation;300
51.1.1.1;Introduction;300
51.1.1.2;Tissue Banking Organization;300
51.1.1.3;Donor Selection;300
51.1.1.3.1;Consent;300
51.1.1.3.2;Donor Selection;301
51.1.1.3.3;Harvesting;301
51.1.1.3.4;Risks and Recommendations;301
51.1.1.4;Graft Sizing;302
51.1.1.5;Types of Grafts;303
51.1.1.6;Data from Our Bank;304
51.1.2;References;305
52;151522_1_En_41_Chapter_OnlinePDF;307
52.1;10.3;307
52.1.1;Meniscal Allograft: French Organization;307
52.1.1.1;Standard Technique of Meniscal Grafting;307
52.1.1.2;Graft Selection, Removal and Preservation Procedure. Graft Distribution by French Tissue Banks;308
52.1.1.2.1;Donor Selection;308
52.1.1.2.2;Graft Removal;308
52.1.1.2.3;Preservation;309
52.1.1.2.4;Transplant Distribution and Preparation;309
52.1.1.3;Effectiveness of Meniscal Grafting: Indications;309
52.1.1.3.1;Material;309
52.1.1.3.2;Method;309
52.1.1.4;Conclusion;309
52.1.2;References;310
53;151522_1_En_42_Chapter_OnlinePDF;311
53.1;10.4;311
53.1.1;Open Technique;311
53.1.1.1;Preoperative Considerations;311
53.1.1.2;Surgical Technique;311
53.1.1.2.1;Introduction;311
53.1.1.2.2;Anaesthesia and Surgical Preparation;311
53.1.1.2.3;Allograft Preparation for the Open Procedure;312
53.1.1.2.4;Open Meniscal Allograft Transplantation;312
53.1.1.2.4.1;Alternative Soft Tissue-Bone Fixation;313
53.1.1.2.4.2;Special Note on Soft-Tissue vs. Bone-Block Fixation .[1, ..2, ..4–..6];314
53.1.1.3;Rehabilitation;314
53.1.2;References;315
54;151522_1_En_43_Chapter_OnlinePDF;316
54.1;10.5;316
54.1.1;Arthroscopic Technique Without Plugs;316
54.1.1.1;Introduction;316
54.1.1.2;Surgical Technique;316
54.1.1.2.1;Medial Meniscal Transplantation;316
54.1.1.2.2;Lateral Meniscal Transplantation;319
54.1.1.2.3;Technical Pitfalls and Tips;321
54.1.1.2.4;Sub-Optimal Graft Size;321
54.1.1.2.5;Wrong-Sided Graft;322
54.1.1.2.6;Too Tight a Working Space;323
54.1.1.2.7;Posterior Graft Retraction;323
54.1.1.3;Results;323
54.1.1.4;Conclusion;323
54.1.2;References;324
55;151522_1_En_44_Chapter_OnlinePDF;325
55.1;10.6;325
55.1.1;Arthroscopic Technique with Bone Plugs;325
55.1.1.1;Introduction;325
55.1.1.2;Allograft Sizing and Selection;325
55.1.1.3;Techniques;325
55.1.1.3.1;Native Meniscus Preparation;325
55.1.1.3.2;Arthroscopically Assisted or Open Technique?;325
55.1.1.3.3;Meniscal Allograft Using Bone Block;326
55.1.1.3.3.1;Principles;326
55.1.1.3.3.2;Technique;326
55.1.1.3.3.3;Medial Meniscal Transplantation;327
55.1.1.3.4;Meniscal Allograft Using Bone Plugs;327
55.1.1.3.4.1;Principles;327
55.1.1.3.4.2;Lateral Meniscal Transplantation: Allograft Preparation;327
55.1.1.3.4.3;Surgical Exposure and Portals;327
55.1.1.3.4.4;Graft Introduction;328
55.1.1.3.4.5;Association with ACL Reconstruction;328
55.1.1.3.4.6;Medial Meniscal Transplantation;328
55.1.1.3.4.7;Rehabilitation;329
55.1.2;References;329
56.1;10.7;1
56.1.1;Results and Indications;1
56.1.1.1;Indications and Contraindications;1
56.1.1.1.1;Indications;1
56.1.1.1.2;Contraindications;1
56.1.1.2;Results;345
56.1.1.2.1;Subjective Assessment;345
56.1.1.2.2;Objective Clinical Scoring;345
56.1.1.2.2.1;Physical Examination;345
56.1.1.2.2.2;Radiological Examination (Table .10.7.5.);345
56.1.1.2.2.3;MRI Analysis (Table .10.7.6.);349
56.1.1.2.2.4;Second-Look Arthroscopy (Table .10.7.7.);353
56.1.1.3;Failures and Survival Analysis;353
56.1.1.4;Conclusion;353
56.1.2;References;357
57;151522_1_En_11_PartFrontmatter_OnlinePDF;359
58;151522_1_En_46_Chapter_OnlinePDF;360
58.1;11.1;360
58.1.1;Menaflex (TM) Collagen Meniscus Implant: Basic Science;360
58.1.1.1;Rationale and Development;360
58.1.1.2;In Vitro Laboratory and In Vivo Animal Studies;360
58.1.1.3;Human Clinical Trials;362
58.1.2;References;364
59;151522_1_En_47_Chapter_OnlinePDF;365
59.1;11.2;365
59.1.1;Collagen Meniscus Implant: Technique and Results;365
59.1.1.1;Introduction;365
59.1.1.1.1;Surgical Procedure;365
59.1.1.2;Technical Points Specific to the Medial CMI;365
59.1.1.2.1;Patient Positioning;365
59.1.1.2.2;Establishing Portals;366
59.1.1.2.3;Preparing the Implant Bed;366
59.1.1.2.4;Suturing;366
59.1.1.2.4.1;Inside–Out Technique;366
59.1.1.2.4.2;All-Inside Technique;369
59.1.1.3;Technical Points Specific to the Lateral CMI;369
59.1.1.3.1;Patient Positioning;369
59.1.1.3.2;Arthroscopic Portals;370
59.1.1.3.3;Preparation and Delivery;370
59.1.1.3.4;Suturing;370
59.1.1.3.4.1;Inside–Out Technique;370
59.1.1.3.4.2;All-Inside Technique;370
59.1.1.4;Combined Surgeries;372
59.1.1.4.1;ACL Deficiency;372
59.1.1.4.2;Axial Malalignment;372
59.1.1.4.3;Chondral Treatment;372
59.1.1.5;Results;372
59.1.1.6;Summary;373
59.1.2;References;373
60;151522_1_En_48_Chapter_OnlinePDF;375
60.1;11.3;375
60.1.1;Actifit, Polyurethane meniscus implant: basic science;375
60.1.1.1;Introduction;375
60.1.1.2;Background;375
60.1.1.3;A New Synthetic Polymer;376
60.1.1.4;Degradation;376
60.1.1.5;Preclinical Biocompatibility and Animal Testing;377
60.1.1.6;Clinical Results;378
60.1.2;References;378
61;151522_1_En_49_Chapter_OnlinePDF;380
61.1;11.4;380
61.1.1;Polyurethane Meniscus Implant: Technique;380
61.1.1.1;Introduction;380
61.1.1.2;Indications for Use;380
61.1.1.3;Methods;381
61.1.1.3.1;Surgical Techniques;381
61.1.1.3.1.1;Medial Meniscal Implant;381
61.1.1.3.1.2;Lateral Meniscal Implant;383
61.1.1.3.2;Postoperative Procedures;384
61.1.1.3.2.1;Postoperative Care;384
61.1.1.3.2.2;Postoperative Rehabilitation;384
61.1.1.4;Clinical Outcome Following Surgery;384
61.1.1.4.1;Preliminary Clinical Results;385
61.1.1.5;Conclusions;385
61.1.2;References;385
62;151522_1_En_50_Chapter_OnlinePDF;386
62.1;11.5;386
62.1.1;Synthesis;386
63;151522_1_En_12_PartFrontmatter_OnlinePDF;388
64;151522_1_En_51_Chapter_OnlinePDF;389
64.1;12.1;389
64.1.1;The Future;389
64.1.2;References;390
65;151522_1_En_13_PartFrontmatter_OnlinePDF;391
66;151522_1_En_52_Chapter_OnlinePDF;392
66.1;13.1;392
66.1.1;General Conclusion;392
67;151522_1_En_BookBackmatter_OnlinePDF;394