The Degeneration of Meniscus Roots Is Accompanied by Fibrocartilage Formation, Which May Precede Meniscus Root Tears in Osteoarthritic Knees

Park, Do Young,Min, Byoung-Hyun,Choi, Byung Hyune,Kim, Young Jick,Kim, Mijin,Suh-Kim, Haeyoung,Kim, Joon Ho SAGE Publications 2015 AMERICAN JOURNAL OF SPORTS MEDICINE - Vol.43 No.12

<P><B>Background:</B></P><P>Fibrocartilage metaplasia in tendons and ligaments is an adaptation to compression as well as a pathological feature during degeneration. Medial meniscus posterior roots are unique ligaments that resist multidirectional forces, including compression.</P><P><B>Purpose:</B></P><P>To characterize the degeneration of medial meniscus posterior root tears in osteoarthritic knees, with an emphasis on fibrocartilage and calcification.</P><P><B>Study Design:</B></P><P>Cross-sectional study; Level of evidence, 3.</P><P><B>Methods:</B></P><P>Samples of medial meniscus posterior roots were harvested from cadaveric specimens and patients during knee replacement surgery and grouped as follows: normal reference, no tear, partial tear, and complete tear. Degeneration was analyzed with histology, immunohistochemistry, and real-time polymerase chain reaction. Uniaxial tensile tests were performed on specimens with and without fibrocartilage. Quantifiable data were statistically analyzed by the Kruskal-Wallis test with the Dunn comparison test.</P><P><B>Results:</B></P><P>Thirty, 28, and 42 samples harvested from 99 patients were allocated into the no tear, partial tear, and complete tear groups, respectively. Mean modified Bonar tendinopathy scores for each group were 3.97, 9.31, and 14.15, respectively, showing a higher degree of degeneration associated with the extent of the tear (<I>P</I> < .05 for all groups). The characterization of root matrices revealed an increase in fibrocartilage according to the extent of the tear. Tear margins revealed fibrocartilage in 59.3% of partial tear samples and 76.2% of complete tear samples, with a distinctive cleavage-like shape. Root tears with a similar shape were induced within fibrocartilaginous areas during uniaxial tensile testing. Even in the no tear group, 56.7% of samples showed fibrocartilage in the anterior margin of the root, adjacent to the meniscus. An increased stained area of calcification and expression of the ectonucleotide pyrophosphatase/phosphodiesterase 1 gene were observed in the complete tear group compared with the no tear group (<I>P</I> < .0001 and <I>P</I> = .24, respectively).</P><P><B>Conclusion:</B></P><P>Fibrocartilage and calcification increased in medial meniscus posterior roots, associated with the degree of the tear. Both findings, which impair the ligament’s resistance to tension, may play a pivotal role during the pathogenesis of degenerative meniscus root tears in osteoarthritic knees. Fibrocartilage and calcification may be useful as diagnostic markers as well as markers of degeneration, which may aid in determining the treatment modality in meniscus root tears. The presence of fibrocartilage in intact roots may suggest an impending tear in osteoarthritic knees.</P>

삼각섬유연골 복합체 척골와 파열의 수술 기법: 관절경을 통한 비매듭성 봉합술

김재광,김재광 대한수부외과학회 2014 대한수부외과학회지 Vol.19 No.2

Knotless repair of triangular fibrocartilage complex has several advantages. All procedures for triangular fibrocartilage complex repair could be done under arthroscopy in this technique. In addition, this technique allows for repair of deep layers of triangular fibrocartilage complex down to fovea of the ulnar head. This article describes arthroscopic repair of the Palmer type 1B triangular fibro- cartilage complex tear using arthroscopic knotless technique. 비매듭성 봉합은 삼각섬유연골 복합체 파열의 치료에 몇 가지 장점이 있는데, 봉합을 위한 모든 과정을 관절경하에서시행하는 것이 가능하고 삼각섬유연골 복합체의 심부 파열 시 척골와에 직접 봉합하는 것이 가능하다. 본 논문은 삼각섬유연골 복합체가 Palmer type 1B의 형태로 척골와에서 파열 시 비매듭성 봉합 나사못을 이용한 수술적 봉합 방법에대해 기술하고자 한다.

삼각섬유연골 복합체에 발생한 결절종 - 1예 보고 -

이상선,박종석,박성용,김준범 대한수부외과학회 2011 대한수부외과학회지 Vol.16 No.1

결절종은 수부와 완관절에서 흔한 연부 조직 양성 종물로 전형적으로 요수근 관절의 배부에 생기면서 통증을 유발하기도 한다. 저자들은 삼각섬유연골 복합체에 발생한 결절종을 관절경을 이용하여 수술적 치료를 경험하였기에 보고하고자 한다. Ganglions are the most common mass occurred in the wrist and hand. Ganglion usually arises from the dorsal aspect of the radiocarpal joint that may lead to the wrist pain. We report a patient with a ganglion of the triangular fibrocartilage complex. Using arthroscopic technique, ganglion located in triangular fibrocartilage complex was successfully excised.

삼각섬유연골 복합체 손상 치료의 최신 경향

김병성 대한수부외과학회 2013 대한수부외과학회지 Vol.18 No.2

The Palmer class 1B triangular fibrocartilage complex injury has two entities: a lesion with stable distal radioulnar joint and a lesion with distal radioulnar joint instability. Arthroscopic debridement of fibrocartilage disk is used in Palmer class 1A lesion. The surgeon should remove the portion of the fibrocartilage tissue until a mechanically stable and smooth residual rim remains. Arthroscopic repair is used in Palmer class 1B or 1D lesion using meniscal repair sutures. Ulnar detachment that can produce distal radioulnar ligament instability can also be repaired using bone anchor or pull out suture. Old age as well as positive ulnar variance is poor prognostic factors. 삼각섬유연골 복합체 외상성 병변 Palmer class 1B 병변은 원위 요척 관절 불안정을 유발 할 수 있는 불안정형 병변과원위 요척관절 불안정을 유발하지 않는 안정형 병변으로 구분된다. 섬유연골 디스크의 관절경적 변연절제술은 Palmer class 1A 병변에 사용되고, 관절경적 봉합술은 Palmer class 1B나, 드물게 1D 병변에서 사용된다. 원위 요척 관절 불안정을 유발할 수 있는 척측부 견열 손상의 경우는 suture anchor를 이용한 고정이나 끌어내기 봉합이 유용하다. 척골양성 변이가 있거나 고령이라면 봉합술 결과가 불량할 수 있으므로 수술 선택에 신중을 기울여야 한다.

삼각섬유연골 복합체 척골두 와 부착부 파열의 수술 방법: 관절경적 척골관통 봉합술

박종웅 대한수부외과학회 2014 대한수부외과학회지 Vol.19 No.2

As the importance of the foveal attachment of the triangular fibrocartilage com- plex (TFCC) on the stability of the distal radioulnar joint (DRUJ) is emphasized, the traditional repair techniques such as arthroscopic capsular repair for the 1B TFCC tear become accepted as ineffective method for treating DRUJ instability. Recently, several techniques which repair the TFCC directly to the ulnar fovea have been developed and introduced. Further advances of the techniques will be expected with increasing knowledge of the anatomy and biomechanics of the TFCC and DRUJ. Regardless of the techniques, fundamental principle of anatomical repair of the TFCC to the ulnar fovea is utmost important. Herein we present our technique of arthroscopic transosseous repair by making a drill hole in the ulnar and securing the sutures with Pushlock anchors. 최근 삼각섬유연골 복합체(triangular fibrocartilage complex, TFCC)의 해부학 및 원위 요척관절의 불안정성에 관여하는 근위 TFCC의 척골두 와 부착부의 중요성이 강조되면서 원위 요척관절의 불안정을 동반한 TFCC 파열의 수술적 치료 시 과거와 같이 경상돌기 부착부, 즉 윈위 TFCC 파열만 관절막에 봉합하는 방법은 더 이상 원위 요척관절의안정성을 회복하기 어려운 것으로 인정되고 있다. 원위 요척관절의 불안정을 동반한 Palmer 1B의 근위 TFCC 파열의수술 방법은 과거 여러 가지 수술 방법이 소개된 바 있고 각 수술법을 행함에 있어서도 술자마다 다양한 변형된 수술 방법을 구사할 수 있다. 향후 TFCC의 기능과 해부학, 원위 요척관절의 생역학에 대한 심층적 연구와 함께 다양한 수술방법의 진화가 기대된다. 하지만 어떤 방법을 사용하든 수술의 가장 중요한 목표는 파열된 부분을 원래 해부학적 위치인 척골두 와에 정확히 부착시킴으로써 파열전의 상태와 가장 가깝게 치유되게 하는 것임에는 이견이 없을 것이다. 본종설에서는 관절경하에서 척골을 통과하여 척골두 와의 등척부에 골관통 구멍을 만든 후 근위 TFCC의 척골두 와 부착부위를 봉합하는 관절경적 골관통 봉합법(arthroscopic transosseous suture repair)을 소개하고자 한다.

삼각 섬유연골 복합체 부분 파열에 대한 관절강내 봉약침 시술 치험 1례

이광호,유영진,선승호,권기록,Lee, Kwang-Ho,Ryu, Young-Jin,Sun, Seung-Ho,Kwon, Ki-Rok 대한약침학회 2009 Journal of pharmacopuncture Vol.12 No.4

Objective: This case was to report a case of Partial Tear of Triangular Fibrocartilage Complex treated by Intra-articular bee venom Pharmacopuncture. Methods: The patient was treated by Intra-articular bee venom Pharmacopuncture. The Effect of Treatment was evaluated by Visual Analog Scale(VAS) and Modified Mayo Wrist Score(Wrist Score). Results & Conclusions: After Treatment, Patient's VAS decreased and Wrist Score increased. For this results, Intra-articular Bee Venom Pharmacopuncture may be effective for Partial Tear of Triangular Fibrocartilage Complex.

가토의 외상성 슬관절염의 자연적 치유 경과에 대한 고찰

김동헌,장병춘,김상윤,김동혁 건국대학교 의과학연구소 1998 건국의과학학술지 Vol.8 No.-

Articular cartilage is a highly differentiated tissue, lacking a vascular supply and having only limited regenerative capability. It has been well documented that articular cartilage of mature animals has little capacity for repair after traumatic injury. Cuts or other mechanical damage restricted to the cartilage alone do not repair. However, it has been observed both experimentally and clinically that articular defects extending to the subchondral bone eventually are resurfaced with a form of fibrous, fibrocartilagenous or hyaline like cartilagenous tissue. Author's study was designed to evaluate the healing process of osteochondral defect of the knee of rabbit. Partial thickness defect of cartilge and full thickness osteochondral defect of 30 rabbits were made with 3mm diameter of drill-bit. Experimental animals were divided into three groups : 1) Group Ⅰ: Control group 2) Group Ⅱ: Partical cartilage defect group 3) Group Ⅲ: Osteochondral defect group The healing of the defect was assessed at 1weeks, 3weeks, 5weeks, 12weeks after operation by gross and histological examination. The principal findings were as follows. 1. The initial formation of repair tissue was variable, but it ocurred in most cases. 2. In partial cartilage defect group, degenerative change was more severe. 3. There is evidence of healing of small (1-4 mm diameter) but not of large full thickness articular defect. 4. Microscopically, resurfacing of the cartilage holes repaired mainly with fibrocartilage at 5 weeks of injury.

비매듭 봉합 나사못을 이용한 삼각섬유연골 복합체 1B형 파열의 All-inside 관절경하 봉합술의 단기 추시 결과

박용철,서창영,김명선,김종석,심상규,이진호 대한수부외과학회 2013 대한수부외과학회지 Vol.18 No.2

목적: 비 매듭 봉합 나사못을 이용한 Palmer 분류 1B형 삼각섬유연골 복합체 파열의 관절경하 봉합술의 단기 추시 결과를 알아보고자 하였다. 방법: 관절경하 삼각섬유연골 복합체 봉합술을 시행하고 3개월 이상 추시가 가능하였던 23명을 대상으로 하였다. 평균추시 기간은 6.6개월(범위, 3-10개월)이었으며 평균 연령은 36.3세(범위, 16-48세)였다. 증상 발현부터 내원까지 기간은평균 10.9개월(범위, 1주-7년)이었다. 관절경 소견상 Palmer 1B형 15예, 1B 및 1D형 2예, 1B 및 2C형은 6예였으며, 모두 hook test 양성이었다. 동반 병변은 주상-월상 인대 손상 16예(69.6%), 월상-삼각 인대 손상 10예(43.5%), 척골 경상돌기 불유합 2예, 척측 결절종이 2예 존재하였다. 삼각섬유연골 복합체 파열에 대해 관절경하 비매듭 봉합 나사못을 이용한 봉합을 시행하였고, 2예의 1D 파열에 대해 부분 절제술을, 6예의 2C 병변에 대해서는 원위 척골 부분 절제술을 시행하였다. 주상-월상 인대 손상 16예 가운데 Geissler 분류상 3도가 7예, 2도가 9예였으며, 3도 손상은 관절경하 봉합을 6예 시행하였고, 2도 손상은 4예에서 관절경하 봉합술을 시행하였다. 결과: Mayo modified wrist score로 평가하였다. 우수 4예, 양호 14예, 보통 5예로 18예(78.3%)에서 양호 이상의 결과를 보였다. 19예(82.6%)에서 직장이나 취미 생활로 복귀가 가능하였다. 결론: Palmer 분류 1B형의 삼각섬유연골 복합체 손상에 대한 비매듭 봉합 나사못을 이용한 관절경하 봉합술은 비교적좋은 결과를 얻을 수 있는 술기이며, 동반 손상에 대한 적절한 조치가 필요할 것으로 생각된다. Purpose: We studied the short term results of the arthroscopic repair of 1B type triangular fibrocartilage complex (TFCC) tear using a knotless suture anchor. Methods: We evaluated 23 patients who underwent all-inside arthroscopic TFCC repair using a knotless suture anchor. The average follow-up duration was 6.6 months (range, 3-10 months). Mean duration of symptom was 10.9months (range, 1 week-7 years). The arthroscopic finding documented 15 type 1B, 2 1B with 1D, and 6 1B with 2C lesions. All showed the positive hook test. The concomitant pathologies were 16 scapholunate injuries and 10 lunotriquetral injuries. TFCC tears were repaired by the knotless suture anchor. The Wafer procedure was done for 2C lesions. Results: According to Mayo modified wrist score, the result was excellent in 4,good in 14 and fair in 5. Nineteen patients (82.6%) could return to his job or hobby. Conclusion: The all-inside arthroscopic repair using knotless suture anchor for TFCC 1B tear can provide good results. The appropriate management should be done for the concomitant pathologies for the better results.

삼각섬유연골 복합체 스포츠 손상에 대한 한방 복합 침치료 시술 치험 1례

전세환(Se Hwan Jeon),조용규(Yong Kyu Cho),강병구(Byeong Gu Gang),고원일(Won Il Koh),이근재(Keun Jae Lee),윤영석(Young Suk Yoon) 대한스포츠한의학회 2018 대한스포츠한의학회지 Vol.18 No.1

Objective This case was to report a case of sports injury of Triangular Fibrocartilage Complex(TFCC) by combined acupuncture treatment. Methods The Patient was treated by combined acupuncture treatment consisted of acupuncture, pharmacopuncture, electroacupuncture, in-frared irradiation therapy. Treatment was evaluated by Numeric Rating Scale(NRS). Results & Conclusions After Treatment, Patient s NRS decreased and Patient can do sports activity like before injury. Combined acupuncture treatment may be effective for sports injury of TFCC.

관절경을 이용한 삼각섬유연골 복합체 봉합 기법에 대한 고찰

가인호(In Ho Ga),차수민(Soo Min Cha),신현대(Hyun Dae Shin) 대한정형외과학회 2024 대한정형외과학회지 Vol.59 No.3