가토에서 반월상연골판을 이용한 후십자인대 재건술에 대한 실험적연구 : An Experimntal Study in Rabbits

안진환,이은우 중앙대학교 의과대학 의과학연구소 1981 中央醫大誌 Vol.6 No.3

Clinically most of the surgical methods for reconstruction of posterior cruciate ligaments have proved not so successful and have therefore been abandoned. The reconstruction of posterior cruciate ligament using meniscus is technically simple and has theoretical advantage; meniscus is essentially avascular and receives its nourishment from the synovial fluid. But little is known about the fate and the strength of transferred meniscus. The present study was designed to observe the results of replacement ligament plasty of the posterior cruciate ligament with medial meniscus in rabbits. 37 rabbits were used as test animal. In all cases the posterior cruciate ligament of the right knee was removed and replaced by medial meniscus. The rabbits were sacrificed, and gross and microscopic changes of the transferred menisci were studied at one, two, three, four weeks, 3 and 5 months affer operation in 28 rabbits respectively. Measurement of tensile strength of operated and opposite normal knee using modified Clayton et al (1968) method were carried out at 4 weeks in 5 and 5 months in 4 rabbits. Results of the study were presented below. 1. Histologically, at two weeks, fibroblast and vessel from fibro-connective tissue invaded into the intra-articular portion of transferred meniscus. Collagen formation and realignment appeared in the transferred meniscus. At five months, the tranferred meniscus had essentially the appearance of a normal ligament except in some area having remnant of focal fibrocartilage. 2. Histologically, at 3 months, the transferred meniscus was incorporated into the femur much like the normal attachment of the posterior cruciate ligament. 3. The implanted meniscus within the substance of medial femoral condyle was accomplished by infiltration of cells from the surrounding bone marrow into degenerated meniscus, ultimately replaced by new bone. Remodeling of osseous tunnel noticed at 5 months postoperatively. 4. In all cases but one, in tensile strength test, the meniscus ruptured at its tibial attachment and did not pull loose at the femoral attachment, nor did rupture occur in the substance of the meniscus itself. 5. The percentile tensile strength of transferred menscus was averaging 23.35±1.30%, of normal posterior cruciate ligament at five months. As a result of this study, it is evident that transferred menisci rapidly incorporate to bone, become vascularized and histologically change to ligamentous structure, Therefore, the meniscus seems to be a useful substitute as a cruciate ligament.

관절경적 반월상 연골 봉합술의 결과

오정환(Jeong Hwan Oh),이미자(Mi Ja Lee),진광훈(Kwang Hoon Jin) 대한슬관절학회 2001 대한슬관절학회지 Vol.13 No.1

Purpose: The clinical outcomes of the arthroscopic meniscus repairs were reviewed retrospectively. Materials and Method: Forty six cases of arthroscopic meniscus repairs which had been performed from September 1993 to December 1998 on the basis of day surgery and followed up for a minimum of one year were analyzed retrospectively about the clinical outcomes, including age, sex, involved meniscus, duration of symptom, tear site, and the associated injuries. We arthroscopically repaired the meniscus which was detached peripherally or vertically over 1 cm in length where the inner portion is found to be salvageable at the outer one-third of the meniscus and where there is a rich blood supply that promotes healing of the torn edges, Inside-out techniques were used for the tears in the middle and posterior one- third of the mensicus and outside-in techniques for the tears in the anterior one-third of the meniscus. Repairs after partial excisions were tried for the tears of the discoid lateral meniscus if possible and the mean follow-up periods was 34 months(ranged, 12~65 months). Results: At the final follow-up evaluation, we obtained 34 cases(76.1 k) of good or excellent clinical results according to the Ikeuchi criteria among 46 arthroscopic meniscus repairs and 9 cases(19.6%) of poor results due to recurrent tears. The best clinical results(80.6%) after repairs according to the comparison of tear patterns is obtained in the longitudinal tears, and the results after repairs for the medial mensicus tears were better than that of the lateral meniscus, but poor results in the tears of the discoid lateral meniscus(64.3%) and tears with associated ligamentous injuries(73.6%), Conclusion: Arthroscopic meniscus repair is thought to be a reliable procedure and recommended if possible as the repaired meniscus gives better function than that of meniscectomy.

반월상 연골판 단독 파열군에서 하지 역학축에 대한 분석

박세진 ( Se Jin Park ),정화재 ( Hwa Jae Jeong ),신헌규 ( Hun Kyu Shin ),김유진 ( Eu Gene Kim ),최재열 ( Jae Yeol Choi ),이진명 ( Jin Myung Lee ) 대한슬관절학회 2009 대한슬관절학회지 Vol.21 No.4

Purpose: We wanted to evaluate the relationship between meniscal tear and the alignment of the lower limb. Materials and Methods: Between Oct 2006 and Jun 2008, 125 patients aged 55 year or less with isolated meniscal tear and who were examined arthroscopically were included in this study. The patients had no severe lesion (ulceration or defect) of cartilage or ligamentous injuries. 21 individuals who had no abnormal findings on MRI were selected as the control group. The patients were divided into the complete discoid lateral meniscus, incomplete discoid lateral meniscus, lateral semilunar meniscus and medial semilunar meniscus groups and they were subdivided according to gender and whether there was an obvious history of trauma. The varus percentage was defined as a percentage of the width from where the mechanical axis passes the level of the tibial articular surface to the middle of the tibial articular surface on the orthoroentgenogram of the lower leg. Each individual`s varus percentage was expressed as the mean of the measurements taken by three observers. The comparisons were done using the Wilcox Signed Ranks Test and the Mann-Whitney Test. Results: There was no significant difference between the involved knee and the contralateral normal knee in terms of the varus percentage in all the groups (p>0.05). There were no significant differences in each group according to the history of trauma, a complete discoid lateral meniscus, an incomplete discoid lateral meniscus, a lateral semilunar meniscus and a medial semilunar meniscus. However, there was a significantly greater varus percentage for the medial semilunar meniscus group without a history of trauma. Conclusion: There was a statistical relationship between tears on the medial semilunar meniscus without a history of trauma and genu varum. Tears on a complete discoid lateral meniscus, incomplete discoid lateral meniscus and lateral semilunar meniscus had a little relationship with the mechanical axis of the lower leg.

슬관절 반월상연골판의 구조 및 운동

김주오,전철홍 ( Ju O Kim,Churl Hong Chun ) 대한슬관절학회 1991 대한슬관절학회지 Vol.3 No.2

ANATOMY The medial meniscus is semicircular and is narrower than the nearly circular lateral meniscus. In prenatal period the menisci are very cellular and highly vascularized throughout the subtances. After skeletal maturity, the peripheral vascularized connec- tive tissue constitutes from outer 1/3 of the total width. This vascular zone attach the meniscus to the joint capsule and probably provides the oxygen and nutrition to the outermost portion of the meniscus. The remaining (termed the midsubstance) is made up of avascular, aneural, and alymphatic fibrocartilage consisting of cells (fibrochond- rocytes) surrounded by the abundant extracellular matrix. The extracellula matrix is composed mainly of Type 1 collagen, with small quantities of proteoglycans, matrix glycoproteins and elastin. The appearance of the fibrochondrocyte is similar to chon- drocyte, yet they synthesize a fibrocartiagenous matrix. MOVEMENTS OF THE MENISCUS Flexion causes the meniscus to slide posteriorly in the tibial plateau. Because of its tight fixation to the joint capsule and medial collateral ligament, the medial meniscus is considerably less mobile fhan the lateral meniscus. With extreme flexion the posterior horn of the medial meniscus is compressed between femur and tibia and can be injured easily. A combination af sudden uncontrolled rotation and flexion-extension motion cause the injury of the meniscus, usually longitudinal tear in the medial meniscus and transverse or langitudinal tear in the lateral meniscus.

외상 없는 젊은 환자에서 반월상 연골의 돌출

심재천(Jae-Cheon Sim),전종현(Jong-Hyun Jeon),서이락(Yi-Rak Seo),박대원(Dae-Won Park),남태석(Tae-Seok Nam) 대한정형외과학회 2018 대한정형외과학회지 Vol.53 No.5

목적: 외상력이 없는 젊은 남자의 무릎 자기공명영상을 통하여 정상적인 반월상 연골의 크기, 돌출의 정도, 동반 변형에 대해 알아보고자 하였다. 대상 및 방법: 슬관절을 제외한 타 부위의 동통을 주소로 정형외과 외래를 방문한 환자 중 연구 당시 슬관절 부위의 동통을 호소하지 않고, 슬관절 외상력이 없는 젊은 77명(91 슬관절)을 대상으로 하였다. 평균 나이는 21.6±1.1세(19-24세)였으며, 1.5Tesla magnetic resonance unit (Magneton Symphony; Siemens, Erlangen, Germany)을 이용하여 검사를 시행하였다. 이를 통하여 반월상 연골의 크기, 돌출, 돌출률, 동반 변형에 대해 알아보았다. 결과: 관상면에서 내측 반월상 연골의 평균 크기는 9.0±1.1 mm (7.1-11.9 mm), 돌출의 정도는 2.0±1.0 mm (0-4.4 mm), 반월상 연골 돌출률(돌출 크기/전체 크기×100)은 22.7%±11.5% (0%-53.7%)였다. 내측 반월상 연골의 돌출은 관상면과 시상면에서 각각 92.3%, 80.2%에서 관찰되었다. 관상면에서 외측 반월상 연골의 평균 크기는 11.1±3.4 mm (7.3-22.9 mm), 돌출의 정도는 0.5±0.7 mm (0-2.5 mm), 반월상 연골 돌출률은 4.0%±6.7% (0%-26.3%)였다. 외측 반월상 연골의 돌출은 관상면에서 34.1%에서 관찰되며, 시상면에서는 관찰되지 않았다. 결론: 외상 없는 젊은 환자의 자기공명영상 검사에서 반월상 연골의 돌출은 흔히 관찰되며, 외측보다 내측에서 더 흔하게 관찰된다. Purpose: The aim of this study was to assess the size and extrusion of the meniscus in young and non-traumatic knees, especially in Korean males. Materials and Methods: The participants (n=91 knees, 77 patients) were consecutive patients observed at an orthopedic outpatient clinic who had another problem unrelated to the knee joint. The patients were excluded from the study if they had a history of trauma and pain on the knee joint. The patients received a magnetic resonance imaging (MRI) scan on the knee joint. The size, extrusion, and extrusion ratio of the meniscus on an MRI scan were evaluated. Results: The mean age of the participants was 21.6±1.1 years (range, 19-24 years). The mean size of the medial meniscus on the coronal plane was 9.0±1.1 mm (range, 7.1-11.9 mm). The extent of extrusion on the coronal plane was 2.0±1.0 mm (range, 0-4.4 mm). The extrusion ratio (extruded size/total size×100) of the medial meniscus on the coronal plane was 22.7%±11.5% (range, 0%-53.7%). The extent of extrusion on the sagittal plane was 1.6±1.1 mm (range, 0-4.0 mm). The extrusion ratio (extruded size/total×100) of the medial meniscus on the sagittal plane was 18.0%±11.9% (range, 0%-40.7%). The incidence of medial meniscal extrusion on the coronal and sagittal plane are 92.3% and 80.2%, respectively. The mean size of lateral meniscus on the coronal plane was 11.1±3.4 mm (range, 7.3- 22.9 mm). The extent of extrusion on the sagittal plane was 0.5±0.7 mm (range, 0-2.5 mm). The extrusion ratio of the lateral meniscus on the sagittal plane was 4.0%±6.7% (range, 0%-26.3%). The incidence of lateral meniscal extrusion on the coronal plane was 34.1%. No extrusion of the lateral meniscus was observed on the sagittal plane. Conclusion: In young and non-traumatic knees, the extrusion of meniscus was common, especially medial meniscus than lateral meniscus.

슬관절 관절경으로 확인한 슬관절 반월상 연골의 손상양상

정현기,최충혁,한희석 ( Hyun Kee Chung,Choong Hyeok Choi,Hee Seok Han ) 대한슬관절학회 1995 대한슬관절학회지 Vol.7 No.2

The authors reviewed the result of I.D.K. patients, treated by arthroscopic surgery from November, 1987 to May 1995. We analysed 410 meniscus tears according to tear type, location and combined ligament injuries. The analyzed results are summerized as follows: 1. The male to female ratio in menisca1 tear incidence was 2.2:1 but the meniscal tear incidence was more frequent iq female than male patients over 50 years old and the age of l6 to 30 years old patients occupied about a half of peniscal tear cases. 2. The lateral meniscal injury was more frequeint than medial meniscus. In lateral meniscus, the predominant types qf meniscal tear were c6mplex aad flap type tear, and the major sites of meniscal tear were nod-poaterior portion and posterior horn of menkscus. In medial meniscus, tbe dominant types were also complex and Aap type, and main tear sit were entire, middle portion and mid-posterior portion of meniscus. 3. Both meniscal tears were detected in 38 cases(9.3% of menical tear cases), In these cases, the predominant meniscal tear types were cornplex and flap tear on posterior horn of medial meniscus and on mid-portion of lateral meniscus. 4. We found 79 cases discoid meniscal tears(34% of latcral meniscal tear cases) which were afl lateral discoid meniscus. The major tear types were complex and longitudinal tear, and the predominant sites of menisca1 tear were entire, ant.-middle and mid-posterior portion of latcra1 discaid meniscus. 5. The meniscal tear with anterior cruciate ligament injury was rnore frequent in chronic anterior cruciate ligament injury than acute injury. In meniscal tear combined with chronic anterior cruciate ligament injury, the main tear types were complex and flap type tear, and the dominant tear sites were mid-posterior and posterior horn of meniscus. 6. The meniscal tear with collatera1 ligament injury was found in 10 cases and 9 cases were occurred in association with acute coliateral ligament injury. 7. The meniscal tear eombined with anterior cruciate ligament and medial collateral ligament injury was developed in 6 cases and 5 cases was oecurred in acute ligament injury. And we experienced 5 cases of anterior cruciate and medial collateral ligament injury with no meniscal tear.

원판형 연골에서 단순 방사선 검사의 의의

안진환,하권익,김형국,김호,Ahn Jin Hwan,Ha Kwon Ick,Kim Hyung Kook,Kim Ho 대한관절경학회 1997 대한관절경학회지 Vol.1 No.1

Discoid meniscus has been well known to a frequent anomaly of meniscus and much reported in diagnosis and treatment. But, associated X-ray findings have not been known well. We reported its significance of X-ray findings in discoid meniscus. From May 1995 to May 1997, 31 cases of discoid meniscus were compared with 51 cases of nondiseoid meniscus both confirmed by arthroscopy, with simple X-my findings. Both groups were evaluated by X-ray findings in view of lateral joint space widening, peripheral spur of lateral joint space, sclerotic change of lateral tibial plateau, concave lateral tibial plateau, flattening of lateral femoral condyle, hypoplasia of lateral femoral condyle and high riding fibula. The results of analysis were as follows: 1. Widening of lateral joint space, sclerotic change of lateral tibial plateau and cupping of lateral tibial plateau were statistically significant in discoid meniscus. 2. X-ray findings in discoid meniscus were not associated with patient's injury history and symptom duration. 3. Other X-ray findings were not related in discoid meniscus significantly. X-ray findings with patient's history and physical examination arc helpful in the diagnosis of discoid meniscus.

Displaced Double-Layered Lateral Meniscus That Mimicked the Bucket-Handle Tear: a Case Report

곽민지,김선기,김기준,이범식,강준 대한자기공명의과학회 2016 Investigative Magnetic Resonance Imaging Vol.20 No.3

Among the various types of congenital meniscal anomalies, the double-layered lateral meniscus is extremely rare. The double-layered meniscus consists of both the upper additional and the lower normal meniscus. As the upper additional meniscus is mobile, it can be easily displaced, while the lower lateral meniscus is usually normal in shape and volume. A 42-year-old woman suffering from pain and locking of her left knee underwent Magnetic resonance imaging (MRI) examination and an arthroscopic surgery. A rare meniscal abnormality was seen in her left knee, which presented as a double-layered lateral meniscus with displacement. It was remarkable that the upper additional meniscus was displaced over the intercondylar eminence of the tibia and it mimicked a bucket-handle tear. Even though it is rare, it is necessary to consider the possibility of displaced double-layered meniscus in the differential diagnosis of a bucket-handle tear. Here, we report the MRI and arthroscopic findings of a displaced double-layered lateral meniscus, which was similar to the bucket-handle tear.

Displaced Double-Layered Lateral Meniscus That Mimicked the Bucket-Handle Tear: a Case Report

Kwak, Min Jee,Kim, Sun Ki,Kim, Ki Jun,Lee, Bum-Sik,Kang, Jun Korean Society of Magnetic Resonance in Medicine 2016 Investigative Magnetic Resonance Imaging Vol.20 No.3

Among the various types of congenital meniscal anomalies, the double-layered lateral meniscus is extremely rare. The double-layered meniscus consists of both the upper additional and the lower normal meniscus. As the upper additional meniscus is mobile, it can be easily displaced, while the lower lateral meniscus is usually normal in shape and volume. A 42-year-old woman suffering from pain and locking of her left knee underwent Magnetic resonance imaging (MRI) examination and an arthroscopic surgery. A rare meniscal abnormality was seen in her left knee, which presented as a double-layered lateral meniscus with displacement. It was remarkable that the upper additional meniscus was displaced over the intercondylar eminence of the tibia and it mimicked a bucket-handle tear. Even though it is rare, it is necessary to consider the possibility of displaced double-layered meniscus in the differential diagnosis of a bucket-handle tear. Here, we report the MRI and arthroscopic findings of a displaced double-layered lateral meniscus, which was similar to the bucket-handle tear.

High incidence of subsequent re-operation following treatments for medial meniscus tears combined with anterior cruciate ligament reconstruction: second-look arthroscopic study

( Sang-gyun Kim ),( Soo-hyun Kim ),( Jung-heum Baek ),( Jae-gyoon Kim ),( Ki-mo Jang ),( Hong-chul Lim ),( Ji-hoon Bae ) 대한슬관절학회 2019 대한슬관절학회지 Vol.31 No.1

Background: The Multicenter Orthopaedic Outcomes Network (MOON) group recently reported that medial meniscus (MM) repairs are associated with more frequent re-operations when compared to lateral meniscus (LM) repairs. The purpose of this study was to compare the meniscal healing and the incidence of subsequent reoperation of medial and lateral meniscal tears that occurred concurrently with anterior cruciate ligament (ACL) injuries. Methods: We retrospectively reviewed patients who underwent second-look arthroscopy after primary ACL reconstruction (ACLR) between June 2005 to December 2016. The healing of meniscal tears following repair or left in situ, and re-tear following partial meniscectomy, were evaluated via second-look arthroscopy and compared between medial and lateral meniscus. Moreover, the incidence of subsequent meniscal re-operation after the index ACLR were investigated and compared between medial and lateral meniscus. Subsequent meniscal re-operation was performed in cases of the following three symptomatic meniscus tears: re-tears at the meniscectomy site; new tears; and failed healing of repaired or left in situ meniscus. Results: There were 148 meniscal tears in 121 patients at index ACLR. There were 62 MM tears, 38 LM tears, and 24 bilateral meniscus tears. At second-look arthroscopy, the “successful healing” rate for tears following repair was higher in LM tears (91.2%) compared to MM tears (80.0%), although it was not statistically significant (p > 0.05). No significant differences were observed in the healing of left in situ tears or re-tear of meniscectomy site between medial and lateral meniscus. Patients with MM tears combined with ACL injuries had a higher incidence of subsequent meniscal re-operation compared to patients with LM tears (25.6% vs 16.1%, p = 0.025). Conclusions: There was a trend for the successful healing rate to be higher in LM repairs than MM repairs. Subsequent meniscal re-operations after ACLR were more frequent in patients with medial meniscal tears concurrently with ACL injuries in comparison to patients with lateral meniscal tears. Level of study: Level IV, retrospective case series.