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Discoid meniscus is a congenital morphological variant of the meniscus, which tends to occur more frequently in its lateral form than in the medial form. This anomaly is characterized by central hypertrophy of the meniscus and a larger diameter than the normal meniscus, resulting in an abnormal shape and greater coverage of the tibial plateau. The clinical presentation of this condition varies depending on the stability of the meniscus. In pediatric patients, in particular, it is common to experience progressive and atraumatic symptoms, such as pain and limited mobility. Diagnosis is based on imaging studies, with magnetic resonance imaging being the preferred tool, where the "bowtie sign" is a classic finding. Surgery is recommended for symptomatic patients, with a focus on preserving the peripheral portion of the meniscus. Saucerization is the most commonly used technique, followed by stability assessment to determine if additional procedures are required. In this case, a 9-year-old patient with a medial discoid meniscus presented symptoms following trauma. Despite this atypical presentation, a successful outcome was achieved through arthroscopic surgery, underscoring the importance of accurate diagnosis and proper management of this condition in pediatric patients. Understanding the anatomical and pathophysiological characteristics of the discoid meniscus is essential for an effective therapeutic approach.

El menisco discoide es una variante morfológica congénita del menisco, que suele presentarse con mayor frecuencia en su forma lateral que en la medial. Esta anomalía se caracteriza por la hipertrofia central del menisco y un diámetro mayor que el menisco normal, lo que resulta en una forma anormal y una mayor cobertura del platillo tibial. La presentación clínica de esta condición varía según la estabilidad del menisco. En pacientes pediátricos, en particular, es común experimentar síntomas progresivos y atraumáticos, como dolor y limitación de la movilidad. El diagnóstico se basa en estudios de imagen, siendo la resonancia magnética la herramienta preferida, donde el "signo del corbatín" es un hallazgo clásico. Se recomienda la cirugía para pacientes sintomáticos, con un enfoque en preservar la porción periférica del menisco. La saucerización es la técnica más utilizada, seguida de la evaluación de la estabilidad para determinar si se requiere un procedimiento adicional. En el presente caso, se describe a un paciente de nueve años con un menisco discoide medial que manifestó síntomas después de un traumatismo. A pesar de esta presentación atípica, se logró un resultado exitoso mediante una cirugía artroscópica, lo que resalta la importancia de un diagnóstico preciso y un manejo adecuado de esta condición en pacientes pediátricos. La comprensión de las características anatómicas y patofisiológicas del menisco discoide es esencial para un enfoque terapéutico efectivo.

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INTRODUCTION: all-in meniscal suture devices have evolved and simplified meniscal repair. In this study we will formulate the following research questions: what is the rate of survival and failure? What are the risk factors associated with failure? And what are the functional results after meniscal repair surgery? MATERIAL AND METHODS: ambispective study from 2001 to 2021 of patients with repairable meniscal injury with all-in meniscal suture devices. The survival and failure ratio were obtained with the Kaplan-Meier test, the risk factors associated with meniscal suture failure were assessed with the logistic regression test, and the pre- and post-surgical functional results were estimated with the test. t-Student. RESULTS: in 20 years of follow-up of 316 menisci repaired with all-in meniscal sutures, a survival rate of 95.9% was obtained. The absence of injury to the anterior horn of the meniscus was shown to be a protective factor [OR = 0.12], together with not practicing impact sports [OR = 0.2]. Post-surgery IKDC and Tegner-Lysholm results were shown to be very good to excellent (p < 0.0001). CONCLUSION: all-in meniscal suture devices are and will continue to be front-line weapons in the repair of meniscal tears. In 20 years of follow-up, a lower failure rate was evidenced, associated with excellent functional results.

INTRODUCCIÓN: los dispositivos de suturas meniscal todo adentro han evolucionado y simplificado la reparación meniscal. En este estudio formulamos las siguientes preguntas de investigación: ¿cuál es la tasa de supervivencia y falla?, ¿cuáles son los factores de riesgo asociado a falla? y ¿cuáles son los resultados funcionales posterior a la cirugía de reparación meniscal? MATERIAL Y MÉTODOS: estudio ambispectivo desde el 2001 al 2021 de pacientes con lesión meniscal reparable con dispositivos meniscales de sutura todo adentro. La razón de supervivencia y falla se obtuvo con el test de Kaplan-Meier, los factores de riesgo asociado con falla de la sutura meniscal se valoraron con el test de regresión logística y los resultados funcionales pre y postquirúrgicos fueron estimados con la prueba t-Student. RESULTADOS: en 20 años de seguimiento de 316 menisco reparados con suturas meniscal todo adentro se obtuvo que la razón de supervivencia de 95.9%. La ausencia de lesión del cuerno anterior del menisco se mostró como un factor protector [OR = 0.12], junto a la no práctica de deportes de impacto [OR = 0.2]. Se mostraron resultados del IKDC y Tegner-Lysholm posterior a la cirugía de muy buenos a excelentes (p < 0.0001). CONCLUSIÓN: los dispositivos de sutura de meniscal todo adentro son y seguirán siendo armas de primera línea en la reparación de las roturas meniscales. En 20 años de seguimiento se evidenció una menor tasa de falla, asociados con excelentes resultados funcionales.

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Transplanted mesenchymal stromal cells (MSCs) exhibit a robust anti-inflammatory and homing capacity in response to high inflammatory signals, as observed in studies focused on rheumatic diseases that target articular cartilage (AC) health. However, AC degradation in osteoarthritis (OA) does not necessarily coincide with a highly inflammatory joint profile. Often, by the time patients seek medical attention, they already have damaged AC. In this study, we examined the therapeutic potential of a single bone marrow MSC transplant (2 × 106 cells/kgbw) through two different routes: intra-articular (MSCs-IAt) and intravenous (MSCs-IVt) in a preclinical model of low-grade inflammatory OA with an established AC degeneration. OA was induced through the destabilization of the medial meniscus (DMM) in female Wistar Kyoto rats. The animals received MSCs 9 weeks after surgery and were euthanized 4 and 12 weeks post-transplant. In vivo and ex vivo tracking of MSCs were analyzed via bioluminescence and imaging flow cytometry, respectively. Cytokine/chemokine modulation in serum and synovial fluid was measured using a multiplex panel. AC degeneration was quantified through histology, and hindlimb muscle balance was assessed with precision weighing. To our knowledge, we are the first group to show the in vivo (8 h) and ex vivo (12 h) homing of cells to the DMM-OA joint following MSCs-IVt. In the case of MSCs-IAt, the detection of cellular bioluminescence at the knee joint persisted for up to 1 week. Intriguingly, intra-articular saline injection (placebo-IAt) resulted in a worse prognosis of OA when compared to a non-invasive control (placebo-IVt) without joint injection. The systemic cytokines/chemokines profile exhibited a time-dependent variation between transplant routes, displaying a transient anti-inflammatory systemic response for both MSCs-IVt and MSCs-IAt. A single injection of MSCs, whether administered via the intra-articular or intravenous route, performed 9 weeks after DMM surgery, did not effectively inhibit AC degeneration when compared to a non-invasive control.

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The anuran knee joint is subjected to the jump, one of the tetrapods' most demanding mechanical stresses. Consistent with this continuous effort, the knee of the anurans has a complex structure comparable to that of an amniote. Here, we describe the ontogeny of the Xenopus knee tissues and study the morphogenesis of the knee joint shape by performing a geometric morphometric analysis of specially selected anatomical structures: the menisci and the long bone epiphyses. A meniscus is a crescent-shaped fibrocartilaginous structure, with a triangular cross-section inserted between joints surfaces. A meniscus transmits load across the tibiofemoral joint by increasing congruity of the long bone epiphysis and decreasing the resulting stress exerted on the articular cartilage. We ask two questions: (1) what is the tissue composition along the ontogeny of the menisci of a swimming frog? (2) How do the menisci acquire the shape that will allow their adjustment? We studied the structures and tissue ontogeny of the knee of several specimens of Xenopus laevis and evaluated the congruity of the knee structures across the species ontogeny. Histological sections showed that the cavitation process responsible for separating the menisci and the epiphyses seems to be pivotal in shaping the conformity of these structures and the long bone epiphyses of the hindlimbs. The geometric morphometric analysis allowed us to interpret three phases of differentiation associated with limb functionality. The characteristic shape of the meniscus appears early in the ontogeny of the knee, simultaneously with the epiphysis contours.

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INTRODUCTION: there is scarce information on meniscal repair in the paediatric population in terms of outcomes of this technique. The aim of this study was to evaluate the clinical outcomes and complications of meniscal repair in paediatric population with isolated lesions, associated with ACL rupture and discoid meniscus with unstable lesions. MATERIAL AND METHODS: data from 78 patients 18 years of age, with arthroscopic diagnosis of isolated meniscal lesion, associated with ACL tear or discoid meniscus, in whom arthroscopic repair was performed, were retrospectively analyzed for demographic characteristics, surgical technique, and perioperative complications. Functional results were assessed with the Lysholm and Pedi-IKDC scales. Time to repair failure was defined as the interval between meniscal repair and revision (re-repair or subtotal meniscectomy). RESULTS: mean age was 14 years (SD 3.1, range 3-19). The patients in group C were significantly younger (15.4 years in group A vs 14.9 in group B vs 12.1 in group C, p = 0.001). The average follow-up was 33.8 months. The mean Lysholm score and Pedi-IKDC were 96.1 points (range, 76-100) and 93.8 points (range, 59.8-100), respectively. The overall failure rate was 14.1% (11/78). There were 4 (13%) failures in group A, 3 failures (12%) in group B, and 5 failures (17%) in group C (p = 0.429). We found a tendency towards a greater number of failures in bucket handle injuries (p = 0.08) and a significant association when 4 sutures were used (p = 0.041). CONCLUSION: in this series, meniscal repair demonstrated a clinical success rate of 85.9%. Patients with discoid meniscus, bucket handle injuries, and those who required a greater number of sutures had a higher risk of failure. Repair should be considered the first surgical treatment option for most meniscal injuries in children and adolescents.

INTRODUCCIÓN: existe escasa información de la reparación meniscal en la población pediátrica en cuanto a resultados de esta técnica. Los objetivos de este estudio fueron evaluar los resultados clínicos y las complicaciones de la reparación meniscal en población pediátrica con lesiones aisladas, asociadas a ruptura del LCA y menisco discoide con lesiones inestables. MATERIAL Y MÉTODOS: los datos de 78 pacientes 18 años de edad, con diagnóstico artroscópico de lesión meniscal aislada, asociada a rotura del ligamento cruzado anterior (LCA) o menisco discoide, en los que se realizó reparación artroscópica, se analizaron retrospectivamente. Los resultados funcionales fueron valorados con las escalas de Lysholm y Pedi-IKDC. El tiempo hasta la falla de la reparación se definió como el intervalo entre la reparación meniscal hasta la revisión artroscópica. RESULTADOS: la edad media fue de 14 años (DE 3.1, rango 3-19). Los pacientes del grupo C eran significativamente más jóvenes (15.4 años en el grupo A frente a 1.9 en el grupo B frente a 12.1 en el grupo C, p = 0.001). El seguimiento medio fue de 33.8 meses. La puntuación media de Lysholm y Pedi-IKDC fueron 96.1 puntos (rango, 76-100) y 93.8 puntos (rango, 59.8-100), respectivamente. La tasa de fallas global fue de 14.1% (11/78). Hubo 4 (13%) fallas en el grupo A, 3 fallas (12%) en grupo B, y 5 fallas (17%) en el grupo C (p = 0.429). Encontramos una tendencia a un mayor número de fallas en las lesiones por mango de cubo (p = 0.08) y una asociación significativa cuando se utilizaron 4 suturas (p = 0.041). CONCLUSIONES: la reparación meniscal demostró una tasa de éxito clínico de 85.9%. Los pacientes con menisco discoide, lesiones asa de balde y aquellos que requirieron mayor número de suturas presentaron un mayor riesgo de falla. La reparación debe considerarse como la primera opción de tratamiento quirúrgico para la mayoría de las lesiones meniscales en niños y adolescentes.

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Introducción: Los meniscos juegan un papel crucial para la correcta biomecánica y función adecuada de la rodilla. Las lesiones, según sean traumáticas o degenerativas, tienen orígenes, algoritmos diagnósticos y tratamientos distintos. En el pasado, la meniscectomía era el tratamiento de elección; a medida que se fue comprendiendo la importancia de estas estructuras anatómicas estos fueron migrando hacia opciones de preservación, intentando resguardar la mayor cantidad de tejido meniscal, fomentar su reparación y así disminuir el riesgo de osteoartritis de manera temprana.El objetivo de este trabajo es mostrar los resultados de las reparaciones meniscales efectuadas entre 2012 y 2018, y complementar con una revisión de las técnicas quirúrgicas que hemos realizado en el trascurso de estos años, y las causas de fallas en nuestra serie de pacientes.Materiales y métodos: evaluamos doscientas treinta y cuatro reparaciones meniscales realizadas entre el 2012 y el 2018. El promedio de edad fue de veintiocho años. Un 72% se asoció a lesión y reconstrucción del ligamento cruzado anterior. Incluimos las reparaciones meniscales aisladas, como también asociadas a plástica de LCA, de ambos sexos, con técnicas dentro-fuera, fuera-dentro, todo-adentro y la asociación de estas técnicas. Por otra parte, excluimos pacientes con datos incompletos en la historia clínica, revisiones de suturas realizadas por otro equipo quirúrgico y por falta de seguimiento. La evaluación se basó en el examen físico, la escala visual análoga (EVA) para el dolor y la funcionalidad mediante los scores de IKDC, Lysholm y Tegner.Resultados: la reparación meniscal artroscópica estuvo asociada a la reconstrucción ligamentaria del LCA en un 72% (169 casos) y en un 28% (65 casos) la sutura meniscal como único procedimiento. Se repararon ciento setenta y un meniscos internos y sesenta y tres externos. Con respecto a la técnica utilizada, la distribución fue la siguiente: 151 fueron fuera-dentro; 31, todo-adentro y 52, híbrida (mixta). El promedio de puntos de sutura fue de 3.11 (rango 2 ­ 10). El seguimiento promedio fue de sesenta meses (rango 48 ­ 72). El score de Lysholm postoperatorio fue de 94 (rango 87 ­ 96), el IKDC postoperatorio de 88 (rango 84 ­ 92) y la escala EVA fue de 1/10. Se registraron veintitrés fallas de reparación meniscal (9.8% del total), trece asociadas a plástica de ligamento cruzado anterior (LCA) (56% de las fallas y el promedio de edad de esta población fue el mismo que el de la serie general, veintiocho años). Las fallas fueron consideradas con los criterios de Barret y se confirmaron en el intraoperatorio con visualización artroscópica.Conclusión: comprendiendo la biomecánica articular y la importancia de las estructuras meniscales en la prevención de lesiones degenerativas de la rodilla, debemos intentar la reparación meniscal en todos los casos que sean posibles. En nuestra serie utilizamos técnicas reproducibles con bajo índice de complicaciones, con un índice de falla del 9.8%. Es por eso que pregonamos la importancia de "salvar el menisco". Nivel de Evidencia: IV

Introduction: Menisci play a crucial role in the proper biomechanics and adequate function of the knee. Traumatic and degenerative injuries have different origins, diagnostic algorithms, and treatments. In the past, meniscectomy was the treatment of choice. As we understood the importance of these anatomical structures, treatments shifted towards more reparative options, aiming to preserve the maximum amount of meniscal tissue, promoting its repair, and reducing the risk of early osteoarthritis.Our objective is to present the results of meniscal repairs performed between 2012 and 2018, complemented by a review of the surgical techniques we have performed over the course of these years and the causes of failures in our patient series.Materials and methods: we evaluated 234 meniscal repairs performed between 2012 and 2018. The average age was twenty-eight years. 72% were associated with anterior cruciate ligament (ACL) injury and reconstruction. We included both isolated meniscal repairs and those associated with ACL reconstruction, performed in both genders, using inside-out, outside-in, and all-inside techniques, as well as the combination of these techniques. Patients with incomplete medical records, suture revisions performed by another surgical team, and lack of follow-up were excluded. Evaluation was based on physical examination, pain assessment using the visual analog scale (VAS), and functionality using the IKDC, Lysholm and Tegner scores.Results: arthroscopic meniscal repair was associated with ACL reconstruction in 72% (169 cases) and meniscal repair as the only procedure in 28% (65 cases), which 171 were medial menisci and 63 lateral menisci. Regarding the technique used, the distribution was as follows: 151 outside-in, 31 all-inside, and 52 hybrids (mixed). The average number of sutures was 3.11, (range 2 ­ 10). The average follow-up was sixty months (range 48 ­ 72 months). The postoperative Lysholm score was 94 (range 87 ­ 96), postoperative IKDC was 88 (range 84 ­ 92), and the VAS score was 1/10. A total of 23 failures were recorded (9.8% of the total), 13 were associated with ACL reconstruction (56% of the failures), and the average age of this population was the same as the overall series (28 years old). Failures were assessed according to Barrett's criteria and confirmed intraoperatively with arthroscopic visualization.Conclusion: understanding joint biomechanics and the importance of meniscal structures in preventing degenerative knee injuries, we should attempt meniscal repair in all possible cases. In our series, we used reproducible techniques with a low complication rate, resulting in a failure rate of 9.8%. Therefore, we emphasize the importance of "save the meniscus". Level of Evidence: IV

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Meniscal root tears represent radial tears or avulsions of the meniscal cartilage at the tibial attachment site that profoundly affect meniscal biomechanics and kinematics. Meniscal root tears have the functional effect of a total meniscectomy and can lead to rapid degenerative change with development of early knee osteoarthritis (OA). A growing range of arthroscopic surgical techniques have been developed to repair meniscal root tears with the aim of restoring joint kinematics and contact pressures and delaying the development of OA. With increased understanding of the anatomy and biomechanics of the meniscal root, meniscal root injury repair has become the treatment of choice in knees with nonadvanced OA. This article reviews the anatomy and biomechanics of the meniscal roots, clinical and imaging diagnostic criteria of meniscal root tears, correlation between arthroscopy and MRI in the diagnosis and classification of meniscal root tears, and expected and abnormal MRI findings after meniscal root repair. Familiarity with MRI signs and classifications of meniscal root tears, as well as with root repair surgical techniques, can aid radiologists in correctly reporting preoperative and postoperative MRI findings.

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The objective of this study was to examine the association between preoperative meniscal extrusion of patients undergoing partial medial meniscectomy with clinical outcomes and progression of osteoarthritis and to determine the extent of meniscal extrusion associated with unsatisfactory clinical outcomes and progression of osteoarthritis. Ninety-five patients who underwent partial medial meniscectomy with a minimum follow-up of 5 years were retrospectively reviewed. Preoperative meniscal extrusion was evaluated with magnetic resonance imaging. Patients were assessed preoperatively and postoperatively with Lysholm and International Knee Documentation Committee (IKDC) subjective scores for clinical outcomes and with IKDC radiographic scale for osteoarthritis. An ANOVA (Analysis of Variance) was used to analyze the variations in meniscal extrusion and the clinical and radiological outcomes. A regression analysis was performed to identify factors that affect preoperative medial meniscus extrusion and that influence results after partial meniscectomy. An optimal cutoff value for meniscal extrusion associated with unsatisfactory clinical outcomes and progression of osteoarthritis was established. Significance was set at p < 0.05. The mean ± SD preoperative and postoperative Lysholm scores were 59.6 ± 15.5 versus 83.8 ± 13.1 (p < 0.001) and the mean preoperative and postoperative IKDC subjective scores were 59.4 ± 16.8 versus 82.0 ± 15.8 (p < 0.001). Meniscal extrusion greater than 2.2 mm (sensitivity, 84%; specificity, 81%) and 2.8 mm (sensitivity, 73%; specificity, 85%) was associated with unsatisfactory (poor/fair) Lysholm and IKDC subjective scores, respectively. The progression of osteoarthritis, characterized as a change of at least one category on the IKDC radiographic scale, occurred when meniscal extrusion was greater than 2.2 mm (sensitivity, 63%; specificity, 75%). Patients with higher body mass index (BMI) had significantly greater meniscal extrusion that patients with normal BMI (p < 0.001). The medial meniscus was more extruded in patients with horizontal and root tears. In conclusion, patients with preoperative meniscal extrusion of 2.2 mm or greater had unsatisfactory clinical outcomes and progression of osteoarthritis after partial medial meniscectomy at a minimum of 5 years follow-up. Higher BMI and horizontal and root tears were associated with greater preoperative meniscal extrusion.

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We report a case of a 49-year-old patient presenting an anteromedial meniscofemoral ligament (AMMFL) on both knees with a tear of this ligament in the left knee associated to a normal anterior cruciate ligament (ACL). The AMMFL is a relatively rare anatomic structure that may correspond to a variant of the ACL type anterior root insertion of the medial meniscus. The findings reported in the literature were in most part results of incidental situations. AMMFL can be visualized through magnetic resonance imaging (MRI) and arthroscopy.

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La incidencia de lesiones meniscales en adolescentes ha aumentado debido a la creciente tendencia, en este grupo de edad, de realizar actividades deportivas, una mayor sospecha diagnóstica y mejora en los métodos para su detección. Estas lesiones suelen asociarse a otras patologías, como lesiones de ligamento cruzado anterior o la presencia de menisco discoideo, un factor de riesgo importante. El menisco discoideo fue descripto por primera vez por Young en 1889, es una variación congénita morfológica del menisco lateral o medial, caracterizado por una hipertrofia central y un diámetro mayor de lo normal. Puede ser asintomático o manifestarse con dolor, bloqueo, chasquidos e hinchazón. El tratamiento histórico era la meniscectomía completa, la que se asociaba a cambios degenerativos articulares tempranos, por lo que actualmente se preconiza la saucerización como tratamiento de elección; además, se describe el trasplante meniscal como procedimiento de salvataje, en caso de daño meniscal irreparable. Se presenta el caso de una paciente femenina de doce años sometida a este procedimiento con antecedentes de múltiples intervenciones quirúrgicas en la rodilla izquierda, incluida la meniscectomía parcial, sin resultado clínico favorable. Nivel de Evidencia: IV

The incidence of meniscal injuries in adolescents has increased due to the growing tendency to perform sports activities in this age group, greater diagnostic suspicion, and improvement in diagnostic methods. They are usually associated with other pathologies, such as anterior cruciate ligament injuries and an important risk factor is the presence of a discoid meniscus. The discoid meniscus, first described by Young in 1889, is a congenital morphological variation of the lateral or medial meniscus, characterized by central hypertrophy and a larger diameter than normal meniscus. It can be asymptomatic or manifest with pain, blockage, clicking and swelling. The historical treatment was complete meniscectomy, which was associated with early degenerative joint changes, nowadays saucerization is recommended as the treatment of choice. In addition, the meniscal transplant is described as a salvage procedure, in case of irreparable meniscal damage. We present the case of a twelve-year-old female patient who underwent this procedure with a history of multiple surgical interventions on the left knee, including partial meniscectomy, without a favorable clinical result. Level of Evidence: IV

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