ObjectiveTo explore the application value and operation skills of arthroscopic automatic reverse guide wire passer (hereinafter referred to as wire passer) in the posterior meniscus root reconstruction. Methods Between August 2015 and December 2020, 36 patients with posterior meniscus root tears were admitted. There were 16 males and 20 females, with an average age of 46 years (range, 26-66 years). There were 15 cases of sports injury and 21 cases of degenerative injury. The disease duration was 3-180 days, with a median of 28 days. The posterior root of the medial meniscus was injured in 29 cases, and the posterior root of the lateral meniscus was injured in 7 cases. The preoperative Lysholm score of the knee joint was 47.6±3.9, and the International Knee Score Committee (IKDC) score was 39.3±3.0. The meniscus was sutured by using wire passer under arthroscopy. During operation, the suture operation was evaluated according to the self-defined evaluation standard. Lysholm score and IKDC score were used to evaluate knee joint function. Results All meniscuses were sutured successfully by using wire passer. The operation time of suture was 5-15 minutes, with an average of 10 minutes. According to the self-defined evaluation standard, the suture operation was scored as 0-10, with an average of 5. After operation, except for 2 cases of incision fat liquefaction, the incisions of the other patients healed by first intention. All patients were followed up 1-3 years, with an average of 1.5 years. The Lysholm score was 88.2±2.1 and the IKDC score was 51.7±2.3 at 1 year after operation, showing significant difference when compared with preoperative ones (P<0.001). Fifteen cases underwent MRI re-examination, the results showed that the continuity and integrity of the posterior root had been restored. Conclusion Under arthroscopy, the wire passer for the posterior meniscus root reconstruction has the advantages of simple operation, reliable suture quality, and shorter operation time.
Objective To summarize the current research progress on the concept, clinical presentation, diagnosis, biomechanical changes, and pathological mechanisms of the medial meniscus posterior root tear (MMPRT), and its clinical correlations with tibial rotation. MethodsThe research literature on MMPRT and its relationship with tibial rotation at home and abroad in recent years was extensively consulted and summarized. Results MMPRT is a specific and common type of medial meniscus injury of the knee joint. The occurrence of posterior medial pumping pain events following low-energy trauma in patients provides important clues for the diagnosis of this injury, with MRI being the preferred imaging modality. The biomechanical effects generated by MMPRT are similar to those caused by total removal of the medial meniscus. And this injury is usually associated with tibial rotation. MMPRT induces pathological external rotation of the tibia, which can be restored by timely medial meniscus posterior root repair. Furthermore, changes in tibial rotation are related to the healing status after medial meniscus posterior root repair. ConclusionMMPRT is closely related to tibial rotation. Understanding the biomechanics, pathological mechanisms, and clinical correlations between the two is of great significance for improving the diagnosis and treatment strategies.
Objective To investigate the short-term effectiveness of high tibial osteotomy (HTO) for treatment of middle aged and older populations with varus knee combined with medial meniscus posterior root tear (MMPRT), and to evaluate the biomechanical changes in the knee joint after operation based on finite element analysis. Methods A retrospective analysis of clinical data was conducted on 35 patients (35 knees) admitted between June 2021 and October 2023, who met the inclusion criteria for varus knee combined with MMPRT. There were 17 males and 18 females with a mean age of 59.2 years (range, 48-65 years). Open wedge HTO was performed to correct the alignment in all patients. X-ray films and MRI were conducted before operation and at 3, 6, and 12 months after operation to assess changes in lower limb alignment and joint structure. And the femorotibial angle, medial proximal tibial angle (MPTA), posterior tibial slope angle (PTSA), weight-bearing line ratio (WBLR), as well as the Lysholm score, Hospital for Special Surgery (HSS) score, and visual analogue scale (VAS) score for pain were compared between pre- and post-operation. Finite element models were reconstructed based on knee CT data from a healthy volunteer to simulate changes in stress distribution at the knee joint before and after HTO, and to analyze postoperative mechanical improvement characteristics. Results All 35 patients underwent successful operations. Postoperatively, 3 cases of incisional fat liquefaction and 2 cases of mild superficial wound infection occurred; no complication such as deep vein thrombosis of the lower extremities, severe infection, or neurovascular injury was observed. All patients were followed up 12-14 months (mean, 13.0 months). Imaging reexamination revealed that all osteotomies had achieved radiographic union, with no complication such as osteotomy loss, significant collapse, or plate fracture. At 12 months after operation, the femorotibial angle, MPTA, WBLR, and PTSA were all significantly higher than preoperative levels (P<0.05). Compared with preoperative values, the Lysholm score and HSS score gradually increased, while the VAS score decreased at 3, 6, and 12 months, with significant differences between different time points (P<0.05). Finite element analysis showed that the stress distribution in the medial and lateral compartments of the knee joint tended toward equilibrium after HTO. Medial cartilage contact stress decreased by approximately 40% compared to preoperative levels, and stress concentration in the medial meniscus was significantly reduced. Conclusion HTO can significantly alleviate knee pain in middle aged and older populations with varus knee combined with MMPRT, improve the distribution of knee joint forces, and promote the recovery of joint function.