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Anatomical description and short-term follow up clinical results for ultrasound-guided injection of medial collateral ligament bursa: New conservative treatment option for symptomatic degenerative medial meniscus tear

      Highlights

      • We describe our newly-developed ultrasound-guided medial collateral ligament bursa injection.
      • Using fresh cadaver knees, we describe the anatomical target and precise technique of this treatment method and confirm its accuracy.
      • We also evaluate preliminary clinical outcomes in 50 patients with medial knee joint pain without knee osteoarthritis.
      • Ultrasound-guided medial collateral ligament bursa injection technique is safe, reproducible, and effective for symptomatic medial meniscus degenerative tears.

      Abstract

      Background

      In this study, we investigated newly developed ultrasound (US)-guided medial collateral ligament (MCL) bursa injection as a conservative therapy for symptomatic degenerative medial meniscal (MM) tears. We aimed to describe the anatomical target and precise technique of this injection, confirm its accuracy using fresh cadaveric knees, and then evaluate preliminary clinical outcomes.

      Methods

      Anatomical studies were performed on three fresh cadavers. For the clinical study, 50 patients with medial knee joint pain without knee osteoarthritis were treated with US-guided MCL bursa injection. Severity of pain was assessed pre-injection, and 1 week and 4 weeks post-injection using a 0–10 numerical rating scale (NRS). Clinical success was defined as a full return to daily activities. All patients underwent magnetic resonance imaging (MRI) within 1 week of the first injection. Patients who underwent surgery within 12 months of the first injection were investigated as clinically unsuccessful cases, and MRI and arthroscopic findings were examined.

      Results

      Compared with pre-injection (6.8 ± 1.2), the average NRS score was significantly lower at 1 week (1.8 ± 2.0) and at 4 weeks (1.5 ± 1.7) post-injection (both P < 0.01). The primary clinical success rate was 76.0%, and injection-related adverse events were not observed. Nine patients underwent surgery (arthroscopic surgery for degenerative flap tear (n = 7) and high tibial osteotomy for medial meniscus posterior root tear and proximal tibial malalignment (n = 2)).

      Conclusions

      US-guided MCL bursa injection is safe, reproducible, and effective for symptomatic MM degenerative tears. However, US-guided injections of the MCL bursa may be ineffective for flap tears and posterior root tears.

      Keywords

      Abbreviations:

      US (Ultrasound), MCL (Medial collateral ligament), MM (Medial meniscus)
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      References

        • Landers S.
        • Hely R.
        • Page R.
        • Maister N.
        • Hely A.
        • Harrison B.
        • et al.
        Genicular artery embolization to improve pain and function in early-stage knee osteoarthritis – 24-Month pilot study results.
        J Vasc Interv Radiol. 2020; 31: 1453-1458
        • Englund M.
        • Guermazi A.
        • Gale D.
        • Hunter D.J.
        • Aliabadi P.
        • Clancy M.
        • et al.
        Incidental meniscal findings on knee MRI in middle-aged and elderly persons.
        N Engl J Med. 2008; 359: 1108-1115
        • Beaufils P.h.
        • Becker R.
        • Kopf S.
        • Englund M.
        • Verdonk R.
        • Ollivier M.
        • et al.
        Surgical management of degenerative meniscus lesions: The 2016 ESSKA Meniscus Consensus.
        Joints. 2017; 25: 335-346
        • Ardern C.L.
        • Paatela T.
        • Mattila V.
        • Taimela S.
        • Järvinen T.L.N.
        When taking a step back is a veritable leap forward. Reversing decades of arthroscopy for managing joint pain: five reasons that could explain declining rates of common arthroscopic surgeries.
        Br J Sports Med. 2020; 54: 1312-1313
        • Beaufils P.
        • Seil R.
        • Becker R.
        • Karlsson J.
        • Menetrey J.
        The orthopaedic community does not oppose the non-surgical treatment of degenerative meniscal lesions.
        Knee Surg Sports Traumatol Arthrosc. 2021; 29: 329-332https://doi.org/10.1007/s00167-020-06411-9
        • De Maeseneer M.
        • Shahabpour M.
        • Van Roy F.
        • Goossens A.
        • De Ridder F.
        • Clarijs J.
        • et al.
        MR imaging of the medial collateral ligament bursa: Findings in patients and anatomic data derived from cadavers.
        AJR Am J Roentgenol. 2001; 177: 911-917
        • Hohmann E.
        • Glatt V.
        • Tetsworth K.
        • Cote M.
        Arthroscopic partial meniscectomy versus physical therapy for degenerative meniscus lesions: How robust is the current evidence? A critical systematic review and qualitative synthesis.
        Arthroscopy. 2018; 34: 2699-2708https://doi.org/10.1016/j.arthro.2018.04.018
        • Sihvonen R.
        • Paavola M.
        • Malmivaara A.
        • Itälä A.
        • Joukainen A.
        • Nurmi H.
        • et al.
        Arthroscopic partial meniscectomy versus placebo surgery for a degenerative meniscus tear: A 2-year follow-up of the randomised controlled trial.
        Ann Rheum Dis. 2018; 77: 188-195
        • Sihvonen R.
        • Paavola M.
        • Malmivaara A.
        • Itälä A.
        • Joukainen A.
        • Kalske J.
        • et al.
        Arthroscopic partial meniscectomy for a degenerative meniscus tear: a 5 year follow-up of the placebo-surgery controlled FIDELITY (Finnish Degenerative Meniscus Lesion Study) trial.
        Br J Sports Med. 2020; 54: 1332-1339
        • Bassett A.J.
        • Hadley C.J.
        • Tjoumakaris F.
        • Freedman K.B.
        The Meniscal Grammar Signs: Comma and Apostrophe Signs for Characterization of a Displaced Fragment in the Meniscal Recess.
        Arthroscopy Techniques. 2019; 8: e727
        • Brignardello-Petersen R.
        • Guyatt G.H.
        • Buchbinder R.
        • Poolman R.W.
        • Schandelmaier S.
        • Chang Y.
        • et al.
        Knee arthroscopy versus conservative management in patients with degenerative knee disease: A systematic review.
        BMJ Open. 2017; 7: e016114
        • Devji T.
        • Guyatt G.H.
        • Lytvyn L.
        • Brignardello-Petersen R.
        • Foroutan F.
        • Sadeghirad B.
        • et al.
        Application of minimal important differences in degenerative knee disease outcomes: A systematic review and case study to inform BMJ Rapid Recommendations.
        BMJ Open. 2017; 7: e015587https://doi.org/10.1136/bmjopen-2016-015587
        • Harwin S.F.
        • Salem H.S.
        • Carter A.H.
        • Shi W.J.
        • Tjoumakaris F.P.
        • Cohen S.B.
        • et al.
        The meniscal comma sign: Characterization and treatment of a displaced fragment in the meniscotibial recess.
        Orthopedics. 2018; 41https://doi.org/10.3928/01477447-20180501-01
        • Helito C.P.
        • Partezani Helito P.V.
        • Sobrado M.F.
        • Giglio P.N.
        • Guimaraes T.M.
        • Pécora J.R.
        • et al.
        Degenerative medial meniscus tear with a displaced flap into the meniscotibial recess and tibial peripheral reactive bone edema presents good results with arthroscopic surgical treatment.
        Arthroscopy. 2021; 37: 3307-3315
        • Lee S.H.
        • Hwang J.H.
        • Kim D.H.
        • So Y.H.
        • Park J.
        • Cho S.B.
        • et al.
        Clinical outcomes of transcatheter arterial embolization for chronic knee pain: Mild-to-moderate versus severe knee osteoarthritis.
        Cardiovasc Intervent Radiol. 2019; 42: 1530-1536https://doi.org/10.1007/s00270-019-02289-4
        • Okuno Y.
        • Korchi A.M.
        • Shinjo T.
        • Kato S.
        Transcatheter arterial embolization as a treatment for medial knee pain in patients with mild to moderate osteoarthritis.
        Cardiovasc Intervent Radiol. 2015; 38: 336-343https://doi.org/10.1007/s00270-014-0944-8
        • Okuno Y.
        • Korchi A.M.
        • Shinjo T.
        • Kato S.
        • Kaneko T.
        Midterm clinical outcomes and MR imaging changes after transcatheter arterial embolization as a treatment for mild to moderate radiographic knee osteoarthritis resistant to conservative treatment.
        J Vasc Interv Radiol. 2017; 28: 995-1002https://doi.org/10.1016/j.jvir.2017.02.033
        • Mapp P.I.
        • Walsh D.A.
        Mechanisms and targets of angiogenesis and nerve growth in osteoarthritis.
        Nat Rev Rheumatol. 2012; 8: 390-398https://doi.org/10.1038/nrrheum.2012.80
        • Coll C.
        • Coudreuse J.-M.
        • Guenoun D.
        • Bensoussan L.
        • Viton J.-M.
        • Champsaur P.
        • et al.
        Ultrasound-guided perimeniscal injections: Anatomical description and feasibility study.
        J Ultrasound Med. 2022; 41: 217-224
        • Di Sante L.
        • Venditto T.
        • Ioppolo F.
        • Paoloni M.
        • Mangone M.
        • Alviti F.
        Ultrasound guided injection of a painful knee osteoarthritis with medial meniscus extrusion: A case series study.
        Muscles Ligaments Tendons J. 2017; 18: 331-337https://doi.org/10.11138/mltj/2017.7.2.331
        • Ricci V.
        • Özçakar L.
        • Galletti L.
        • Domenico C.
        • Galletti S.
        Ultrasound-guided treatment of extrusive medial meniscopathy: A 3-step protocol.
        J Ultrasound Med. 2020; 39: 805-810https://doi.org/10.1002/jum.15142
        • Wilderman I.
        • Berkovich R.
        • Meaney C.
        • Kleiner O.
        • Perelman V.
        Meniscus-targeted injections for chronic knee pain due to meniscal tears or degenerative fraying: A retrospective study.
        J Ultrasound Med. 2019; 38: 2853-2859https://doi.org/10.1002/jum.14987