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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 3/2018

01-03-2018 | Knee

Large meniscus extrusion ratio is a poor prognostic factor of conservative treatment for medial meniscus posterior root tear

Authors: Yoon-Ho Kwak, Sahnghoon Lee, Myung Chul Lee, Hyuk-Soo Han

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 3/2018

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Abstract

Purpose

The purpose of this study was to find a prognostic factor of medial meniscus posterior root tear (MMPRT) for surgical decision making.

Methods

Eighty-eight patients who were diagnosed as acute or subacute MMPRT without severe degeneration of the meniscus were treated conservatively for 3 months. Fifty-seven patients with MMPRT showed good response to conservative treatment (group 1), while the remaining 31 patients who failed to conservative treatment (group 2) received arthroscopic meniscus repair. Their demographic characteristics and radiographic features including hip-knee-ankle angle, joint line convergence angle, Kellgren–Lawrence grade in plain radiographs, meniscus extrusion (ME) ratio (ME-medial femoral condyle ratio, ME-medial tibial plateau ratio, ME-meniscus width ratio), the location of bony edema, and cartilage lesions in MRI were compared. Receiver operating characteristic (ROC) curve analysis was also performed to determine the cut-off values of risk factors.

Results

The degree of ME-medial femoral condyle and medial tibia plateau ratio of group 2 was significantly higher than group 1 (0.08 and 0.07 vs. 0.1 and 0.09, respectively, both p < 0.001). No significant (n.s.) difference in other variables was found between the two groups. On ROC curve analysis, ME-medial femoral condyle ratio was confirmed as the most reliable prognostic factor of conservative treatment for MMPRT (area under ROC = 0.8).

Conclusion

The large meniscus extrusion ratio was the most reliable poor prognostic factor of conservative treatment for MMPRT. Therefore, for MMPRT patients with large meniscus extrusion, early surgical repair could be considered as the primary treatment option.

Level of evidence

III.
Literature
1.
Ahn JH, Jeong HJ, Lee YS, Park JH, Lee JW, Park JH, Ko TS (2015) Comparison between conservative treatment and arthroscopic pull-out repair of the medial meniscus root tear and analysis of prognostic factors for the determination of repair indication. Arch Orthop Trauma Surg 135:1265–1276CrossRefPubMed
2.
Allaire R, Muriuki M, Gilbertson L, Harner CD (2008) Biomechanical consequences of a tear of the posterior root of the medial meniscus. Similar to total meniscectomy. J Bone Joint Surg Am 90:1922–1931CrossRefPubMed
3.
Bhatia S, LaPrade CM, Ellman MB, LaPrade RF (2014) Meniscal root tears: significance, diagnosis, and treatment. Am J Sports Med 42:3016–3030CrossRefPubMed
4.
Bin SI, Kim JM, Shin SJ (2004) Radial tears of the posterior horn of the medial meniscus. Arthroscopy 20:373–378CrossRefPubMed
5.
Choi CJ, Choi YJ, Lee JJ, Choi CH (2010) Magnetic resonance imaging evidence of meniscal extrusion in medial meniscus posterior root tear. Arthroscopy 26:1602–1606CrossRefPubMed
6.
Choi ES, Park SJ (2015) Clinical evaluation of the root tear of the posterior horn of the medial meniscus in total knee arthroplasty for osteoarthritis. Knee Surg Relat Res 27:90–94CrossRefPubMedPubMedCentral
7.
Choi NH, Son KM, Victoroff BN (2008) Arthroscopic all-inside repair for a tear of posterior root of the medial meniscus: a technical note. Knee Surg Sports Traumatol Arthrosc 16:891–893CrossRefPubMed
8.
Chung JY, Song HK, Jung MK, Oh HT, Kim JH, Yoon JS, Min BH (2016) Larger medial femoral to tibial condylar dimension may trigger posterior root tear of medial meniscus. Knee Surg Sports Traumatol Arthrosc 24:1448–1454CrossRefPubMed
9.
Chung KS, Ha JK, Ra HJ, Kim JG (2016) A meta-analysis of clinical and radiographic outcomes of posterior horn medial meniscus root repairs. Knee Surg Sports Traumatol Arthrosc 24:1455–1468CrossRefPubMed
10.
Chung KS, Ha JK, Ra HJ, Nam GW, Kim JG (2016) Pullout fixation of posterior medial meniscus root tears: correlation between meniscus extrusion and midterm clinical results. Am J Sports Med. doi:10.​1177/​0363546516662445​
11.
Costa CR, Morrison WB, Carrino JA (2004) Medial meniscus extrusion on knee MRI: is extent associated with severity of degeneration or type of tear? AJR Am J Roentgenol 183:17–23CrossRefPubMed
12.
Dumont GD, Hogue GD, Padalecki JR, Okoro N, Wilson PL (2012) Meniscal and chondral injuries associated with pediatric anterior cruciate ligament tears: relationship of treatment time and patient-specific factors. Am J Sports Med 40:2128–2133CrossRefPubMed
13.
Englund M, Guermazi A, Roemer FW, Aliabadi P, Yang M, Lewis CE, Torner J, Nevitt MC, Sack B, Felson DT (2009) Meniscal tear in knees without surgery and the development of radiographic osteoarthritis among middle-aged and elderly persons: the Multicenter Osteoarthritis Study. Arthritis Rheum 60:831–839CrossRefPubMedPubMedCentral
14.
Englund M, Roemer FW, Hayashi D, Crema MD, Guermazi A (2012) Meniscus pathology, osteoarthritis and the treatment controversy. Nat Rev Rheumatol 8:412–419CrossRefPubMed
15.
Feucht MJ, Kuhle J, Bode G, Mehl J, Schmal H, Sudkamp NP, Niemeyer P (2015) Arthroscopic transtibial pullout repair for posterior medial meniscus root tears: a systematic review of clinical, radiographic, and second-look arthroscopic results. Arthroscopy 31:1808–1816CrossRefPubMed
16.
Forkel P, Herbort M, Schulze M, Rosenbaum D, Kirstein L, Raschke M, Petersen W (2013) Biomechanical consequences of a posterior root tear of the lateral meniscus: stabilizing effect of the meniscofemoral ligament. Arch Orthop Trauma Surg 133:621–626CrossRefPubMed
17.
Forkel P, Herbort M, Sprenker F, Metzlaff S, Raschke M, Petersen W (2014) The biomechanical effect of a lateral meniscus posterior root tear with and without damage to the meniscofemoral ligament: efficacy of different repair techniques. Arthroscopy 30:833–840CrossRefPubMed
18.
Gadeyne S, Besse JL, Galand-Desme S, Lerat JL, Moyen B (2006) Analysis of meniscal lesions accompanying anterior cruciate ligament tears: a retrospective analysis of 156 patients. Rev Chir Orthop Reparatrice Appar Mot 92:448–454CrossRefPubMed
19.
Harner CD, Mauro CS, Lesniak BP, Romanowski JR (2009) Biomechanical consequences of a tear of the posterior root of the medial meniscus. Surgical technique. J Bone Joint Surg Am 91(Suppl 2):257–270CrossRefPubMed
20.
Hein CN, Deperio JG, Ehrensberger MT, Marzo JM (2011) Effects of medial meniscal posterior horn avulsion and repair on meniscal displacement. Knee 18:189–192CrossRefPubMed
21.
Hwang BY, Kim SJ, Lee SW, Lee HE, Lee CK, Hunter DJ, Jung KA (2012) Risk factors for medial meniscus posterior root tear. Am J Sports Med 40:1606–1610CrossRefPubMed
22.
Jeffery RS, Morris RW, Denham RA (1991) Coronal alignment after total knee replacement. J Bone Joint Surg Br 73:709–714CrossRefPubMed
23.
Johnson DL, Swenson TM, Livesay GA, Aizawa H, Fu FH, Harner CD (1995) Insertion-site anatomy of the human menisci: gross, arthroscopic, and topographical anatomy as a basis for meniscal transplantation. Arthroscopy 11:386–394CrossRefPubMed
24.
Kamimura M, Umehara J, Takahashi A, Aizawa T, Itoi E (2015) Medial meniscus tear morphology and related clinical symptoms in patients with medial knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 23:158–163CrossRefPubMed
25.
26.
Krych AJ, Reardon PJ, Johnson NR, Mohan R, Peter L, Levy BA, Stuart MJ (2016) Non-operative management of medial meniscus posterior horn root tears is associated with worsening arthritis and poor clinical outcome at 5-year follow-up. Knee Surg Sports Traumatol Arthrosc. doi:10.​1007/​s00167-016-4359-8
27.
Kurosawa H, Fukubayashi T, Nakajima H (1980) Load-bearing mode of the knee joint: physical behavior of the knee joint with or without menisci. Clin Orthop Relat Res:283–290
28.
Lee YG, Shim JC, Choi YS, Kim JG, Lee GJ, Kim HK (2008) Magnetic resonance imaging findings of surgically proven medial meniscus root tear: tear configuration and associated knee abnormalities. J Comput Assist Tomogr 32:452–457CrossRefPubMed
29.
Lerer DB, Umans HR, Hu MX, Jones MH (2004) The role of meniscal root pathology and radial meniscal tear in medial meniscal extrusion. Skeletal Radiol 33:569–574CrossRefPubMed
30.
Lim HC, Bae JH, Wang JH, Seok CW, Kim MK (2010) Non-operative treatment of degenerative posterior root tear of the medial meniscus. Knee Surg Sports Traumatol Arthrosc 18:535–539CrossRefPubMed
31.
Moon HK, Koh YG, Kim YC, Park YS, Jo SB, Kwon SK (2012) Prognostic factors of arthroscopic pull-out repair for a posterior root tear of the medial meniscus. Am J Sports Med 40:1138–1143CrossRefPubMed
32.
Neogi DS, Kumar A, Rijal L, Yadav CS, Jaiman A, Nag HL (2013) Role of nonoperative treatment in managing degenerative tears of the medial meniscus posterior root. J Orthop Traumatol 14:193–199CrossRefPubMedPubMedCentral
33.
Ozkoc G, Circi E, Gonc U, Irgit K, Pourbagher A, Tandogan RN (2008) Radial tears in the root of the posterior horn of the medial meniscus. Knee Surg Sports Traumatol Arthrosc 16:849–854CrossRefPubMed
34.
Papalia R, Vasta S, Franceschi F, D’Adamio S, Maffulli N, Denaro V (2013) Meniscal root tears: from basic science to ultimate surgery. Br Med Bull 106:91–115CrossRefPubMed
35.
Petersen W, Forkel P, Feucht MJ, Zantop T, Imhoff AB, Brucker PU (2014) Posterior root tear of the medial and lateral meniscus. Arch Orthop Trauma Surg 134:237–255CrossRefPubMed
36.
Ra HJ, Ha JK, Jang HS, Kim JG (2015) Traumatic posterior root tear of the medial meniscus in patients with severe medial instability of the knee. Knee Surg Sports Traumatol Arthrosc 23:3121–3126CrossRefPubMed
37.
Shino K, Hamada M, Mitsuoka T, Kinoshita H, Toritsuka Y (1995) Arthroscopic repair for a flap tear of the posterior horn of the lateral meniscus adjacent to its tibial insertion. Arthroscopy 11:495–498CrossRefPubMed
38.
Slauterbeck JR, Kousa P, Clifton BC, Naud S, Tourville TW, Johnson RJ, Beynnon BD (2009) Geographic mapping of meniscus and cartilage lesions associated with anterior cruciate ligament injuries. J Bone Jt Surg Am 91:2094–2103CrossRef
39.
Terauchi M, Shirakura K, Katayama M, Higuchi H, Takagishi K, Kimura M (2002) Varus inclination of the distal femur and high tibial osteotomy. J Bone Jt Surg Br 84:223–226CrossRef
40.
Vedi V, Williams A, Tennant SJ, Spouse E, Hunt DM, Gedroyc WM (1999) Meniscal movement. An in-vivo study using dynamic MRI. J Bone Jt Surg Br 81:37–41CrossRef
41.
Metadata
Title
Large meniscus extrusion ratio is a poor prognostic factor of conservative treatment for medial meniscus posterior root tear
Authors
Yoon-Ho Kwak
Sahnghoon Lee
Myung Chul Lee
Hyuk-Soo Han
Publication date
01-03-2018
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 3/2018
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-017-4441-x

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