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  1 / 6093 MEDLINE  
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PMID:29443758
Autor:Atsumi S; Hara K; Arai Y; Yamada M; Mizoshiri N; Kamitani A; Kubo T
Endereço:Department of Orthopedics, JCHO Kyoto Kuramaguchi Medical Center.
Título:A novel arthroscopic all-inside suture technique using the Fast-Fix 360 system for repairing horizontal meniscal tears in young athletes: 3 case reports.
Fonte:Medicine (Baltimore); 97(7):e9888, 2018 Feb.
ISSN:1536-5964
País de publicação:United States
Idioma:eng
Resumo:RATIONALE: Considering the risk of osteoarthritis following resection of a horizontally torn meniscus of the knee, repairing and preserving the meniscus as much as possible is preferred. We report 3 cases of restoration of horizontally torn menisci using a novel arthroscopic method we have called "all-inside interleaf vertical suture" that afforded preservation. PATIENT CONCERNS: The 3 patients (aged 14, 17, and 21 years) had knee pain through sports activity. DIAGNOSES: All patients had horizontal tears in the posteromedial part of the meniscus. INTERVENTIONS: The method uses Fast-Fix, whereby a first anchor is inserted from the tibial surface of the tear's superior leaflet and a second anchor is inserted from the femoral surface of the tear's inferior leaflet, and the 2 leaflets are closed using vertical suture. In all cases, the suture knots were embedded between the superior leaflet and inferior leaflet, avoiding contact with the articular cartilage, and superior leaflet and inferior leaflet crimping was good. OUTCOMES: All 3 were able to resume competing in sport and ≥ 1 year after surgery they had no pain and their postoperative mean Lysholm scores were 99.7. There were no complications or recurrence. On magnetic resonance imaging, the signal intensity of all the horizontal tears was high before surgery but low after surgery, suggesting that the repaired tear was healing. LESSONS: The all-inside interleaf vertical suture procedure is a new surgical technique that can repair posteromedial horizontal meniscal tears of the knee of young people by easy crimping of the superior and inferior leaflets without the suture knots causing complications.
Tipo de publicação: CASE REPORTS; JOURNAL ARTICLE


  2 / 6093 MEDLINE  
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PMID:29252630
Autor:Mahapatra S; Ambasta S
Endereço:Department of Orthopaedics, Mahatma Gandhi Medical College and Research Institute, Pondicherry, India.
Título:Bilateral Discoid Medial Menisci: A Case Report.
Fonte:JBJS Case Connect; 6(3):e53, 2016 Jul-Sep.
ISSN:2160-3251
País de publicação:United States
Idioma:eng
Resumo:CASE: We present the case of a 37-year-old man with features of a meniscal tear in 1 symptomatic knee and radiographic findings of discoid menisci in both knees. A provisional diagnosis of bilateral discoid medial menisci was made. Magnetic resonance imaging confirmed the discoid nature of the medial menisci in both knees. The symptomatic knee was managed with good results by partial meniscectomy using a routine arthroscopic procedure. CONCLUSION: Discoid medial meniscus is a relatively rare pathology of the knee joint, and bilateral cases are extremely rare. A high index of suspicion is necessary for diagnosis; only symptomatic knees should be treated surgically.
Tipo de publicação: CASE REPORTS; JOURNAL ARTICLE


  3 / 6093 MEDLINE  
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PMID:29419685
Autor:Dong J; Xu H; Jin G; Xin D; Zhang J; Kang K; Gao S; Chen B; Shen Y
Endereço:The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei.
Título:The adaptive change of patellofemoral joint after arthroscopic discoid lateral meniscus plasty: An observational study.
Fonte:Medicine (Baltimore); 97(6):e9827, 2018 Feb.
ISSN:1536-5964
País de publicação:United States
Idioma:eng
Resumo:The purpose of this study was to investigate the patellofemoral joint adaptive changes after discoid lateral meniscus (DLM) plasty.Forty-one patients with unilateral complete type DLM tears were included in this study. Demographic variables, including gender, age, body mass index (BMI), injury to operation interval, type of injury, and follow-up time, were recorded. The evolution of physical examination, imaging index, and functional score were analyzed by Chi-squared test, Wilcoxon signed ranks test, and Friedman test. Mann-Whitney test was used to analyze the difference at different time points between group PFI > 1.6 and PFI < 1.6.After the patients received arthroscopic DLM plasty, the positive rate of Patella grinding test increased from 19.5% to 29.3%, and it showed significant increased at last follow-up time point (48.8%) (P = .005). Mechanical axis deviation (MAD) significant decreased from -0.7 ±â€Š2.1 mm to -9.4 ±â€Š3.2 mm (P < .001). Lateral patellofemoral angle (LPFA) and lateral shift distance (LSD), respectively, decreased from 11.9 ±â€Š5.8° and 1.0 ±â€Š4.0 mm to 7.2 ±â€Š4.5° and -0.5 ±â€Š3.3 mm (P < .001). Patellofemoral index (PFI) increased from 1.7 ±â€Š0.3 to 1.9 ±â€Š0.4 (P < .001). Kujala score and Lysholm score, respectively, increased from 65.9 ±â€Š10.0 and 85.2 ±â€Š6.4 mm to 61.8 ±â€Š10.2 and 89.5 ±â€Š5.0 (P < .001). Only LSD in group > 1.6 were significant lower than those in group < 1.6 (>1.6: -1.5 ±â€Š2.8, -1.6 ±â€Š2.7, -1.5 ±â€Š2.6; <1.6: 0.8 ±â€Š3.4, 0.4 ±â€Š3.6, 0.6 ±â€Š2.8. P = .010,.038,.011) at the 3 postoperative follow-up time points.After arthroscopic plasty for complete type DLM which decreased the thickness and width of the residual meniscus, in turn causing the varus deformity significantly decreased or a valgus inclination developed. Moreover, the consequent changes of patellofemoral joint caused a certain amount of patellar tilt and patellar dislocation, might aggravated the symptomatic anterolateral knee pain or the lateral patellar compression syndrome.
Tipo de publicação: JOURNAL ARTICLE; OBSERVATIONAL STUDY


  4 / 6093 MEDLINE  
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PMID:29249200
Autor:Sadigursky D; Garcia LC; Martins RR; De Queiroz GC; Carneiro RJF; Colavolpe PO
Endereço:Division of Knee Surgery, Clínica Ortopédica Traumatológica - COT, Salvador, Bahia, Brazil. davidsad@gmail.com.
Título:Anatomical variant of the meniscus related to posterior junction: a case report.
Fonte:J Med Case Rep; 11(1):351, 2017 Dec 18.
ISSN:1752-1947
País de publicação:England
Idioma:eng
Resumo:BACKGROUND: There are several reports on anatomical differences of the meniscus. However, there are only a few reports on abnormalities in both menisci and anatomical differences in anterior cruciate ligament insertions. CASE PRESENTATION: This is a case report of a 36-year-old Hispanic man presenting symptoms, including knee pain, locking, and effusion, with an anatomical abnormality of the menisci corresponding to the fusion of the posterior horns of the menisci in tandem with the insertion of the posterior meniscus fibers in the anterior cruciate ligament. CONCLUSIONS: This is the first study describing a meniscus anatomical variant with isolated posterior junction of the posterior horn with an anomalous insertion to the anterior cruciate ligament. The recognition of meniscus variants is important as they can be misinterpreted for more significant pathology on magnetic resonance images.
Tipo de publicação: CASE REPORTS; JOURNAL ARTICLE


  5 / 6093 MEDLINE  
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PMID:28464560
Autor:Wilkinson DJ; Habgood A; Lamb HK; Thompson P; Hawkins AR; Désilets A; Leduc R; Steinmetzer T; Hammami M; Lee MS; Craik CS; Watson S; Lin H; Milner JM; Rowan AD
Endereço:Newcastle University, Newcastle upon Tyne, UK.
Título:Matriptase Induction of Metalloproteinase-Dependent Aggrecanolysis In Vitro and In Vivo: Promotion of Osteoarthritic Cartilage Damage by Multiple Mechanisms.
Fonte:Arthritis Rheumatol; 69(8):1601-1611, 2017 08.
ISSN:2326-5205
País de publicação:United States
Idioma:eng
Resumo:OBJECTIVE: To assess the ability of matriptase, a type II transmembrane serine proteinase, to promote aggrecan loss from the cartilage of patients with osteoarthritis (OA) and to determine whether its inhibition can prevent aggrecan loss and cartilage damage in experimental OA. METHODS: Aggrecan release from human OA cartilage explants and human stem cell-derived cartilage discs was evaluated, and cartilage-conditioned media were used for Western blotting. Gene expression was analyzed by real-time polymerase chain reaction. Murine OA was induced by surgical destabilization of the medial meniscus, and matriptase inhibitors were administered via osmotic minipump or intraarticular injection. Cartilage damage was scored histologically and aggrecan cleavage was visualized immunohistochemically using specific neoepitope antibodies. RESULTS: The addition of soluble recombinant matriptase promoted a time-dependent release of aggrecan (and collagen) from OA cartilage, which was sensitive to metalloproteinase inhibition and protease-activated receptor 2 antagonism. Although engineered human (normal) cartilage discs failed to release aggrecan following matriptase addition, both matrix metalloproteinase- and aggrecanase-mediated cleavages of aggrecan were detected in human OA cartilage. Additionally, while matriptase did not directly degrade aggrecan, it promoted the accumulation of low-density lipoprotein receptor-related protein 1 (LRP-1) in conditioned media of the OA cartilage explants. Matriptase inhibition via neutralizing antibody or small molecule inhibitor significantly reduced cartilage damage scores in murine OA, which was associated with reduced generation of metalloproteinase-mediated aggrecan cleavage. CONCLUSION: Matriptase potently induces the release of metalloproteinase-generated aggrecan fragments as well as soluble LRP-1 from OA cartilage. Therapeutic targeting of matriptase proteolytic activity reduces metalloproteinase activity, further suggesting that this serine proteinase may have potential as a disease-modifying therapy in OA.
Tipo de publicação: JOURNAL ARTICLE; RESEARCH SUPPORT, N.I.H., EXTRAMURAL; RESEARCH SUPPORT, NON-U.S. GOV'T
Nome de substância:0 (Aggrecans); 0 (Antibodies, Neutralizing); 0 (Low Density Lipoprotein Receptor-Related Protein-1); 0 (Membrane Proteins); 0 (Recombinant Proteins); EC 3.4.- (Endopeptidases); EC 3.4.21.- (Serine Endopeptidases); EC 3.4.21.109 (ST14 protein, human); EC 3.4.21.109 (St14 protein, mouse); EC 3.4.24.- (ADAMTS5 Protein); EC 3.4.24.- (Matrix Metalloproteinases); EC 3.4.24.82 (ADAMTS4 Protein); EC 3.4.99.- (aggrecanase)


  6 / 6093 MEDLINE  
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PMID:29305451
Autor:Smith NA; Parsons N; Wright D; Hutchinson C; Metcalfe A; Thompson P; Costa ML; Spalding T
Endereço:University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK.
Título:A pilot randomized trial of meniscal allograft transplantation versus personalized physiotherapy for patients with a symptomatic meniscal deficient knee compartment.
Fonte:Bone Joint J; 100-B(1):56-63, 2018 Jan.
ISSN:2049-4408
País de publicação:England
Idioma:eng
Resumo:AIMS: Meniscal allograft transplantation is undertaken to improve pain and function in patients with a symptomatic meniscal deficient knee compartment. While case series have shown improvements in patient reported outcome measures (PROMs), its efficacy has not been rigorously evaluated. This study aimed to compare PROMs in patients having meniscal transplantation with those having personalized physiotherapy at 12 months. PATIENTS AND METHODS: A single-centre assessor-blinded, comprehensive cohort study, incorporating a pilot randomized controlled trial (RCT) was performed on patients with a symptomatic compartment of the knee in which a (sub)total meniscectomy had previously been performed. They were randomized to be treated either with a meniscal allograft transplantation or personalized physiotherapy, and stratified for malalignment of the limb. They entered the preference groups if they were not willing to be randomized. The Knee injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC) score and Lysholm score and complications were collected at baseline and at four, eight and 12 months following the interventions. RESULTS: A total of 36 patients entered the study; 21 were randomized and 15 chose their treatments. Their mean age was 28 years (range 17 to 46). The outcomes were similar in the randomized and preference groups, allowing pooling of data. At 12 months, the KOOS composite score (mean difference 12, p = 0.03) and KOOS subscales of pain (mean difference 15, p = 0.02) and activities of daily living (mean difference 18, p = 0.005) were significantly superior in the meniscal transplantation group. Other PROMs also favoured this group without reaching statistical significance. There were five complications in the meniscal transplantation and one in the physiotherapy groups. CONCLUSION: This is the first study to compare meniscal allograft transplantation to non-operative treatment. The results provide the best quality evidence to date of the symptomatic benefits of meniscal allograft transplantation in the short term, but a multicentre RCT is required to investigate this question further. Cite this article: 2018;100-B:56-63.
Tipo de publicação: COMPARATIVE STUDY; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL


  7 / 6093 MEDLINE  
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PMID:28808951
Autor:Van der Post A; Noorduyn JCA; Scholtes VAB; Mutsaerts ELAR
Endereço:Universiteit van Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. annesophievanderpost@gmail.com.
Título:What Is the Diagnostic Accuracy of the Duck Walk Test in Detecting Meniscal Tears?
Fonte:Clin Orthop Relat Res; 475(12):2963-2969, 2017 Dec.
ISSN:1528-1132
País de publicação:United States
Idioma:eng
Resumo:BACKGROUND: Clinical weightbearing provocation tests, like the duck walk test, may be of value in diagnosing or screening for medial meniscal tears. However, evidence of the diagnostic accuracy of the duck walk test is lacking. QUESTIONS/PURPOSES: (1) To determine the sensitivity and specificity of the duck walk test in diagnosing medial meniscal tears. (2) To determine whether tear location, tear cause (traumatic versus degenerative), and ACL insufficiency were associated with differences in the sensitivity and specificity of the test. METHODS: A convenience sample of 136 patients of all ages was retrospectively analyzed by evaluating the outpatient knee clinic appointment list of one orthopaedic surgeon for patients with a broad range of knee injuries who had a prior MRI before (24%) or after (76%) physical examination and had a duck walk test stated in their patient records. Of 230 patients with MRI requested by one orthopaedic surgeon attributable to knee complaints, 136 (59%) fulfilled the inclusion criteria; 70 (52%) patients were male and 66 (49%) were female, with a mean age of 42 (± SD 14) years. The duck walk test was performed in case of suspected meniscal injury, based on mechanism of injury, general joint line pain, and/or mechanical complaints (ie, locking, giving away). The test is performed by squatting and "waddling" before rising and is positive in case of general joint line pain or painful "clicking". Interobserver repeatability was not evaluated, but the test is well defined and leaves little room for difference in interpretation. Diagnostic accuracy measures were evaluated. Since the convenience sample in this study consisted of patients who had a duck walk test and MRI, and a positive result of the duck walk test almost certainly increased the probability that MRI would be ordered in the majority (76%) of the patients, the test properties calculated here-especially sensitivity-should be considered inflated. RESULTS: The calculated sensitivity of the duck walk test was 71% (95% CI, 59%-81%) and there was low specificity of 39% (95% CI, 27%-52%). We found no difference in sensitivity between medial (67%; 95% CI, 51%-80%) and lateral (76%; 95% CI, 50%-92%; p = 0.492) meniscal tears. With the numbers available, we compared these patients with patients without a history of trauma and with an intact ACL. We found no difference among patients with traumatic tears (79%; 95% CI, 59%-91%; p = 0.253) and in patients with ACL tears (77%; 95% CI, 46%-94%; p = 0.742). CONCLUSIONS: Because of the issue of verification bias, the actual sensitivity of this test in practice is likely much lower than the calculated sensitivity we observed. In addition, the test did not seem to perform better in patients with trauma or ACL insufficiency, nor was it more effective in detecting medial than lateral tears, although the numbers on some of those comparisons were rather small. Based on these results, we conclude that used alone, the duck walk test likely has little value in practice as a screening test. However, it is conceivable that it could be used in combination with other provocative tests for screening purposes. Future studies might consider using it as a means to best identify which patients should undergo MRI for the possibility of a meniscal tear. LEVEL OF EVIDENCE: Level III, diagnostic study.
Tipo de publicação: COMPARATIVE STUDY; EVALUATION STUDIES; JOURNAL ARTICLE


  8 / 6093 MEDLINE  
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PMID:28787249
Autor:Hare KB; Stefan Lohmander L; Kise NJ; Risberg MA; Roos EM
Endereço:a Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark , Denmark.
Título:Middle-aged patients with an MRI-verified medial meniscal tear report symptoms commonly associated with knee osteoarthritis.
Fonte:Acta Orthop; 88(6):664-669, 2017 Dec.
ISSN:1745-3682
País de publicação:England
Idioma:eng
Resumo:Background and purpose - No consensus exists on when to perform arthroscopic partial meniscectomy in patients with a degenerative meniscal tear. Since MRI and clinical tests are not accurate in detecting a symptomatic meniscal lesion, the patient's symptoms often play a large role when deciding when to perform surgery. We determined the prevalence and severity of self-reported knee symptoms in patients eligible for arthroscopic partial meniscectomy due to a degenerative meniscal tear. We investigated whether symptoms commonly considered to be related to meniscus injury were associated with early radiographic signs of knee osteoarthritis. Patients and methods - We included individual baseline items from the Knee injury and Osteoarthritis Outcome Score collected in 2 randomized controlled trials evaluating treatment for an MRI-verified degenerative medial meniscal tears in 199 patients aged 35-65 years. Each item was scored as no, mild, moderate, severe, extreme, and at least "mild" considering the symptoms present. Early radiographic signs of osteoarthritis, defined as a Kellgren and Lawrence grade of at least 1, were seen in 70 patients. Results - At least monthly knee pain, pain during stair walking and when twisting on the knee, and lack of confidence in knee was present in at least 80% of the patients. Median severity was at least moderate for knee pain, pain when twisting on the knee, pain walking on stairs, lack of confidence in knee, and clicking. Mechanical symptoms such as catching were rare. Early radiographic signs of osteoarthritis were associated with an increased risk of self-reported swelling, catching, and stiffness later in the day; the odds ratio was 2.4 (95% CI 1.2-4.9), 2.3 (1.2-4.3), and 2.3 (1.1-5.0), respectively. Interpretation - Middle-aged patients with a degenerative medial meniscus tear reported symptoms commonly associated with knee osteoarthritis. Frequent knee pain, presence of lack of confidence in the knee, and clicking did not distinguish those with a meniscal tear alone from those with early radiographic knee OA. Our findings support the notion that symptoms reported by those with a degenerative meniscal tear represent early signs of knee osteoarthritis.
Tipo de publicação: JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL


  9 / 6093 MEDLINE  
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PMID:28678120
Autor:Bisson LJ; Kluczynski MA; Wind WM; Fineberg MS; Bernas GA; Rauh MA; Marzo JM; Zhou Z; Zhao J
Endereço:1The State University of New York at Buffalo, Buffalo, New York.
Título:Patient Outcomes After Observation Versus Debridement of Unstable Chondral Lesions During Partial Meniscectomy: The Chondral Lesions And Meniscus Procedures (ChAMP) Randomized Controlled Trial.
Fonte:J Bone Joint Surg Am; 99(13):1078-1085, 2017 Jul 05.
ISSN:1535-1386
País de publicação:United States
Idioma:eng
Resumo:BACKGROUND: It is unknown whether unstable chondral lesions observed during arthroscopic partial meniscectomy (APM) require treatment. We examined differences at 1 year with respect to knee pain and other outcomes between patients who had debridement (CL-Deb) and those who had observation (CL-noDeb) of unstable chondral lesions encountered during APM. METHODS: Patients who were ≥30 years old and undergoing APM were randomized to receive debridement (CL-Deb group; n = 98) or observation (CL-noDeb; n = 92) of unstable Outerbridge grade-II, III, or IV chondral lesions. Outcomes were evaluated preoperatively and at 8 to 12 days, 6 weeks, 3 months, 6 months, and 1 year postoperatively. Outcome measures included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS), visual analog scale (VAS) pain score, Short Form-36 (SF-36) health survey, range of motion, quadriceps circumference, and effusion. The primary outcome was the WOMAC pain score at 1 year. T tests were used to examine group differences in outcomes, and the means and standard deviations are reported. RESULTS: There were no significant differences between the groups with respect to any of the 1-year outcome scores. Compared with the CL-Deb group, the CL-noDeb group had improvement in the KOOS quality-of-life (p = 0.04) and SF-36 physical functioning scores (p = 0.01) as well as increased quadriceps circumference at 8 to 12 days (p = 0.02); had improvement in the pain score on the WOMAC (p = 0.02) and KOOS (p = 0.04) at 6 weeks; had improvement in SF-36 physical functioning scores at 3 months (p = 0.01); and had increased quadriceps circumference at 6 months (p = 0.02). CONCLUSIONS: Outcomes for the CL-Deb and CL-noDeb groups did not differ at 1 year postoperatively. This suggests that there is no benefit to arthroscopic debridement of unstable chondral lesions encountered during APM, and it is recommended that these lesions be left in situ. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Tipo de publicação: JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL


  10 / 6093 MEDLINE  
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PMID:28665174
Autor:Muheim LLS; Senn O; Früh M; Reich O; Rosemann T; Neuner-Jehle SM
Endereço:a Institute of Primary Care, University of Zurich , Zurich , Switzerland.
Título:Inappropriate use of arthroscopic meniscal surgery in degenerative knee disease.
Fonte:Acta Orthop; 88(5):550-555, 2017 Oct.
ISSN:1745-3682
País de publicação:England
Idioma:eng
Resumo:Background and purpose - Current evidence suggests that arthroscopic knee surgery has no added benefit compared with non-surgical management in degenerative meniscal disease. Yet in many countries, arthroscopic partial meniscectomy (APM) remains among the most frequently performed surgeries. This study quantifies and characterizes the dynamics of the current use of knee arthroscopies in Switzerland in a distinctively non-traumatic patient group. Methods - We assessed a non-accident insurance plan of a major Swiss health insurance company for surgery rates of APM, arthroscopic debridement and lavage in patients over the age of 40, comparing the years 2012 and 2015. Claims were analyzed for prevalence of osteoarthritis, related interventions and the association of surgery with insurance status. Results - 648,708 and 647,808 people were examined in 2012 and 2015, respectively. The incidence of APM, debridement, and lavage was 388 per 10 person-years in 2012 and 352 per 10 person-years in 2015 in non-traumatic patients over the age of 40, consisting mostly of APM (96%). Between years, APM surgery rates changed in patients over the age of 65 (p < 0.001) but was similar in patients aged 40-64. Overall prevalence of osteoarthritis was 25%. Insurance status was independently associated with arthroscopic knee surgery. Interpretation - APM is widely used in non-traumatic patients in Switzerland, which contrasts with current evidence. Many procedures take place in patients with degenerative knee disease. Surgery rates were similar in non-traumatic middle-aged patients between 2012 and 2015. Accordingly, the potential of inappropriate use of APM in non-traumatic patients in Switzerland is high.
Tipo de publicação: JOURNAL ARTICLE



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