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Boksh K, Martins A, Elbashir M, Boutefnouchet T, Aujla R. Modified Mason-Allen vs Two Simple Stitch Fixation for Medial Meniscus Posterior Root Tears: A Systematic Review and Meta-analysis. Am J Sports Med 2024; 52:1877-1887. [PMID: 38258492 DOI: 10.1177/03635465231190650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
BACKGROUND Various suture configurations are available for medial meniscus posterior root tear (MMPRT) repair. The modified Mason-Allen (MMA) technique has been proposed as a refixation technique for MMPRT instead of the conventional 2 simple stitches (TSS). This is in view of its superior biomechanical characteristics. PURPOSE To perform a systematic review and meta-analysis to compare MMA and TSS configuration techniques for MMPRT repair and identify any differences between the 2 techniques in terms of clinical outcomes, medial meniscal extrusion (MME), and postoperative healing. STUDY DESIGN Meta-analysis; Level of evidence, 4. METHODS The Cochrane Controlled Register of Trials, PubMed, Medline, and Embase databases were used to perform a systematic review and meta-analysis using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria with the following search terms: ("meniscus" OR "meniscal injuries") AND ("Mason-Allen" OR "simple stitch" OR "suture techniques"). Data pertaining to all patient-reported outcome measures, postoperative complications, MME, postoperative healing, cartilage degeneration, and progression of knee osteoarthritis were extracted from each study. The pooled outcome data were analyzed using random- and fixed-effects models. RESULTS After abstract and full-text screening, 6 clinical studies were included. In total, there were 291 patients; 160 underwent MMA fixation, and 131 underwent the TSS technique. The majority of studies had similar surgical techniques regarding repair technique, suture material, tibial fixation, and number and position of tibial tunnels. There were no differences between the groups in terms of patient-reported outcome measures at 14.2 months. Both techniques were also similar in the degree of postoperative MME and meniscal healing. CONCLUSION Both suture configurations were equivalent in terms of clinical outcomes, the extent of meniscal extrusion, and postoperative healing. The TSS technique may offer advantages in terms of faster learning curve and shorter operative time. However, randomized controlled trials with large sample sizes, longer follow-up and assessment of chondral degeneration, and presence of knee osteoarthritis are required to assess whether a true difference exists, as the majority of included studies were limited by their retrospective design.
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Affiliation(s)
- Khalis Boksh
- Leicester Knee Unit, Department of Trauma and Orthopaedics, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Andre Martins
- Leicester Knee Unit, Department of Trauma and Orthopaedics, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Mohamed Elbashir
- Leicester Knee Unit, Department of Trauma and Orthopaedics, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Tarek Boutefnouchet
- Department of Mechanical Engineering, University of Birmingham, Birmingham, United Kingdom
| | - Randeep Aujla
- Leicester Knee Unit, Department of Trauma and Orthopaedics, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
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Krych AJ, Boos AM, Lamba A, Smith PA. Satisfactory Clinical Outcome, Complications, and Provisional Results of Meniscus Centralization with Medial Meniscus Root Repair for the Extruded Medial Meniscus at Mean 2-Year Follow-Up. Arthroscopy 2024; 40:1578-1587. [PMID: 37832745 DOI: 10.1016/j.arthro.2023.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/23/2023] [Accepted: 10/04/2023] [Indexed: 10/15/2023]
Abstract
PURPOSE To describe the patient-reported clinical outcomes following medial meniscus root repair with meniscus centralization and to identify common complications and detail provisional results. METHODS Patients undergoing medial meniscus root repair with meniscus centralization from 2020 to 2022 were identified using an institutional database. Patients were followed prospectively using postoperative Tegner Activity Scale, visual analog scale (VAS) for pain, Knee Injury and Osteoarthritis Outcome Score, Joint Replacement, International Knee Documentation Committee score, and a Likert score for improvement, surgery satisfaction, and subsequent surgeries at minimum 1-year follow-up with mean 2-year follow-up. Demographics, injury characteristics, and surgical details were also collected. RESULTS Twenty-five patients (age: 50 ± 11 years; sex: 76% female; body mass index: 33 ± 8) were included in this study. Postoperative Tegner score was maintained at preoperative levels (P = .233), and VAS at rest, VAS with use, Knee Injury and Osteoarthritis Outcome Score, Joint Replacement, and International Knee Documentation Committee improved significantly postoperatively (P = .003; P < .001, P < .001, P = .023, respectively). Eighty-eight percent of patients reported subjective improvement in their knee at final follow-up. Postoperative radiographs did not show any significant osteoarthritis progression, and no patients had undergone a revision meniscus surgery or total knee arthroplasty at the time of follow-up. CONCLUSIONS At minimum 1-year follow-up and mean 2-year follow-up, patients undergoing medial meniscus root repair with meniscus centralization demonstrated significant postoperative improvements in pain, function, and quality of life and reported high rates of surgery satisfaction. There was no evidence of significant arthritic progression on postoperative imaging, and no patients underwent revision meniscus surgery or total knee arthroplasty. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Aaron J Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A..
| | - Alexander M Boos
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Abhinav Lamba
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Patrick A Smith
- Department of Orthopedic Surgery, Columbia Orthopaedic Group, Columbia, Missouri, U.S.A.; Department of Orthopedic Surgery, University of Missouri, Columbia, Missouri, U.S.A
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Mundal K, Geeslin AG, Solheim E, Inderhaug E. Differences Between Traumatic and Degenerative Medial Meniscus Posterior Root Tears: A Systematic Review. Am J Sports Med 2024:3635465241237254. [PMID: 38600780 DOI: 10.1177/03635465241237254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
BACKGROUND Intact meniscus roots are a prerequisite for normal meniscal function, including even distribution of compressive forces across the knee joint. An injury to the root disrupts the hoop strength of the meniscus and may lead to its extrusion and the development of osteoarthritis. A medial meniscus posterior root tear (MMPRT) is often thought to have a primary degenerative pathogenesis. However, there is mention of some cases of MMPRTs where the patients have a solely traumatic injury to a previously healthy meniscus. PURPOSE To describe a subpopulation of patients with traumatic MMPRT. STUDY DESIGN Systematic review; Level of evidence, 5. METHODS The Web of Science database (www.webofscience.com) was queried using the Medical Subject Headings term "medial root tear." Articles were reviewed, and those evaluated for MMPRTs in a degenerative meniscus were excluded. A total of 25 articles describing cases of acute traumatic causes were included in this study. For these articles, the patient characteristics, injury mechanisms, and concomitant injuries evaluated were recorded and pooled. RESULTS The search revealed 660 articles, and 25 were selected for inclusion. A total of 113 patients with a traumatic MMPRT were identified and included in this review. The study population had a mean age of 27.1 years and a high share of men (64%). Also, this review displays how most patients with traumatic MMPRTs also suffer concomitant injuries (68%). CONCLUSION The findings in this review support our hypothesis that there is a unique subgroup with acute traumatic MMPRTs that have unique patient characteristics, injury mechanisms, and combined injuries, compared with previously published reviews on MMPRTs.
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Affiliation(s)
- Kristine Mundal
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Haukeland University Hospital, Bergen, Norway
| | - Andrew G Geeslin
- Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Eirik Solheim
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Aleris Nesttun Bergen, Bergen, Norway
| | - Eivind Inderhaug
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Haukeland University Hospital, Bergen, Norway
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Manatrakul R, Loeffler M, Bharadwaj UU, Joseph GB, Lansdown D, Feeley B, Baal JD, Guimaraes JB, Link TM. Clinical and radiologic outcomes in patients with meniscal root tears. BMC Musculoskelet Disord 2024; 25:232. [PMID: 38521904 PMCID: PMC10960405 DOI: 10.1186/s12891-024-07359-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 03/14/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Meniscal root tears can lead to early knee osteoarthritis and pain. This study aimed (1) to compare clinical and radiological outcomes between patients who underwent arthroscopic meniscal root repair after meniscal root tears and those who received non-surgical treatment, and (2) to identify whether baseline MRI findings could be potential predictors for future treatment strategies. METHODS Patients with meniscal root tears were identified from our picture archiving and communication system from 2016 to 2020. Two radiologists reviewed radiographs and MRI studies using Kellgren-Lawrence (KL) grading and a modified Whole Organ MRI Scoring (WORMS) at baseline and follow-up. The median (interquartile range [IQR]) of follow-up radiographs and MRI studies were 134 (44-443) days and 502 (260-1176) days, respectively. MR images were assessed for root tear-related findings. Pain scores using visual analogue scale (VAS) and management strategies (non-surgical vs. arthroscopic root repair) were also collected. Chi-squared tests and independent t-tests were used to assess differences regarding clinical and imaging variables between treatment groups. Logistic regression analyses were performed to evaluate the associations between baseline MRI findings and each future treatment. RESULTS Ninety patients were included. VAS pain scores were significantly (p < 0.01) lower after arthroscopic repair compared to conservative treatment (1.27±0.38vs.4±0.52) at the last follow-up visit with median (IQR) of 325 (180-1391) days. Increased meniscal extrusion (mm) was associated with higher odds of receiving non-surgical treatment (OR = 1.65, 95%CI 1.02-2.69, p = 0.04). The odds of having arthroscopic repair increased by 19% for every 1 mm increase in the distance of the tear from the root attachment (OR = 1.19, 95% CI: 1.05-1.36, p < 0.01). The odds of undergoing arthroscopic repair were reduced by 49% for every 1 mm increase in the extent of meniscal extrusion (OR = 0.51, 95% CI: 0.29-0.91, p = 0.02) as observed in the baseline MRI. CONCLUSIONS Patients who underwent arthroscopic repair had lower pain scores than patients with conservative treatment in the follow-up. Distance of the torn meniscus to the root attachment and the extent of meniscal extrusion were significant predictors for arthroscopic repair in the next three weeks (time from the baseline MRI to the surgery date).
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Affiliation(s)
- Rawee Manatrakul
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA, 94158, USA
- Department of Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Maximilian Loeffler
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA, 94158, USA
- Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Freiburg im Breisgau, Germany
| | - Upasana U Bharadwaj
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA, 94158, USA
| | - Gabby B Joseph
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA, 94158, USA
| | - Drew Lansdown
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Brian Feeley
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Joe D Baal
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA, 94158, USA
| | - Julio B Guimaraes
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA, 94158, USA
- Department of Radiology, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil
- Department of Musculoskeletal Radiology, Fleury Medicina e Saúde, São Paulo, Brazil
| | - Thomas M Link
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA, 94158, USA.
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Lee DR, Lu Y, Reinholz AK, Till SE, Lamba A, Saris DBF, Camp CL, Krych AJ. Root Repair Has Superior Radiological and Clinical Outcomes Than Partial Meniscectomy and Nonoperative Treatment in the Management of Meniscus Root Tears: A Systematic Review. Arthroscopy 2024:S0749-8063(24)00152-X. [PMID: 38401664 DOI: 10.1016/j.arthro.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 02/04/2024] [Accepted: 02/15/2024] [Indexed: 02/26/2024]
Abstract
PURPOSE To compile and analyze structural and clinical outcomes after meniscus root tear treatment as currently described in the literature. METHODS A review was conducted to identify studies published since 2011 on efficacy of repair, meniscectomy, and nonoperative management in the treatment of meniscus root tears. Patient cohorts were grouped into treatment categories, with medial and lateral root tears analyzed separately; data were collected on patient demographics, structural outcomes including joint space width, degree of medial meniscal extrusion, progression to total knee arthroplasty, and patient-reported outcome measures. Risk of bias was assessed using the MINORS (methodological index for non-randomized studies) criteria. Heterogeneity was measured using the I-statistic, and outcomes were summarized using forest plots without pooled means. RESULTS The 56 included studies comprised a total of 3,191 patients. Mean age among the included studies ranged from 24.6 to 65.6 years, whereas mean follow-up ranged from 12 to 125.9 months. Heterogeneity analysis identified significant differences between studies. Change in joint space width ranged from -2.4 to -0.6 mm (i.e., decreased space) after meniscectomy (n = 186) and -0.9 to -0.1 mm after root repair (n = 209); change in medial meniscal extrusion ranged from -0.6 to 6.5 mm after root repair (n = 521) and 0.2 to 4.2 mm after meniscectomy (n = 66); and event rate for total knee arthroplasty ranged from 0.00 to 0.22 after root repair (n = 205), 0.35 to 0.60 after meniscectomy (n = 53), and 0.27 to 0.35 after nonoperative treatment (n = 93). Root repair produced the greatest numerical increase in International Knee Documentation Committee and Lysholm scores of the 3 treatment arms. In addition, root repair improvements in Knee Injury and Osteoarthritis Outcome Score Pain (range: 22-32), Sports and Recreational Activities (range: 23-36), Quality of Life (range: 22-42), and Symptoms subscales (range: 10-19), in studies with low risk of bias. CONCLUSIONS The literature reporting on the treatment of meniscus root tears is heterogenous and largely limited to Level III and IV studies. Current evidence suggests root repair may be the most effective treatment strategy in lessening joint space narrowing of the knee and producing improvements in patient-reported outcomes. LEVEL OF EVIDENCE Level IV, systematic review of Level II-IV studies.
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Affiliation(s)
- Dustin R Lee
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Yining Lu
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Anna K Reinholz
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Sara E Till
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Abhinav Lamba
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Daniel B F Saris
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Christopher L Camp
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Aaron J Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A..
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Hiranaka T, Furumatsu T, Yokoyama Y, Higashihara N, Tamura M, Kawada K, Xue H, Ozaki T. Intercondylar notch width and osteophyte width impact meniscal healing and clinical outcomes following transtibial pullout repair of medial meniscus posterior root tears. Knee Surg Sports Traumatol Arthrosc 2024; 32:116-123. [PMID: 38226691 DOI: 10.1002/ksa.12032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 12/08/2023] [Indexed: 01/17/2024]
Abstract
PURPOSE This retrospective study aimed to investigate the relationship between intercondylar notch width (ICNW), osteophyte width (OW), and the healing of medial meniscus posterior root tears (MMPRTs) following arthroscopic pullout repair. METHODS The study included 155 patients diagnosed with MMPRTs who underwent transtibial pullout repair. Meniscal healing status was evaluated on second-look arthroscopy using a previously reported meniscus healing score. Patients were divided into two groups based on this score: the high healing score (group HH, healing score ≥ 8 points) and suboptimal healing score (group SO, healing score ≤ 6 points) groups. Computed tomography scans were performed on patients 1 week postsurgery. ICNW and OW widths were measured and relatively evaluated based on their ratio to the intercondylar distance (ICD), represented as the ICNW/ICD ratio (%) and OW/ICD ratio (%), respectively. Patient-reported outcomes were assessed preoperatively and on second-look arthroscopy using the Knee injury and Osteoarthritis Outcome Score (KOOS) and visual analogue scale (VAS). RESULTS There were no significant demographic differences between the SO and HH group (n = 35 and 120 patients, respectively). Regarding radiographic measurements, significant differences were observed in the ICNW/ICD ratio (group SO, 24.2%; group HH, 25.2%; p = 0.024), OW (group SO, 2.6 mm; group HH, 2.0 mm; p < 0.001), and OW/ICD ratio (group SO, 3.5%; group HH, 2.7%; p < 0.001). Both groups had similar preoperative clinical scores, but postoperative clinical scores, including KOOS-activities of daily living (group SO, 83.4; group HH, 88.7; p = 0.035) and VAS (group SO, 19.1; group HH, 11.3; p = 0.005), were significantly better in group HH. CONCLUSION The study suggests that ICNW and OW may play a crucial role in MMPRT healing following arthroscopic pullout repair, as evidenced by the worse clinical outcomes associated with a narrower ICNW and wider OW. These findings highlight the potential significance of ICNW and OW assessments when evaluating meniscal repair indications. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Takaaki Hiranaka
- Department of Orthopaedic Surgery, Okayama Saiseikai General Hospital, Okayama, Japan
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama, Japan
| | - Takayuki Furumatsu
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama, Japan
| | - Yusuke Yokoyama
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama, Japan
| | - Naohiro Higashihara
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama, Japan
| | - Masanori Tamura
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama, Japan
| | - Koki Kawada
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama, Japan
| | - Haowei Xue
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama, Japan
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Hiranaka T, Furumatsu T, Yokoyama Y, Higashihara N, Tamura M, Kawada K, Ozaki T. Weight loss enhances meniscal healing following transtibial pullout repair for medial meniscus posterior root tears. Knee Surg Sports Traumatol Arthrosc 2024; 32:143-150. [PMID: 38226719 DOI: 10.1002/ksa.12037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 12/11/2023] [Indexed: 01/17/2024]
Abstract
PURPOSE This study investigated the impact of weight change on the success of transtibial pullout repair for medial meniscus (MM) posterior root tears (MMPRTs). METHODS The study included 129 patients diagnosed with MMPRTs who had undergone transtibial pullout repair. The patients were screened between July 2018 and November 2021. Patient-reported outcomes were assessed preoperatively and at 12 months postoperatively using the Knee injury and Osteoarthritis Outcome Score (KOOS). MM extrusion (MME) and ΔMME (postoperative MME - preoperative MME) were calculated preoperatively and at 12 months postoperatively using magnetic resonance imaging. RESULTS Patients were divided into weight loss (body mass index [BMI] decrease of at least 0.5 kg/m2 after primary repair; n = 63) and weight gain (BMI increase of at least 0.5 kg/m2 ; n = 66) groups. Both groups had similar demographic variables and preoperative clinical scores; patient-reported outcomes significantly improved postoperatively. The weight loss group had significantly greater improvement in KOOS-quality of life (weight loss, 29.4 ± 23.7; weight gain, 23.9 ± 27.6; p = 0.034), lower postoperative MME (weight loss, 3.9 ± 1.7 mm; weight gain, 4.2 ± 1.2 mm; p = 0.043) and lower ΔMME (weight loss, 0.8 ± 0.8 mm; weight gain, 1.2 ± 0.9 mm; p = 0.002) than the weight gain group. Total arthroscopic healing scores (weight loss, 7.6 ± 1.0; weight gain, 7.2 ± 1.5; p = 0.048) and associated subscales, including anteroposterior bridging tissue width (weight loss, 4.0 ± 0.0; weight gain, 3.8 ± 0.7; p = 0.004) and MM posterior root stability (weight loss, 2.6 ± 0.7; weight gain, 2.4 ± 0.7; p = 0.041), significantly differed between the groups. CONCLUSIONS Weight loss was associated with better meniscal healing and less MME progression after MMPRT repair, highlighting the significance of weight management in individuals undergoing meniscal surgery. These findings provide valuable insights into the clinical significance of weight loss in the success of transtibial pullout repair for MMPRTs. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Takaaki Hiranaka
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama, Japan
- Department of Orthopaedic Surgery, Okayama Saiseikai General Hospital, Okayama, Japan
| | - Takayuki Furumatsu
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama, Japan
| | - Yusuke Yokoyama
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama, Japan
| | - Naohiro Higashihara
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama, Japan
| | - Masanori Tamura
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama, Japan
| | - Koki Kawada
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama, Japan
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Liao X, Li H, Nie S, Lan M. Risk factors of incomplete healing following medial meniscus posterior root tear repair with gracilis tendon. Sci Rep 2023; 13:22978. [PMID: 38151519 PMCID: PMC10752884 DOI: 10.1038/s41598-023-50358-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 12/19/2023] [Indexed: 12/29/2023] Open
Abstract
To evaluate the clinical efficacy and meniscus healing rates of the arthroscopically assisted tendon graft fixation of the medial meniscus posterior root tears (MMPRTs), and to identify some independent risk factors correlated with meniscal root healing status. We conducted a retrospective study with 129 patients who received arthroscopically assisted tendon graft fixation of the MMPRTs between January 2018 and September 2021. Functional recovery of the knee was evaluated and meniscal root healing status was assessed. The associations between different clinical factors and meniscal root healing status were analyzed. 98 (76.0%) patients had complete meniscal root healing with a minimum 2-year follow-up, and the Lysholm score, international knee documentation committee score, and visual analogue scale score were significantly improved at final follow-up (P < 0.001; respectively). Binary logistic regression models analysis and the receiver operating characteristic curve was performed to detect independent risk factors for incomplete healing, and these results indicated that age (OR = 1.095, P = 0.039), body mass index (BMI) (OR = 1.259, P = 0.018), preoperative meniscus extrusion (OR = 5.181, P < 0.001) and varus degree (OR = 7.764, P < 0.001) were the independent risk factors correlated with incomplete healing in patients with repaired MMPRTs. In conclusion, the arthroscopically assisted tendon graft fixation of the MMPRTs can provide good clinical and radiological outcome. Additionally, we identified age > 37.5 years, BMI > 24.5 kg/m2, preoperative meniscus extrusion > 2.7 mm and varus degree > 3.3° as independent risk factors correlated with incomplete meniscus root healing status.
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Affiliation(s)
- Xingen Liao
- Department of Orthopedics, Jiangxi Provincial People's Hospital (The First Affiliated Hospital of Nanchang Medical College), No.92 Aiguo Road, Donghu District, Nanchang, 330006, Jiangxi Province, People's Republic of China
| | - Hongbo Li
- Department of Orthopedics, Jiangxi Provincial People's Hospital (The First Affiliated Hospital of Nanchang Medical College), No.92 Aiguo Road, Donghu District, Nanchang, 330006, Jiangxi Province, People's Republic of China
| | - Si Nie
- Department of Radiology, Jiangxi Provincial People's Hospital (The First Affiliated Hospital of Nanchang Medical College), Nanchang, 330006, People's Republic of China
| | - Min Lan
- Department of Orthopedics, Jiangxi Provincial People's Hospital (The First Affiliated Hospital of Nanchang Medical College), No.92 Aiguo Road, Donghu District, Nanchang, 330006, Jiangxi Province, People's Republic of China.
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Nie S, Li H, Liao X, Liu Q, Lan M. Younger patients, lower BMI, complete meniscus root healing, lower HKA degree and shorter preoperative symptom duration were the independent risk factors correlated with the good correction of MME in patients with repaired MMPRTs. Knee Surg Sports Traumatol Arthrosc 2023; 31:3775-3783. [PMID: 36790456 DOI: 10.1007/s00167-023-07330-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 01/30/2023] [Indexed: 02/16/2023]
Abstract
PURPOSE To evaluate the clinical and radiological outcomes of arthroscopically assisted tendon graft anatomic reinforced reconstruction of the medial meniscus posterior root tears (MMPRTs) and identify relevant factors affecting the correction of medial meniscal extrusion (MME). METHODS Fifty-three MMPRTs patients who underwent arthroscopically assisted tendon graft reconstruction of the meniscal root between 2018 and 2020 were evaluated retrospectively. the patients were divided into 2 groups according to the correction of MME (maintained MME group: 32 cases vs. increased MME group: 21 cases). The clinical and radiological outcomes of arthroscopically assisted tendon graft reconstruction of the meniscal root, including postoperative correction of MME and functional recovery of the knee were assessed in this study, and potential independent risk factors that could influence the correction of MME were also evaluated. RESULTS The functional recovery of the knee was significantly improved at the end of follow-up (P < 0.001; respectively), furthermore, a comparison of the final functional outcomes between the groups showed that the mean Lysholm score and IKDC score of the maintained MME group were significantly improved than those of increased MME group. 60.4% had good correction of MME, and patients with complete healing had better extrusion correction than those with partial healing and non-healing. Binary logistic regression models analysis indicated that the age (OR = 1.053, P = 0.048), BMI (OR = 1.376, P = 0.004), meniscus root healing status (OR = 7.701, P = 0.005), HKA degree (OR = 1.891, P = 0.011) and preoperative symptom duration (OR = 1.055, P = 0.013) were the independent risk factors correlated with correction of MME. Additionally, the ROC curve demonstrated the cut-off values of the Age, BMI, HKA degree and preoperative symptom duration were 46.0 years, 22.5 kg/m2, 3.2° and 9.5 months, respectively, CONCLUSIONS: The arthroscopically assisted tendon graft anatomic reinforced reconstruction of the meniscal root showed clinical improvement and prevented the progression of postoperative MME. Additionally, younger patients, lower BMI, complete meniscus root healing, lower HKA degree and shorter preoperative symptom duration were the independent risk factors correlated with the good correction of MME in patients with repaired MMPRTs. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Si Nie
- Department of Radiology, Jiangxi Provincial People's Hospital, (The First Affiliated Hospital of Nanchang Medical College), Nanchang, 330006, People's Republic of China
| | - Hongbo Li
- Department of Orthopedics, Jiangxi Provincial People's Hospital, (The First Affiliated Hospital of Nanchang Medical College), No.92 Aiguo Road, Donghu District, Nanchang, Jiangxi Province, 330006, People's Republic of China
| | - Xingen Liao
- Department of Orthopedics, Jiangxi Provincial People's Hospital, (The First Affiliated Hospital of Nanchang Medical College), No.92 Aiguo Road, Donghu District, Nanchang, Jiangxi Province, 330006, People's Republic of China
| | - Qing Liu
- Department of Nursing Science, Jiangxi Provincial People's Hospital, (The First Affiliated Hospital of Nanchang Medical College), Nanchang, 330006, People's Republic of China
| | - Min Lan
- Department of Orthopedics, Jiangxi Provincial People's Hospital, (The First Affiliated Hospital of Nanchang Medical College), No.92 Aiguo Road, Donghu District, Nanchang, Jiangxi Province, 330006, People's Republic of China.
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10
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Hiranaka T, Furumatsu T, Yokoyama Y, Kintaka K, Higashihara N, Tamura M, Kawada K, Xue H, Hamada M, Ozaki T. The clinical and radiographic outcomes of type 2 medial meniscus posterior root tears following transtibial pullout repair. Knee Surg Sports Traumatol Arthrosc 2022; 31:2323-2330. [PMID: 36566386 DOI: 10.1007/s00167-022-07293-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 12/13/2022] [Indexed: 12/26/2022]
Abstract
PURPOSE The aim of this study was to compare the clinical outcomes of different subtypes of type 2 medial meniscus posterior root tears following transtibial pullout repair. METHODS In total, 147 patients (mean age: 66.2 ± 8.3 years) who were diagnosed with type 2 medial meniscus posterior root tears and underwent transtibial pullout repair were included. Patients were divided into 2A (n = 31), 2B (n = 90), and 2C (n = 26) groups according to tear type. Clinical outcomes were assessed pre-operatively and at second-look arthroscopy using the Knee injury and Osteoarthritis Outcome Score. The meniscal healing status was evaluated at second-look arthroscopy. Medial meniscus extrusion was calculated using magnetic resonance imaging pre-operatively and at second-look arthroscopy. RESULTS No significant differences in pre-operative or post-operative clinical scores were observed between each subtype, although clinical scores improved post-operatively for each subtype. Significant differences were noted in the anteroposterior width of the bridging tissues at second-look arthroscopy (2A, 7.1 ± 1.2; 2B, 6.2 ± 1.7; and 2C, 6.2 ± 1.7 mm; p = 0.045); type 2A tears were the widest. There was a significant difference in post-operative medial meniscus extrusion (2A, 3.2 ± 0.9; 2B, 4.0 ± 1.2; and 2C, 4.0 ± 1.4 mm; p = 0.004) and its progression (2A, 0.7 ± 0.6; 2B, 1.2 ± 0.8; and 2C, 1.2 ± 0.8 mm; p = 0.008), and type 2A tears were the shortest. CONCLUSION Although there was no significant difference in the post-operative clinical scores among different type 2 tears in the short term, type 2A tears showed better healing and medial meniscus extrusion progression prevention, thus indicating the usefulness of classifying tear type in estimating post-operative outcomes. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Takaaki Hiranaka
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan.,Department of Orthopaedic Surgery, Ako Central Hospital, 52‑6 Sohmon‑cho, Ako, Hyogo, 678‑0241, Japan
| | - Takayuki Furumatsu
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan.
| | - Yusuke Yokoyama
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Keisuke Kintaka
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Naohiro Higashihara
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Masanori Tamura
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Koki Kawada
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Haowei Xue
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Masanori Hamada
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
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11
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Lee DR, Reinholz AK, Till SE, Lu Y, Camp CL, DeBerardino TM, Stuart MJ, Krych AJ. Current Reviews in Musculoskeletal Medicine: Current Controversies for Treatment of Meniscus Root Tears. Curr Rev Musculoskelet Med 2022; 15:231-243. [PMID: 35476312 PMCID: PMC9276892 DOI: 10.1007/s12178-022-09759-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/21/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The role of the meniscus in preserving the biomechanical function of the knee joint has been clearly defined. The hypothesis that meniscus root integrity is a prerequisite for meniscus function is supported by the development of progressive knee osteoarthritis (OA) following meniscus root tears (MRTs) treated either non-operatively or with meniscectomy. Consequently, there has been a resurgence of interest in the diagnosis and treatment of MRTs. This review examines the contemporary literature surrounding the natural history, clinical presentation, evaluation, preferred surgical repair technique and outcomes. RECENT FINDINGS Surgeons must have a high index of suspicion in order to diagnose a MRT because of the nonspecific clinical presentation and difficult visualization on imaging. Compared with medial MRTs that commonly occur in middle age/older patients, lateral meniscus root injuries tend to occur in younger males with lower BMIs, less cartilage degeneration, and with concomitant ligament injury. Subchondral insufficiency fractures of the knee have been found to be associated with both MRTs and following arthroscopic procedures. Meniscus root repair has demonstrated good outcomes, and acute injuries with intact cartilage should be repaired. Cartilage degeneration, BMI, and malalignment are important considerations when choosing surgical candidates. Meniscus centralization has emerged as a viable adjunct strategy aimed at correcting meniscus extrusion. Meniscus root repair results in a decreased rate of OA and arthroplasty and is economically advantageous when compared with nonoperative treatment and partial meniscectomy. The transtibial pull-through technique with the addition of centralization for the medial meniscus is associated with encouraging early results.
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Affiliation(s)
- Dustin R. Lee
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
| | - Anna K. Reinholz
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
| | - Sara E. Till
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
| | - Yining Lu
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
| | - Christopher L. Camp
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
| | - Thomas M. DeBerardino
- Department of Orthopaedics, Joe R. and Teresa Lozano Long School of Medicine, UT Health San Antonio, San Antonio, TX USA
| | - Michael J. Stuart
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
| | - Aaron J. Krych
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
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