[Clinical natural development in human meniscus injury].
OBJECTIVE
To investigate the changes of clinic and wound edge of the meniscus without treatment in order to provide a theoretical basis for clinical treatment.


METHODS
From January 2001 to December 2011,68 patients with knee injury without diagnosis and treatment were selected in the study. According to clinical symptoms (pain,interlocking,instability, etc.) and knee MRI,32 patients were diagnosed as meniscus injury and underwent the arthroscopy. Total meniscectomy was performed in 32 cases on account of impossible repair of the meniscus. There were 21 males and 11 females,ranging in age from 15 to 49 years old with an average age of 25 years old,with an average time from diagnosis to arthroscopy for 46 weeks. Observation indexes included 1Preoperative and postoperative Lysholm scores of knee. 2Position,type and status of injury by arthroscopy. 3Observation of histology. With the procedure as follow: tissue samples were taken from different positions of the edge of the meniscus wound,and were divided into two parts. One part of sample was fixed with formalin, sliced with paraffin imbedding,and observed under an electron microscope after HE staining,and the other part of the sample was fixed with glutaraldehyde of 3%,sliced with ethoxyline imbedding ,and observed under an electron microscope after Lead Citrate staining.


RESULTS
Thirty-two patients were followed up more than one year. There was significant differences in Lysholm scores bewteen preoperative and postoperative 3 months (t=15.6,P<0.01). Arthroscopy showed typical differences in 28 cases between the middle and the two ends of the wound edge and atypical differences in 4 cases. Light microscope showed typical manifestations in 26 cases, a few epithelioid cells could been seen fat the middle of the wound edge as well as cells tissue healing (such as fibroblasts) at the junction of each end,and atypical manifestations in 2 cases. Electron microscope showed typical manifestation in 25 cases and atypical manifestations in 3 cases. Typical manifestations in electron microscope showed the atrophic state tions in 25 cases and atypical manifestations in 3 cases. Typical manifestations electron microscope showed the atrophic state of nuclei and kytoplasm of cell (isogenous cells and epithelioid cells) at the middle of the wound edge; at the either junction of the wound edge, the fibroblasts exhibited an enlarged volume with many protuberances; the nuclei also increased in size, and the cytoplasm contained major rough endoplasmic reticulum, free ribosomes and Golgi complex; chondrocytes were round or oval with a large,round nucleus ; a large amount of rough endoplasmic reticulum and many free ribosomes could be observed in the cytoplasm;cartilage lacunae were observed surrounding chondrocytes.


CONCLUSIONS
Weight loading activities with meniscus injury without treatment or before healing will increase the length of the wound and aggravate clinical symptoms. These findings indicate that early diagnosis and treatment combined with timely and effective immobilization is a key to the healing of meniscus injury and avoiding further surgery. The recent clinical effect of total meniscectomy is satisfacory in treating impossible repair meniscus.
Third Affiliated Hospital, Medical College of Xi'an Jiaotong University,Xi'an 710068, Shaanxi,China. xuhonghai1963@126.com
X u
Xu
Hong-hai
Third Affiliated Hospital, Medical College of Xi'an Jiaotong University,Xi'an 710068, Shaanxi,China.
Feng
F
Zhang
Third Affiliated Hospital, Medical College of Xi'an Jiaotong University,Xi'an 710068, Shaanxi,China.
Ning
N
Liu
Third Affiliated Hospital, Medical College of Xi'an Jiaotong University,Xi'an 710068, Shaanxi,China.
Jing-Jing
JJ
Zheng
Third Affiliated Hospital, Medical College of Xi'an Jiaotong University,Xi'an 710068, Shaanxi,China.
Yin-Ping
YP
Zhang
Third Affiliated Hospital, Medical College of Xi'an Jiaotong University,Xi'an 710068, Shaanxi,China.
Quan-min
QM
Zhao
Third Affiliated Hospital, Medical College of Xi'an Jiaotong University,Xi'an 710068, Shaanxi,China.
Xiong
X
Guo
Third Affiliated Hospital, Medical College of Xi'an Jiaotong University,Xi'an 710068, Shaanxi,China.
Min
M
Yu
Third Affiliated Hospital, Medical College of Xi'an Jiaotong University,Xi'an 710068, Shaanxi,China.
Zong-Zhi
ZZ
Liu
Third Affiliated Hospital, Medical College of Xi'an Jiaotong University,Xi'an 710068, Shaanxi,China.
Zheng-Ming
ZM
Sun
Third Affiliated Hospital, Medical College of Xi'an Jiaotong University,Xi'an 710068, Shaanxi,China.
Qing-Yang
QY
Zou
Third Affiliated Hospital, Medical College of Xi'an Jiaotong University,Xi'an 710068, Shaanxi,China.
Cong
C
Liu
D000293:Adolescent; D000328:Adult; D001182:Arthroscopy; D005260:Female; D006801:Humans; D008297:Male; D008592:Menisci, Tibial / Q000473:pathology / Q000601:surgery / Q000648:ultrastructure; D046529:Microscopy, Electron, Transmission; D008875:Middle Aged; D000070600:Tibial Meniscus Injuries; D014945:Wound Healing