Quantitative analysis of participants

[1] Fu D, Guo L, Yang L, et al. Discoid lateral meniscus tears and concomitant articular cartilage lesions in the knee. Arthroscopy. 2014;30(3):311-318. [2] Ahn J H, Kim K I, Wang J H, et al. Long-term results of arthroscopic reshaping for symptomatic discoid lateral meniscus in children. Arthroscopy. 2015;31(5):867-873. [3] Dai Z,Chen ZW. Research in meniscus root tear. Zhongguo Jiaoxing Waike Zazhi. 2014;22(8):715-718. [4] Huang CZ, Fan WJ, Chen ZW, et al. Application of menisci reformation and repair in the treatment of the discoid meniscus injuries. Zhongguo Gushang. 2010;23 (6): 409-412. [5] lkeuchi H. Arthroscopic treatment of the discoid lateral meniscus technique and long term results. Clin Orthop Relat Res. 1982;(167):19-28． [6] Liu YJ, Wang Y, Wang LE. Applied Arthroscopic Surgery. Beijing: People’s Military Medical Press.2006: 47-50. [7] Chung JY, Roh JH, Kim JH, et al. Bilateral occurrence and morphologic analysis of complete discoid lateral meniscus. Yonsei Med J. 2015;56(3):753-759. [8] Ding J, Zhao J, He Y, et al. Risk factors for articular cartilage lesions in symptomatic discoid lateral meniscus. Arthroscopy. 2009;25(12):1423-1426. [9] Ao YF. Arthroscopic Knee Surgery. Beijing: Peking University Medical Press. 2004:120. [10] Roberts SB, Beattie N, Brown G, et al. Interventions for treating injuries of the medial ligaments of the knee. The Cochrane Library. 2014． [11] Forst R. Bedeutung der orthopädischen Krankheitsbilder in der Geriatrie[J]. Mobilität im Alter. Herausforderungen für Orthopädie und Unfallchirurgie. Deutscher Ärzte-Verlag GmbH Köln. 2006. [12] Shah AM, Mann DL. In search of new therapeutic targets and strategies for heart failure: recent advances in basic science. The Lancet. 2011;378(9792):704-712. [13] Holzmeister J, Leclercq C. Implantable cardioverter defibrillators and cardiac resynchronisation therapy. The Lancet. 2011;378(9792):722-730.[14] Dou XL,Duan XQ,Xia L,et al.Osteoarthritis: study and progress in articular cartilage degeneration.Zhongguo Zuzhi Gongcheng Yanjiu. 2011;15(20):3763-3766. [15] Wang ZB, Xu YL, Liao WM, et al. Cartilage surface of early osteoarthritis in rats induced by papain under scanning electron microscope. Zhongguo Zuzhi Gongcheng Yanjiu. 2014;18(2):177-182. [16] Lee DH, Kim TH, Kim JM, et al. Resdts of subtotal/total or partial meniscectomy for discoid lateral meniscus in children. Arthroscopy. 2009;25(5):496-503． [17] Ahn JH, Lee SH, Yoo JC, et al. Bilateral discoid lateral meniscus in knees: evaluation of the contralateral knee in patients with symptomatic discoid lateral meniscus. Arthroscopy. 2010;26(10):1348-1356. [18] Ikeuchi H. Arthroscopie treatment of the discoid lateral meniscus:technique and long termresults. Clin Orthop. 1998;167:19-28． [19] Wasser L, Knörr J, Accadbled F, et al. Arthroscopic treatment of discoid meniscus in children: clinical and MRI results. Orthop Traumatol Surg Res. 2011;97(3):297-303. [20] Adachi N, Ochi M, Uchio Y, et al. Torn discoid lateral meniscus treated using partial central meniscectomy and suture of the peripheral tear. Arthroscopy. 2004;20(5):536-542. [21] Kim JM, Bin SI. Meniscal allugraft transplantation after total meniscectomy of torn discoid lateral meniscus. Arthroscopy. 2006;22(12):1344-1350. [22] Hommen JP, Applegate GR, Del Pizzo W. Meniscus allograft transplantation:ten-year results of cryopreserved allografts. Arthroscopy. 2007;23(4):388-393. [23] Hayashi LK, Yamaga H, Ida K, et al. Arthroscopic meniscectomy for discoid lateral meniscus in children. J Bone Joint Surg Am. 1988;70(10):1495-1500. [24] Mayer-Wagner S, von Liebe A, Horng A, et al. Discoid lateral meniscus in children: magnetic resonance imaging after arthroscopic resection. Knee Surgery. Sports Traumatology, Arthroscopy. 2011;19(11):1920-1924. [25] Miller MD, Ritchie JR, Gomez BA, et al. Meniscal repair: an experimental study in the goat. Am J Sports Med. 1995; 23(1):124-128. [26] Henning CE. Arthroscopic repair of meniscus tears. Orthopedics. 1983;6(9):1130-1132. [27] Chen S, Fu PL, Cong RJ, et al. Research progress of meniscus tissue engineering. Zhonggou Gu yu Guanjie Zazhi. 2013;2(12):694-698. [28] Zhong WJ, Wang YB, Zhang YD, et al. Experimental study of effect of meniscus suture on meniscus healing. Zhongguo Xiufu Zhongjian Waike Zazhi. 2000;14(21): 77-79. [29] Li X, Zhong J, Hong L, et al. Hybrid suture technique for repairing bucket-handle tear of the lateral meniscus. Zhonghua Guke Zazhi. 2012;32(2):101-105． [30] He RZ, Wu S, Cao X, et al. Therapeutic Effect of Early Rehabilitative Training after Arthroscopic Anterior Cruciate Ligament Reconstruction. Xiandai Shengwu Yixue Jinzhan. 2012;12(7):1274-1276,1269.

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Healthy lateral and medial menisci are respectively shaped like a “0” shape and “C” shape. Discoid meniscus accounts for 0.4%-17.0%, most of which occur in the knee lateral meniscus rather than in the medial meniscus^[1]. Discoid meniscus injury is one of the common diseases of the knee. Discoid meniscus is a human anatomic variant, which is larger and thicker than the normal meniscus. Normally, the meniscus is a thin crescent-shaped piece of cartilage that sites in between the weight bearing joint surfaces of the femur and the tibia. A discoid meniscus is thicker than the normal, which is a human anatomic variant. During the knee movement, compared with the normal meniscus, a discoid meniscus is more prone to be injured by the friction, extrusion and torsion between the femoral condyle and tibial plateau, thereby triggering changes in a series of clinical symptoms and signs and joint functions^[2]. Meniscectomy is the only treatment for discoid meniscus, but it will inevitably lead to articular cartilage injury, thereby resulting in secondary traumatic arthritis. With the development of arthroscopic surgery, knee arthroscopy is widely used in the diagnosis and treatment of discoid meniscus, with less trauma, clear diagnosis, and endoscopic resection, remodeling and total removal of damaged meniscus. Under the arthroscopy, the synovium cannot be damaged, with mild inflammatory reaction, small surgical trauma, and short operative time, all of which help to restore knee function and carry out rehabilitation training after repair, as well as lower the incidence of complications and mental burden of patients^[3]. It provides an excellent means for the treatment of discoid meniscus and treatment decisions can be made according to endoscopic findings. As the meniscus plays an important role in transferring articular stress and maintaining the joint stability, most scholars recommend discoid meniscus plasty to reserve the meniscus with near-normal appearance, reduce incidence of joint degeneration. In addition, sodium hyaluronate can promote knee cartilage repair^[4]. This study aimed to arthroscopic suture technology combined with sodium hyaluronate treatment for treatment of lateral discoid meniscus with attached edge relaxation or longitudinal crack in 22 cases. 中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

Mechanisms and features of discoid meniscus injury The meniscus is a vital structure of the knee, functioning as transferring load, absorbing shock, strengthening coordination of knee movement, maintaining joint stability, improving knee pressure distribution and synovial fluid distribution, strengthening articular cartilage nutrition, preventing degeneration and stabilizing the knee joint^[6]. Discoid meniscus is an anatomical variation, mainly involving the lateral meniscus. Most scholars believe that a discoid meniscus develops due to meniscal developmental disorder. Discoid meniscus has poor vascular constitution and no regular arrangement of longitudinal and annular fibers^[7]. It is larger than the normal that acts as a cushion between the femoral condyles and the tibial plateau, and therefore, these two articular surfaces cannot be in direct contact. During the knee joint movement, the discoid meniscus is more prone to injury than a normal meniscus as a result of friction, extrusion and contortion between the femoral condyle and tibial plateau. Due to its special anatomical features, the incidence of discoid meniscus injury is 10.9%^[8]. In this study, the 22 cases were confirmed as lateral discoid meniscus by arthroscopy. Blood supply in the meniscus is poor, and poor healing often occurs after fracture. The meniscus is divided into three zones horizontally: zone I is named as red zone (blood supply region) that is a region within 3 mm between the synovium and meniscus, and another synovial tissues reenter through blood vessels covering front and rear corners into 1-3 mm interface between meniscal tibia and femur surface, which have a strong ability to heal via suturing and fixation. Zone II refers to 3-5 mm interface between the meniscus and synovium, which is also known as red-white zone or fringe area, in which, there is the potential for healing and a wound is possible to heal after filing suture repair. Zone III is name white zone with no blood supply that is located over 5 mm at the junction between the meniscus and synovium, in which, nutrition is from the synovial fluid supply, and it is considered to have no healing ability in the past^[9-10]. Based on these characteristics, the patients who had attached edge relaxation or longitudinal crack, incomplete discoid meniscus injury or mild complete-type discoid meniscus, complete-type discoid meniscus with no crack damage were selected in the present trial. Significance and purpose of arthroscopic all-inside suture repair combined with sodium hyaluronate injection for discoid meniscus The menisci act to undergo and disperse the weight of the body as well as reduce friction during movement, and act as a buffer to protect the cartilage of the knee^[11]. It becomes an indispensable part of the knee joint. Therefore, the maximum meniscal repair or reconstruction has important clinical significance to maintain normal physiological function of the knee joint in patients with meniscus injury or meniscectomy, which is very crucial for prevention of early osteoarthritis^[12-13]. Sodium hyaluronate functions to promote proteoglycan synthesis^[14] and repair and prevent the cartilage^[15]; thus, intraoperative and postoperative supplement of exogenous sodium hyaluronate as well as to induce the secretion of endogenous sodium hyaluronate from synovial cells in the joint are in favor of meniscal repair. In this study, the meniscus was preserved to the greatest extent, and intra-articular injection of sodium hyaluronate promoted meniscal healing. After operation, joint locking symptoms and snapping disappeared, and the overall good rate was 86.36%, with satisfied clinical results. In addition, most patients agreed with this therapeutic method in doctor-patient communication. Therapeutic methods and indications Current surgical methods for discoid meniscus injury include angioplasty, partial resection, subtotal resection and total resection. Our experience is that the choice of surgical approach depends on the type of discoid meniscus injury, and the principle is to retain the normal meniscus and try to avoid total resection of discoid meniscus. The remaining part can function partially as the normal meniscus. There is ample evidence that after total resection of discoid meniscus, the degeneration of the knee accelerate^[16-17]. Ikeuchi et al ^[18-19] believed that the total resection of discoid meniscus obviously caused joint instability; therefore, excessive resection should be avoided. For discoid lateral meniscus with peripheral tears, the combined therapy of subtotal resection and tear suturing is preferred to avoid the total resection of discoid meniscus^[20]. Autolougous meniscus transplantation has been reported to repair discoid lateral meniscus with tears, and its short-term efficacy is favorable^[21], but the long-term outcome is less than satisfactory^[22]. Research findings from Hayashi et al ^[23-24] show that an edge of 6 mm and 8 mm should be remained in patients with complete type discoid meniscus and incomplete discoid meniscus, respectively. In our study, an edge of 6-8 mm was reserved in patients with discoid meniscus according with the width of the normal meniscus edge, which was trimmed to normal shape as much as possible, and the femoral shape was trimmed as a slope-like shape to fit the condyle. During the operation, it is important to test knee flexion and extension activities. As there is snapping, it indicates the preserved meniscus is still thicker that should be thinned. Three basic techniques of meniscal suture are described: outside-in, inside-out, and all-inside. In this study, inside-out suture of meniscus was adopted. During the suture of meniscus rupture, the edge of injured meniscus was shaped by the planer cutter to remove the free edge and pieces, and the meniscal synovium should be fully polished to bleeding, in order to facilitate the healing of meniscus. The tearing edge was sutured with synovial layer and fibrous layers of the joint capsule to provide better blood supply. The number of pins depends on the size of crack, but the suturing can aggravate the severity of meniscal fibrocartilage damage. With the gap enlargement and increase in the number of pins, meniscal healing becomes more difficult. Based on our treatment experiments and other literatures, the rate of meniscal healing is significantly higher in patients undergoing meniscal suture than those with no suture, which has been proved by Miller et al ^[25] through animal experiments. Henning^[26] reported that arthroscopic suture of injured vessels and proper braking achieve satisfactory clinical efficacy. After vascular injury, the separated tissue cracks are interconnected by the local bleeding and formed clots, thereby providing a scaffold for fiber regeneration^[27]. We selected the patients who had attached edge relaxation or longitudinal crack, incomplete discoid meniscus injury or mild complete-type discoid meniscus, complete-type discoid meniscus with no crack. Good clinical efficacy was achieved in all the patients according to our therapeutic schedules. Treatment advantages and clinical efficacy Arthroscopic suture of discoid meniscus has the following advantages: (1) small surgical trauma and short operative time: the incision is small that almost has no damage to the ligaments and muscles. (2) It is conducive to postoperative knee function recovery and rehabilitation training: it has little damage to the joint capsule and avoids postoperative adhesions and knee joint effusion, accelerates postoperative recovery by removing influential factors of postoperative knee function recovery. (3) Low postoperative complication rate and small psychological burden of patients: arthroscopic technique eliminates secondary impact of the joint resection, such as neuroma formation, painful scar, functional imbalances (such as unbalanced knee extension mechanism). (4) Economic rationality: it shortens hospital stays, lowers cost, thus reducing the financial burden of patients. Less postoperative pain is conducive to early functional training as soon as possible to restore the function of the knee. In view of these, this method has higher clinical value. Based on our experiences and other literature, the following points should be noticed. (1) Positioning of injury: preoperative tenderness, McMurray test, intraoperative range of meniscus motion and synovial hyperemia. (2) Postoperative rehabilitation is crucial for the recovery of patients. Meniscal healing can be achieved within 6 weeks after suturing^[28]. Systemic and formal rehabilitation training is preferred, and the training that is too aggressive or too conservative is likely to have adverse consequences. (3) Older patients with osteoarthritis should be informed in the doctor-patient communication that suture angioplasty is not able to fully relive preoperative symptoms. Full description is necessary to obtain the patient’s understanding. Secondly, inflammatory synovial tissues should be removed appropriately to thoroughly rinse the joint cavity, which will help to improve the clinical efficacy. Conservative treatment is necessary postoperatively that is good for both doctors and patients. (4) Based on the foreign data, the type and thickness of discoid meniscus are associated with articular cartilage wear and clinical outcomes. Articular cartilage wear induced by “plate-shaped” discoid meniscus is significantly severer than that induced by “shallow dish-shaped” and incomplete discoid menisci. More meniscal tissues need to be cut for the “plate-shaped” discoid meniscus, and a certain degree of postoperative knee laxity can be caused. Some patients who have complained of symptoms and signs related to joint instability should strengthen the muscle training around the knee. Postoperative rehabilitation training Fair or foul function recovery in patients undergoing arthroscopic suture with sodium hyaluronate for treatment of discoid meniscus injury mainly depends on severity of discoid meniscus injury, stable meniscus formed by suture technology and early rehabilitation training after surgery. Functional training can accelerate the venous return of affected limbs, effectively eliminate knee swelling; improve local blood circulation, promote absorption of exudate as soon as possible, prevent adhesions of the knee joint; avoid atrophy, contracture and stiffness of the extensor muscle, and meanwhile, enhance muscle strength and joint stability, so as to recover the functions of limbs and joints as soon as possible. In addition, the functional training also can promote local nutritional and metabolic activity, avoid or reduce joint cartilage degeneration, and help repair of injured meniscus^[29]. External brace of the knee joints cannot only control the range of knee motion, but also protect the stability of the knee joints. Therefore, whether the functional training is proper or not will directly affect the recovery of knee function, and too aggressive or too conservative may both result in adverse consequences. In this study, the affected knee joint was fixed in the extension position using a brace. The patients began to do muscular training, isometric contraction of the quadriceps and ankle pump exercise until the quadriceps and hamstrings restored the muscle strength. Two or three days later, the patients could walk with crutches; meanwhile, the patients underwent non-weight-bearing exercise at a movement range of 0°-90°^[30]. The joint activities gradually restored after 3 weeks. At 4 weeks after operation, the brace was removed and the patients could walk with crutches under partial weight-bearing, and walk with no crutches under full weight bearing at 8 weeks after operation. Quadriceps isometric exercise should be carried out at early stage; within 6 months after operation, sudden stop and squat of the knee and rotational movement of the knee relying on the affected limb (steering run, flashback) should be forbidden. According to our rehabilitation schemes, the knee function recovered well in all the 22 cases In summary, arthroscopic suture with sodium hyaluronate is an effective means for treatment of incomplete discoid meniscus or mild complete-type discoid meniscus with attached edge relaxation or longitudinal crack. With the general development of MRI and arthroscopic surgery, the number of cases diagnosed as discoid meniscus injury is increased year by year. The main purpose of this surgery is to try to preserve the normally shaped meniscus to form a stable meniscus, and to try to restore the physiological structure of the knee. Intra-articular injection of sodium hyaluronate can quickly establish an intraarticular environment similar to physiological synovial fluid so as to protect the articular cartilage, delay or reduce knee joint degeneration, joint instability and chronic synovitis. Therefore, the knee function can be recovered to the maximum degree. In clinical work, we should strictly control surgical indications, improve surgical skills, enhance patient’s awareness of self-protection, and exhort the patients to avoid strenuous exercise or heavy physical labor. In this study, a good clinical efficacy was achieved in all the patients, indicating the above-mentioned treatment is feasible, effective and accepted by the majority of patients in the doctor-patient communication. But due to a small number of cases and follow-up, its long-term effect needs further observation. It can be learned from the results that over time, the scores on patients have a downward trend, which may be related to joint degeneration and reduced number of cases receiving follow-up visits. In addition, whether there are synergistic and additive effects between sodium hyaluronate treatment and surgery still need to be further studied in the clinical work. 中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

1 研究表明，关节镜下缝合成形治疗膝关节半月板损伤临床效果满意，而结合玻璃酸钠对促进软骨修复有重要作用。试验针对盘状半月板附着缘松弛或破裂，在关节镜1下采用缝合、成形并结合玻璃酸钠治疗。从Ikeuchi评分，Lysholm评分等疗效评分方面探讨了关节镜下缝合成形结合玻璃酸钠治疗盘状半月板损伤的临床疗效。

2 试验结果表明，膝关节镜下盘状半月板缝合成形可以最大程度地保留半月板解剖结构，使其发挥有效功能，损伤小，关节修复后配和关节腔注射玻璃酸钠治及正规的康复训练疗，恢复快，并发症少，可获得良好疗效，本组临床疗效满意。

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

正盘状半月板即盘状软骨,是先天性半月板形态异常,形成大而肥厚的类似圆盘的畸形软骨,多见于膝关节外侧。本病多发生于青壮年,男性发病多于女性,大约(2~7)∶关节镜手术是一种集诊断及治疗于一体的微创手术方法,关节镜下行半月板成形术治疗半月板损伤具有手术创伤小、视野清晰及术后康复快等特点。

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

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