Meniscus

弯月面
  • 文章类型: Journal Article
    为了确定使用通过双能量计算机断层扫描(DECT)技术获得的虚拟单色图像进行半月板成像的可行性,并确定哪些keV水平优化对比度分辨率。
    所有DECT检查均在GEHealthcare的DiscoveryCT750HD系统上进行。在40keV下重建虚拟单色图像,73keV,106keV,和139keV。在每个keV水平上使用5点Likert量表的内侧和外侧半月板的对比分辨率是通过2位受过研究训练的肌肉骨骼放射科医生达成共识来确定的。Friedman和Wilcoxon符号等级测试用于比较不同keV级别的可视化分数。
    10名患者的17次膝关节检查符合纳入研究的标准。纳入研究队列的所有患者均为男性。患者的中位年龄为46岁(四分位距,35-53岁)。40keV的虚拟单色图像显示出半月板的最高对比度分辨率,在40keV和76keV的对比分辨率分数之间存在统计学上的显着差异,弗里德曼检验:p<0.0001。
    在低keV水平下使用DECT虚拟单色图像进行半月板成像是可行的。在这些指定的KeV值下,改进的对比度分辨率可以为该领域的进一步研究铺平道路,以确定其在将来作为评估MRI禁忌症患者或关节周围铁磁性异物的情况下半月板的替代选择视野。
    UNASSIGNED: To determine the feasibility of meniscal imaging using virtual monochromatic images obtained through dualenergy computed tomography (DECT) technique, and to determine which keV levels optimise contrast resolution.
    UNASSIGNED: All DECT exams were performed on a Discovery CT750 HD system from GE Healthcare. Virtual monochromatic images were reconstructed at 40 keV, 73 keV, 106 keV, and 139 keV. Contrast resolution of the medial and lateral menisci using a 5-point Likert scale at each keV level was determined through a consensus agreement by 2 fellowship-trained musculoskeletal radiologists. Friedman\'s and Wilcoxon signed rank tests were used to compare visualisation scores across different keV levels.
    UNASSIGNED: Seventeen knee exams from 10 patients met criteria for inclusion in the study. All patients included in the study cohort were male. The median age of patients was 46 years (interquartile range, 35-53 years). Virtual monochromatic images at 40 keV demonstrated highest contrast resolution of the menisci, with a statistically significant difference between contrast resolution scores at 40 keV and 76 keV, Friedman test: p < 0.0001.
    UNASSIGNED: Meniscal imaging is feasible using DECT virtual monochromatic images at low keV levels. Improved contrast resolution at these specified KeV values could pave the way for further research in this field to determine its role in the future as an alternative option for assessment of the menisci in patients with contraindications to MRI or in the setting of a periarticular ferromagnetic foreign body obscuring the field of view.
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  • 文章类型: Journal Article
    背景:全内技术现在是半月板修复的最成熟的治疗方法,这通常涉及使用中断的缝合线进行基于缝合线的修复。也可以使用使用连续缝线的类似技术;但是文献中没有研究评估这种技术。这项研究旨在回顾使用连续全内缝合技术进行半月板修复的患者的结果。
    方法:我们回顾了使用连续全内缝合技术进行半月板修复5年的患者。我们记录了人口统计细节,损伤类型,外科手术,再手术发生率,功能结局(Tegner-Lysholm和国际膝关节文献委员会(IKDC)评分)返回运动和修复失败。
    结果:收集了37例患者的数据。平均年龄为25.8岁,81%,是男性,到达剧院的中位时间为169天,平均随访时间为2.9年.57%的患者同时发生ACL破裂,所有患者均在同一坐位中接受了ACL重建.Tegner-Lysholm的平均得分为89分。平均IKDC评分为90.2。78%的人能够重返体育运动。总体失败率为10.81%。年龄增加与IKDC评分降低相关(p=0.02)。在并发ACL损伤(p=0.03)和外侧半月板撕裂(p=0.04)的患者中,Tegner-Lysholm评分明显更高。
    结论:在第一项研究中,我们证实了IKDC良好的临床效果,以回顾连续全内缝合半月板修复后的结果,Tegner-Lysholm,与其他常用技术相当的恢复播放和故障率。我们得出的结论是,这是一种可接受且具有成本效益的技术。
    BACKGROUND: The all-inside technique is now the most established treatment for meniscal repair, this usually involves a suture-based repair utilising interrupted sutures. A similar technique using continuous sutures can also be used; however there are no studies in the literature appraising this technique. This study aims to review outcomes for patients undergoing meniscal repair using a continuous suture all-inside technique.
    METHODS: We reviewed patients undergoing meniscal repair using a continuous suture all-inside technique over a 5 year period. We recorded demographic details, injury type, surgical procedure, incidence of reoperation, functional outcomes (Tegner-Lysholm and International Knee Documentation Committee (IKDC) score) return to sport and failure of repair.
    RESULTS: Data were collected for 37 patients. Mean age was 25.8 years, 81%, were male, median time to theatre was 169 days, mean follow-up time was 2.9 years. Concurrent ACL ruptures were present in 57%, all underwent ACL reconstruction in the same sitting. The mean Tegner-Lysholm score was 89. Mean IKDC score was 90.2. 78% were able to return to sport. Overall failure rate was 10.81%. Increasing age was associated with a decreased IKDC score (p = 0.02). Tegner-Lysholm score was significantly greater in patients with concurrent ACL injuries (p = 0.03) and patients with lateral meniscal tears (p = 0.04).
    CONCLUSIONS: In the first study to review outcomes following continuous all-inside suture-based meniscal repair we demonstrate excellent clinical outcomes with IKDC, Tegner-Lysholm, return to play and failure rates comparable to other commonly used techniques. We conclude that this is an acceptable and cost-effective technique.
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  • 文章类型: English Abstract
    Intraligamentous injuries to the anterior cruciate ligament (ACL) and meniscus injuries are rare in children and adolescents and often occur as a result of sports injuries. Clinically, they usually present as a hemarthrosis. The diagnosis of choice is the MRI examination. Surgical treatment of intraligamentary ACL injuries using the transphyseal technique is now also the gold standard treatment for children and adolescents, leg axis and length checks are necessary after surgery until growth is complete. Meniscus injuries are also addressed surgically. Postoperative follow-up treatment and rehabilitation are particularly important in order to prevent reinjury. The disc meniscus is a special entity and is also treated surgically if it is symptomatic. Isolated collateral ligament and posterior cruciate ligament ruptures are rarities.
    UNASSIGNED: Intraligamentäre Verletzungen des vorderen Kreuzbandes (VKB) sowie Meniskusverletzungen sind im Kindes- und Jugendalter selten und treten häufig als Folge von Sportverletzungen auf. Klinisch präsentieren sie sich meist durch ein Hämarthros. Die Diagnostik der Wahl ist die MRT-Untersuchung. Mittlerweile ist auch im Kindes- und Jugendalter die operative Versorgung von intraligamentären Verletzungen des VKB mittels der transphysären Technik der Goldstandard in der Behandlung, allerdings sind hier bis zum Wachstumsabschluss Beinachs- und -längenkontrollen notwendig. Auch Meniskusverletzungen werden operativ adressiert. Besondere Bedeutung hat die postoperative Nachbehandlung und Rehabilitation, um eine Reruptur zu vermeiden. Der Scheibenmeniskus stellt eine besondere Entität dar und wird bei Symptomatik ebenfalls operativ angegangen. Isolierte Seitenband- und HKB-Rupturen sind Raritäten.
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  • 文章类型: Journal Article
    与半月板切除术相比,半月板修复与患者的长期获益相关。作为一个概括,老年患者半月板修复不太可能成功,与年轻患者相比,导致半月板修复的采用减少。
    建立“老年”患者半月板修复的临床表现(年龄,≥40岁),并将其与“年轻”患者(年龄,<40年)。
    系统评价;证据水平,4.
    于2021年9月使用Embase和PubMed进行了系统的文献综述,以确定已发表的英语研究,这些研究报道了>5名年龄≥40岁的患者的半月板修复。感兴趣的结果是成功/失败率(由研究定义),修正半月板手术率,和患者报告的结果。荟萃分析用于综合所有老年患者研究的结果。荟萃分析还用于比较研究中老年和年轻患者之间的结果,提供两个年龄组的数据。
    确定了14项研究。老年患者半月板修复的失败率为12%(95%CI,7.3%至19.4%),半月板翻修率为9.8%(95%CI,6.2%至15.0%)。术后Lysholm评分为86.7(95%CI,81.7~91.7)。老年和年轻患者的失败率无统计学差异(相对风险[RR],0.73[95%CI,0.44至1.21];P=.2205),修正半月板手术率(RR,0.69[95%CI,0.41至1.16];P=.1613),或Lysholm分数(平均差,2.3[95%CI,-4.7至9.2];P=.5278,4项研究)。
    选定的年龄≥40岁患者的半月板修复获得了良好的成功率和患者报告的结局指标,这似乎与年龄<40岁的患者的报告相似。因此,半月板修复至少可以在“老年”患者的特定部分进行,年龄本身不应该是是否进行半月板修复的唯一决定因素。
    UNASSIGNED: Meniscal repair has been associated with long-term benefit in patients compared with meniscectomy. As a generalization, meniscal repair in older patients is less likely to be successful, leading to reduced adoption of meniscal repair compared with younger patients.
    UNASSIGNED: To establish the clinical performance of meniscal repair in \"older\" patients (age, ≥40 years) and compare it with performance in \"younger\" patients (age, <40 years).
    UNASSIGNED: Systematic review; Level of evidence, 4.
    UNASSIGNED: A systematic literature review was performed in September 2021 using Embase and PubMed to identify published English-language studies that reported on a meniscal repair in >5 patients aged ≥40 years. Outcomes of interest were success/failure rate (as defined by the study), revision meniscal procedure rate, and patient-reported outcomes. Meta-analyses were used to synthesize outcomes across all studies in older patients. Meta-analyses were also used to compare outcomes between older and younger patients across studies, providing data on both age groups.
    UNASSIGNED: Fourteen studies were identified. Meniscal repair in older patients was determined to have a failure rate of 12% (95% CI, 7.3% to 19.4%) and a revision meniscal procedure rate of 9.8% (95% CI, 6.2% to 15.0%). The postoperative Lysholm score was 86.7 (95% CI, 81.7 to 91.7). No statistically significant differences were observed between older and younger patients in failure rate (relative risk [RR], 0.73 [95% CI, 0.44 to 1.21]; P = .2205), revision meniscal procedure rate (RR, 0.69 [95% CI, 0.41 to 1.16]; P = .1613), or Lysholm scores (mean difference, 2.3 [95% CI, -4.7 to 9.2]; P = .5278, 4 studies).
    UNASSIGNED: Meniscal repair in selected patients aged ≥40 years resulted in good success rates and patient-reported outcome measures, which appear similar to those reported for patients aged <40 years. Therefore, meniscal repairs can be performed in at least a specific portion of \"older\" patients, and age per se should not be the sole determining factor in whether to perform a meniscal repair.
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  • 文章类型: Journal Article
    目的:探讨膝关节骨性关节炎(OA)患者半月板钙化的发生情况。此外,我们旨在确定钙化的具体类型:碱性磷酸钙(BCP)和二水合焦磷酸钙(CPP).
    方法:我们分析了从41名人类受试者收集的82个半月板后角样本(内侧和外侧)。其中,由于内侧间室OA,20个人接受了全膝关节置换术,而21名已故捐献者没有已知的膝关节OA。半月板钙化的评估和Pauli的组织病理学评分使用组织学切片进行。此外,使用拉曼光谱对相邻切片进行测量,以根据其不同的光谱指纹表征BCP和CPP钙化。
    结果:所有OA个体在至少一个半月板出现钙化,与9.5%(95CI1%,30%)的捐献者。在35个伴有钙化的OA半月板中,28(80%)患有BCP,5(14%)有CPP,2(6%)有两种类型。在4个供体半月板中,3(75%)患有CPP,而1(25%)患有两种类型。我们估计了Pauli评分与OA个体中BCP的存在之间的关联,每1个保利得分的比值比为2.1(95CI0.8,5.3)。Pauli评分与CPP的存在(在整个研究样本中)之间的关联似乎较弱,比值比为1.3(95CI1.1,1.7)。
    结论:在OA个体的半月板中主要存在BCP,而CPP在有和没有OA的个体中表现出相似的患病率。半月板中BCP晶体的形成可能代表OA疾病过程的重要和特定特征,值得进一步关注。
    OBJECTIVE: To investigate the occurrence of meniscal calcifications in individuals with and without knee osteoarthritis (OA). Additionally, we aim to identify the specific types of calcifications: basic calcium phosphate (BCP) and calcium pyrophosphate dihydrate (CPP).
    METHODS: We analyzed 82 meniscal posterior horn samples (medial and lateral) collected from 41 human subjects. Among them, 20 individuals underwent total knee replacement due to medial compartment OA, while 21 deceased donors had no known knee OA. The assessment of meniscal calcifications and Pauli\'s histopathological scoring was conducted using histological sections. Furthermore, adjacent sections underwent measurement using Raman spectroscopy to characterize BCP and CPP calcifications based on their distinct spectral fingerprints.
    RESULTS: All OA individuals exhibited calcifications in at least one meniscus, compared to 9.5% (95%CI 1%, 30%) of donors. Among 35 OA menisci with calcifications, 28(80%) had BCP, 5(14%) had CPP and 2(6%) had both types. In 4 donor menisci, 3(75%) had CPP while 1(25%) had both types. We estimated the association between Pauli score and presence of BCP in OA individuals, yielding an odds ratio of 2.1 (95%CI 0.8, 5.3) per 1 Pauli score. The association between Pauli score and presence of CPP (in whole study sample) seemed weaker, with odds ratio of 1.3 (95%CI 1.1, 1.7).
    CONCLUSIONS: The presence of BCP was predominant in menisci of OA individuals, whereas CPP exhibited similar prevalence in individuals with and without OA. The formation of BCP crystals in menisci may represent an important and specific characteristic of OA disease process that warrants further attention.
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  • 文章类型: Journal Article
    描述保持半月板稳定且很少讨论的人MTL(半月板胫骨韧带)的解剖学和组织学特征。
    描述性实验室研究。
    总共,解剖了六个新鲜冷冻的成年尸体,解剖方案是由两位经验丰富的解剖学教授设计的。观察MTL的解剖形态。主要解剖标本包括半月板,胫骨平台,MTL.骨凿用于切除胫骨平台的部分,可以获得包括部分弯月面的复合物,MTL,还有胫骨碎片.组织病理学研究由两名经验丰富的病理学家进行。
    宏观上,MTL可分为内侧半月板韧带(MMTL)和外侧半月板韧带(LMTL)两部分。MMTL是连续分布的,而LMTL在胫骨平台上是不连续的。从LMTL的胫骨附件到关节面的平均长度为19±1.0mm(平均值±SD)。从MMTL的胫骨附着到关节面的平均长度为10±1.2mm(平均值±SD)。MTL的显微镜检查显示MTL是韧带组织,由定向胶原纤维网络组成。
    在所有膝盖上,将MTL插入弯月面的外边缘,附着在胫骨关节软骨水平以下,这对于维持胫骨平台上生理位置的膝关节和半月板的旋转稳定性至关重要。该韧带的组织学分析表明,MTL是一种名副其实的韧带结构,由表达I型胶原的成纤维细胞组成。
    本文有助于了解MTL的解剖学和组织学特征。有利于促进MTL病变相关手术技术的发展。
    UNASSIGNED: To describe the anatomical and histological characteristics of the human MTL (meniscotibial ligament) that keeps the meniscus stable and are rarely discussed.
    UNASSIGNED: Descriptive laboratory study.
    UNASSIGNED: In total, six fresh-frozen adult cadaver knees were dissected, and the dissection protocol were designed by two experienced anatomy professors. The anatomical morphology of MTL was observed. The main anatomical specimens included meniscus, tibial plateau, MTL. The osteotome was used to excise the portion of the tibial plateau, which could obtain the complex including partial meniscus, MTL, and a tibial fragment. A histopathologic study was performed by two experienced pathologists.
    UNASSIGNED: Macroscopically, the MTL could be divided into two parts: medial meniscotibial ligament (MMTL)and lateral meniscotibial ligament (LMTL). The MMTL is distributed continuously, whereas the LMTL is discontinuous on the tibial plateau. The average length from the tibial attachment of the LMTL to the articular surface was 19 ± 1.0mm (mean ± SD). The average length from the tibial attachment of the MMTL to the articular surface was 10 ± 1.2 mm (mean ± SD). Microscopy of the MTL showed that the MTL is a ligamentous tissue, composed of a network of oriented collagenous fibers.
    UNASSIGNED: In all knees, the MTL was inserted on the outer edge of the meniscus, attaching to the tibia below the level of articular cartilage, which was key to maintaining the rotational stability of knee and the meniscus in the physiological position on the tibial plateau. Histological analysis of this ligament demonstrated that the MTL is a veritable ligamentous structure, which is made up of collagen type I-expressing fibroblasts.
    UNASSIGNED: This article contributes to the understanding of the anatomical and histological characteristics of the MTL. It is beneficial to promote the development of relevant surgical techniques for the MTL lesion.
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  • 文章类型: Journal Article
    背景:这项研究调查了新的半月板参数在四年内作为影像学膝关节骨关节炎(ROA)的预测因素的潜力,作为骨关节炎倡议(OAI)研究的一部分。
    目的:半月板参数改变的定量测量可作为OA发生和进展的预测因子。
    方法:采用嵌套匹配的病例对照研究设计从OAI研究中选择参与者。病例膝盖(n=178)定义为具有事件ROA(基线(BL)时的KellgrenLawrenceGrade(KLG)0或1,到第4年演变为KLG2或以上)。控制膝盖按性别一对一匹配,年龄和影像学状况与病例膝盖。从内侧到外侧半月板病变的平均距离[平均值(MLD)],胫骨平台宽度的平均值[平均值(TPW)]和内侧至外侧半月板病变距离的相对百分比的平均值[平均值(RMLD)]通过冠状T2加权涡轮自旋回波(TSE)MRI在P-0(X线片上发现事件ROA时就诊)进行评估,P-1(P-0前一年)和基线,分别。使用一名患者的成像数据,通过有限元分析研究了该机理。
    结果:参与者平均年龄为60.22岁,主要为女性(66.7%)和超重(平均BMI:28.15)。基线时,平均(MLD)和平均(RMLD)明显高于未发生的膝盖。P-1和P-0。[平均值(MLD),平均值(RMLD);(42.56-49.73)平均值±(7.70-9.52)mmSDvs.(38.14-40.78)平均值±(5.51-7.05)mmSD;(58.61-68.95)平均值±(8.52-11.40)mmSD与(52.52-56.35)平均值±(6.53-7.85)mmSD,分别]。基线平均值(MLD)和平均值(RMLD),[调整或,95CI:1.11(1.07至1.16)和1.13(1.09至1.17),分别],在4年内与事件ROA相关,然而,平均值(TPW)[调整后或,95CI:0.98(0.94至1.02)]在4年内与事件ROA无关。虽然P-1和P-0的平均值(TPW)与事件ROA的风险无关,P-1和P-0的平均值(MLD)和平均值(RMLD)与事件ROA的风险显著正相关。
    结论:半月板参数改变可能是预测ROA发生的重要影像学生物标志物。
    BACKGROUND: This study investigates the potential of novel meniscal parameters as predictive factors for incident radiographic knee osteoarthritis (ROA) over a span of four years, as part of the Osteoarthritis Initiative (OAI) study.
    OBJECTIVE: Quantitative measurements of meniscal parameters alteration could serve as predictors of OA\'s occurrence and progression.
    METHODS: A nested matched case-control study design was used to select participants from OAI study. Case knees (n = 178) were defined as those with incident ROA (Kellgren Lawrence Grade (KLG) 0 or 1 at baseline (BL), evolving into KLG 2 or above by year 4). Control knees were matched one-to-one by sex, age and radiographic status with case knees. The mean distance from medial-to-lateral meniscal lesions [Mean(MLD)], mean value of tibial plateau width [Mean(TPW)] and the mean of the relative percentage of the medial-to-lateral meniscal lesions distance [Mean(RMLD)] were evaluated through coronal T2-weighted turbo spin echo (TSE) MRI at P-0 (visit when incident ROA was found on radiograph), P-1(one year prior to P-0) and baseline, respectively. Using the imaging data of one patient, the mechanism was investigated by finite element analysis.
    RESULTS: Participants were on average 60.22 years old, predominantly female (66.7%) and overweight (mean BMI: 28.15). Mean(MLD) and Mean(RMLD) were significantly greater for incident knees compared to no incident knees at baseline, P-1 and P-0. [Mean(MLD), Mean(RMLD); (42.56-49.73) mean ± (7.70-9.52) mm SD vs. (38.14-40.78) mean ± (5.51-7.05)mm SD; (58.61-68.95) mean ± (8.52-11.40) mm SD vs. (52.52-56.35) mean ± (6.53-7.85)mm SD, respectively]. Baseline Mean(MLD) and Mean(RMLD), [Adjusted OR, 95%CI: 1.11(1.07 to 1.16) and 1.13(1.09 to 1.17), respectively], were associated with incident ROA during 4 years, However, Mean(TPW) [Adjusted OR, 95%CI: 0.98(0.94 to 1.02)] was not associated with incident ROA during 4 years. While Mean(TPW) at P-1 and P-0 was not associated with the risk of incident ROA, Mean(MLD) and Mean(RMLD) at P-1 and P-0 were significantly positively associated with the risk of incident ROA.
    CONCLUSIONS: The meniscal parameters alteration could be an important imaging biomarker to predict the occurrence of ROA.
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  • 文章类型: Journal Article
    在患有前交叉韧带(ACL)撕裂的成年人中,磁共振成像(MRI)扫描的骨瘀伤提供了对损伤的潜在机制的深入了解。很少有文献研究患有ACL眼泪的儿童的这些关系。
    检查并比较儿科患者接触和非接触ACL撕裂之间的骨瘀伤的数量和位置。
    队列研究;证据水平,3.
    在3个独立的机构中确定了在2018年至2022年期间接受ACL重建手术的男孩≤14岁和女孩≤12岁。合格标准要求在初次ACL撕裂后30天内详细记录损伤机制和MRI。先天性下肢异常患者,伴随骨折,后外侧角和/或后交叉韧带受伤,以前同侧膝盖受伤或手术,排除MRI扫描中明显的闭合性physes或闭合性physes.根据接触或非接触损伤机制将患者分为2组。使用脂肪抑制的T2加权图像和基于网格的胫骨股关节标测技术,对术前MRI扫描进行了回顾性审查,以确定冠状和矢状平面中是否存在骨瘀伤。
    共纳入109名患者,76例(69.7%)患者遭受非接触伤害,33例(30.3%)患者遭受接触伤害。接触组和非接触组之间的年龄没有显着差异(11.8±2.0vs12.4±1.3岁;P=.12),男性(90.9%vs88.2%;P>.99),从初次损伤到MRI的时间(10.3±8.1vs10.4±8.9天;P=.84),同时存在内侧半月板撕裂(18.2%vs14.5%;P=0.62)或外侧半月板撕裂(69.7%vs52.6%;P=0.097),和运动相关伤害(82.9%vs81.8%;P=.89)。胫骨外侧(股骨外侧髁+胫骨外侧平台)合并骨挫伤(87.9%接触vs78.9%非接触;P=.41)或胫骨内侧(股骨内侧髁[MFC]+胫骨内侧平台)合并骨挫伤(54.5%接触vs35.5%非接触;P=.064)。有接触性ACL撕裂的患者明显更有可能有位于中央的MFC瘀伤(赔率比,4.3;95%CI,1.6-11;P=.0038)并且在胫骨外侧平台的前部不太可能出现瘀伤(赔率比,0.27;95%CI,0.097-0.76;P=0.013)。
    与持续非接触式ACL撕裂的儿童相比,在术前MRI扫描中,有接触式ACL撕裂的儿童出现中央位置MFC骨瘀伤的可能性要高出4倍。未来的研究应该调查这些骨挫伤模式与儿童接触ACL撕裂患者关节软骨损伤的潜在风险之间的关系。
    In adults with anterior cruciate ligament (ACL) tears, bone bruises on magnetic resonance imaging (MRI) scans provide insight into the underlying mechanism of injury. There is a paucity of literature that has investigated these relationships in children with ACL tears.
    To examine and compare the number and location of bone bruises between contact and noncontact ACL tears in pediatric patients.
    Cohort study; Level of evidence, 3.
    Boys ≤14 years and girls ≤12 years of age who underwent primary ACL reconstruction surgery between 2018 and 2022 were identified at 3 separate institutions. Eligibility criteria required detailed documentation of the mechanism of injury and MRI performed within 30 days of the initial ACL tear. Patients with congenital lower extremity abnormalities, concomitant fractures, injuries to the posterolateral corner and/or posterior cruciate ligament, previous ipsilateral knee injuries or surgeries, or closed physes evident on MRI scans were excluded. Patients were stratified into 2 groups based on a contact or noncontact mechanism of injury. Preoperative MRI scans were retrospectively reviewed for the presence of bone bruises in the coronal and sagittal planes using fat-suppressed T2-weighted images and a grid-based mapping technique of the tibiofemoral joint.
    A total of 109 patients were included, with 76 (69.7%) patients sustaining noncontact injuries and 33 (30.3%) patients sustaining contact injuries. There were no significant differences between the contact and noncontact groups in terms of age (11.8 ± 2.0 vs 12.4 ± 1.3 years; P = .12), male sex (90.9% vs 88.2%; P > .99), time from initial injury to MRI (10.3 ± 8.1 vs 10.4 ± 8.9 days; P = .84), the presence of a concomitant medial meniscus tear (18.2% vs 14.5%; P = .62) or lateral meniscus tear (69.7% vs 52.6%; P = .097), and sport-related injuries (82.9% vs 81.8%; P = .89). No significant differences were observed in the frequency of combined lateral tibiofemoral (lateral femoral condyle + lateral tibial plateau) bone bruises (87.9% contact vs 78.9% noncontact; P = .41) or combined medial tibiofemoral (medial femoral condyle [MFC] + medial tibial plateau) bone bruises (54.5% contact vs 35.5% noncontact; P = .064). Patients with contact ACL tears were significantly more likely to have centrally located MFC bruising (odds ratio, 4.3; 95% CI, 1.6-11; P = .0038) and less likely to have bruising on the anterior aspect of the lateral tibial plateau (odds ratio, 0.27; 95% CI, 0.097-0.76; P = .013).
    Children with contact ACL tears were 4 times more likely to present with centrally located MFC bone bruises on preoperative MRI scans compared with children who sustained noncontact ACL tears. Future studies should investigate the relationship between these bone bruise patterns and the potential risk of articular cartilage damage in pediatric patients with contact ACL tears.
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  • 文章类型: Journal Article
    目的:软骨和半月板是维持膝关节健康的重要结构。在发生形态学变化之前,早期检测软骨和半月板内部成分的变化对于预防和延迟骨关节炎(OA)的发展至关重要。本研究旨在确定前交叉韧带(ACL)断裂急性期形态完整的软骨和半月板的基质组成变化,以及急性期半月板不同状态(完整或撕裂)对相邻软骨的影响。
    方法:这项横断面研究比较并分析了50例ACL断裂急性期患者,这些患者接受了手术治疗,年龄66岁,从2022年5月到2023年5月在我们机构的体重和身高匹配的健康志愿者。使用Mann-Whitney非参数t检验比较两组胫骨股关节软骨和半月板不同区域的平均T2弛豫时间和效应大小,分析不同半月板状态与相邻软骨的相关性。
    结果:在膝关节的外侧和内侧,ACL破裂组的软骨和半月板的所有亚区的T2弛豫时间均明显高于(p<0.05),损伤部位主要集中在内侧隔室(股骨,p=0.000;胫骨,p=0.000;前角,p=0.000)。在各自的隔间中,外侧半月板后角与股骨和胫骨中部软骨呈显著正相关(r=0.566,p=0.035;r=0.611,p=0.02);内侧半月板后角与胫骨后部软骨呈显著正相关(r=0.668,p=0.018)。
    结论:在ACL破裂的急性期,软骨和半月板的内部成分发生了重大变化,即使形态完好无损。更重要的是,半月板的状态显着影响相邻软骨的内部组成。这是OA的预警信号,在临床实践中应密切监测和小心管理。
    OBJECTIVE: Cartilage and meniscus are important structures that maintain the health of the knee joint. Early detection of changes in the internal components of cartilage and meniscus before morphological changes occur is essential to prevent and delay the development of osteoarthritis (OA). This study was designed to determine the changes in the matrix composition of morphologically intact cartilage and meniscus during the acute phase of an anterior cruciate ligament (ACL) rupture, as well as the effect of different states of meniscus (intact or tear) on adjacent cartilage during the acute phase.
    METHODS: This cross-sectional study compared and analyzed 50 patients in the acute phase of ACL rupture who underwent surgical treatment and 66 age-, weight- and height-matched healthy volunteers from May 2022 to May 2023 at our institution. Mean T2 relaxation times and effect sizes in different regions of tibiofemoral articular cartilage and meniscus were compared between the two groups using the Mann-Whitney nonparametric t-test, and correlations between different meniscal states and adjacent cartilage were analyzed.
    RESULTS: Both in the lateral and medial compartments of the knee, T2 relaxation times were significantly higher in all subregions of cartilage and meniscus in the ACL rupture group (p < 0.05), and the site of injury was predominantly centered in the medial compartment (femur, p = 0.000; tibia, p = 0.000; anterior horn, p = 0.000). In the respective compartments, the posterior horn of the lateral meniscus showed a significant positive correlation with the mid-cartilage of the femoral and tibial (r = 0.566, p = 0.035; r = 0.611, p = 0.02); and the posterior horn of the medial meniscus showed a significant positive correlation with the posterior tibial cartilage (r = 0.668, p = 0.018).
    CONCLUSIONS: During the acute phase of ACL rupture, the internal composition of the cartilage and meniscus undergoes significant changes, even if the morphology is intact. More importantly, the state of the meniscus significantly affects the internal composition of the adjacent cartilage. This is an early warning sign of OA, which should be closely monitored and carefully managed in clinical practice.
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  • 文章类型: Journal Article
    半月板损伤在临床环境中构成重大挑战,主要是由于组织的内在异质性和当前治疗的有限疗效。内源性细胞迁移对于愈合过程至关重要,然而,半月板细胞迁移的调节机制及其在半月板内的区域依赖性尚未完全了解。因此,这项研究调查了表观遗传机制在控制炎症条件下半月板细胞迁移中的作用,重点关注它们对损伤愈合和再生的影响。这里,我们发现一种促炎细胞因子,TNF-α处理显著阻碍了内半月板细胞的迁移速度,而半月板外细胞不受影响,强调半月板内的区域依赖性反应。我们的分析确定了不同的组蛋白修饰模式和染色质动态内和外半月板细胞在迁移过程中,强调在设计修复策略时考虑这些依赖于区域的特性的必要性。具体来说,我们发现TNF-α差异影响组蛋白修饰,特别是H3K27me3,在两种细胞类型之间。转录组分析进一步显示,TNF-α治疗诱导实质性的基因表达变化,内半月板细胞比外细胞表现出更明显的改变。基因簇分析指出染色质重塑中的不同反应,细胞外基质组装,以及带状细胞群之间的伤口愈合过程。此外,我们通过使用现有的表观遗传药物确定了潜在的治疗靶点,GSKJ4(组蛋白脱甲基酶抑制剂)和C646(组蛋白乙酰转移酶抑制剂),在炎症条件下成功恢复内半月板细胞的迁移速度。这突出了它们在治疗半月板撕裂伤方面的潜在效用。总的来说,我们的发现阐明了表观遗传机制和半月板细胞迁移之间复杂的相互作用,以及它的弯月面带状依赖性。这项研究提供了对增强半月板修复和再生的潜在目标的见解,这可能会改善半月板损伤和骨关节炎患者的临床结局。
    Meniscus injuries pose significant challenges in clinical settings, primarily due to the intrinsic heterogeneity of the tissue and the limited efficacy of current treatments. Endogenous cell migration is crucial for the healing process, yet the regulatory mechanisms of meniscus cell migration and its zonal dependency within the meniscus are not fully understood. Thus, this study investigates the role of epigenetic mechanisms in governing meniscus cell migration under inflammatory conditions, with a focus on their implications for injury healing and regeneration. Here, we discovered that a proinflammatory cytokine, TNF-α treatment significantly impedes the migration speed of inner meniscus cells, while outer meniscus cells are unaffected, underscoring a zonal-dependent response within the meniscus. Our analysis identified distinct histone modification patterns and chromatin dynamics between inner and outer meniscus cells during migration, highlighting the necessity to consider these zonal-dependent properties in devising repair strategies. Specifically, we found that TNF-α differentially influences histone modifications, particularly H3K27me3, between the two cell types. Transcriptome analysis further revealed that TNF-α treatment induces substantial gene expression changes, with inner meniscus cells exhibiting more pronounced alterations than outer cells. Gene cluster analysis pointed to distinct responses in chromatin remodeling, extracellular matrix assembly, and wound healing processes between the zonal cell populations. Moreover, we identified potential therapeutic targets by employing existing epigenetic drugs, GSKJ4 (a histone demethylase inhibitor) and C646 (a histone acetyltransferase inhibitor), to successfully restore the migration speed of inner meniscus cells under inflammatory conditions. This highlights their potential utility in treating meniscus tear injuries. Overall, our findings elucidate the intricate interplay between epigenetic mechanisms and meniscus cell migration, along with its meniscus zonal dependency. This study provides insights into potential targets for enhancing meniscus repair and regeneration, which may lead to improved clinical outcomes for patients with meniscus injuries and osteoarthritis.
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