Top

Archives of Orthopaedic and Trauma Surgery

Published in:

01-09-2015 | Arthroscopy and Sports Medicine

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

Authors: Jin Hwan Ahn, Hwa Jae Jeong, Yong Seuk Lee, Jai Hyung Park, Jae Wook Lee, Jong-Hyon Park, Taeg Su Ko

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 9/2015

Abstract

Introduction

This study was undertaken to compare the clinical outcomes between the conservative treatment and pull-out repair of the medial meniscus root tear (MMRT), and to analyze the prognostic factors of the MMRT repair for the determination of repair indication.

Materials and methods

38 patients, diagnosed with a MMRT between August 2010 and February 2012, were retrospectively evaluated. Among these patients, 25 patients (pull-out repair group) underwent arthroscopic pull-out repair and the remaining 13 patients (conservative treatment group) underwent conservative management. Two groups were compared using the final clinical outcomes (using Tegner and Lysholm activity scale, IKDC subjective score). For the analysis of prognostic factors of the pull-out repair, patients’ factors, radiologic, and magnetic resonance imaging factors were evaluated. Degrees of varus alignment (≥5°) and cartilage status (≥outerbridge III) were employed as a cut-off value in comparing the final clinical outcomes among the subgroups.

Results

In the final clinical results, the MMRT pull-out repair group had better IKDC subjective scores (p < 0.001), Tegner and Lysholm activity scale (p = 0.017). In the MMRT pull-out repair group, mild varus knee patient achieved better clinical outcome than the severe varus knee patient (p = 0.006). And the mild cartilage degenerative patient group achieved better outcomes than the severe cartilage degenerative patient group (p = 0.009). However, there was no significant difference between the severe varus alignment group and conservative treatment group (p = 0.487). Severe cartilage changes also show no significant difference (p = 0.643).

Conclusions

The MMRT pull-out repair group had better clinical results than that the conservative treatment group. However, severe varus alignment and severe degeneration of cartilage status were a poor prognostic factor, and there was no significant difference between the severe varus alignment or severe cartilage change and the conservative treatment group in the clinical results. The other optional treatment could be recommended for patients who have MMRT with a severe varus knee alignment or severe cartilage.

Bessette GC (1992) The meniscus. Orthopedics 15:35–42PubMed

Petersen W, Tillmann B (1998) Collagenous fibril texture of the human knee joint menisci. Anat Embryol (Berl) 197:317–324CrossRef

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

Vedi V, Williams A, Tennant SJ, Spouse E, Hunt DM, Gedroyc WM (1999) Meniscal movement. An in vivo study using dynamic MRI. J Bone Joint Surg Br 81:37–41CrossRefPubMed

Bin SI, Kim JM, Shin SJ (2004) Radial tears of the posterior horn of the medial meniscus. Arthroscopy 20:373–378CrossRefPubMed

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

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

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. Arthrosc J Arthros Relat Surg 30:833–840CrossRef

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

10.

Kim JG, Lee YS, Bae TS, Ha JK, Lee DH, Kim YJ, Ra HJ (2012) Tibiofemoral contact mechanics following posterior root of medial meniscus tear, repair, meniscectomy, and allograft transplantation. Knee Surg Sports Traumatol Arthrosc 21:2121–2125CrossRefPubMed

11.

Ahn JH, Kim SH, Yoo JC, Wang JH (2004) All-inside suture technique using two posteromedial portals in a medial meniscus posterior horn tear. Arthroscopy 20:101–108CrossRefPubMed

12.

Ahn JH, Wang JH, Lim HC, Bae JH, Park JS, Yoo JC, Shyam AK (2009) Double transosseous pull out suture technique for transection of posterior horn of medial meniscus. Arch Orthop Trauma Surg 129:387–392CrossRefPubMed

13.

Ahn JH, Wang JH, Yoo JC, Noh HK, Park JH (2007) A pull out suture for transection of the posterior horn of the medial meniscus: using a posterior trans-septal portal. Knee Surg Sports Traumatol Arthrosc 15:1510–1513CrossRefPubMed

14.

Kim YM, Rhee KJ, Lee JK, Hwang DS, Yang JY, Kim SJ (2006) Arthroscopic pullout repair of a complete radial tear of the tibial attachment site of the medial meniscus posterior horn. Arthroscopy 22(795):e791–e794

15.

Kim SB, Ha JK, Lee SW, Kim DW, Shim JC, Kim JG, Lee MY (2011) Medial meniscus root tear refixation: comparison of clinical, radiologic, and arthroscopic findings with medial meniscectomy. Arthroscopy 27:346–354CrossRefPubMed

16.

Lee JH, Lim YJ, Kim KB, Kim KH, Song JH (2009) Arthroscopic pullout suture repair of posterior root tear of the medial meniscus: radiographic and clinical results with a 2-year follow-up. Arthroscopy 25:951–958CrossRefPubMed

17.

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

18.

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

19.

Hunter DJ (2011) Osteoarthritis. Best Pract Res Clin Rheumatol 25:801–814CrossRefPubMed

20.

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

21.

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

22.

Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16:494–502PubMedCentralCrossRefPubMed

23.

Cooke TD, Li J, Scudamore RA (1994) Radiographic assessment of bony contributions to knee deformity. Orthop Clin North Am 25:387–393PubMed

24.

Utzschneider S, Goettinger M, Weber P, Horng A, Glaser C, Jansson V, Müller PE (2011) Development and validation of a new method for the radiologic measurement of the tibial slope. Knee Surg Sports Traumatol Arthrosc 19:1643–1648CrossRefPubMed

25.

Jones AO, Houang MT, Low RS, Wood DG (2006) Medial meniscus posterior root attachment injury and degeneration: MRI findings. Australas Radiol 50:306–313CrossRefPubMed

26.

Shepard MF, Hunter DM, Davies MR, Shapiro MS, Seeger LL (2002) The clinical significance of anterior horn meniscal tears diagnosed on magnetic resonance images. Am J Sports Med 30:189–192PubMed

27.

Rennie WJ, Finlay DB (2006) Meniscal extrusion in young athletes: associated knee joint abnormalities. AJR Am J Roentgenol 186:791–794CrossRefPubMed

28.

Lee SY, Jee WH, Kim JM (2008) Radial tear of the medial meniscal root: reliability and accuracy of MRI for diagnosis. AJR Am J Roentgenol 191:81–85CrossRefPubMed

29.

Van Dyck P, Gielen J, D’Anvers J, Vanhoenacker F, Dossche L, Van Gestel J, Parizel PM (2007) MR diagnosis of meniscal tears of the knee: analysis of error patterns. Arch Orthop Trauma Surg 127:849–854CrossRefPubMed

30.

Magee T, Shapiro M, Williams D (2002) MR accuracy and arthroscopic incidence of meniscal radial tears. Skeletal Radiol 31:686–689CrossRefPubMed

31.

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

32.

Petersen W, Zantop T (2006) Avulsion injury to the posterior horn of the lateral meniscus. Technique for arthroscopic refixation. Unfallchirurg 109:984–987CrossRefPubMed

33.

Bolano LE, Grana WA (1993) Isolated arthroscopic partial meniscectomy. Functional radiographic evaluation at 5 years. Am J Sports Med 21:432–437CrossRefPubMed

34.

Han SB, Shetty GM, Lee DH, Chae DJ, Seo SS, Wang KH, Yoo SH, Nha KW (2010) Unfavourable results of partial meniscectomy for complete posterior medial meniscus root tear with early osteoarthritis: a 5- to 8-year follow-up study. Arthroscopy 26:1326–1332CrossRefPubMed

Title: 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
Authors: Jin Hwan Ahn
Hwa Jae Jeong
Yong Seuk Lee
Jai Hyung Park
Jae Wook Lee
Jong-Hyon Park
Taeg Su Ko
Publication date: 01-09-2015
Publisher: Springer Berlin Heidelberg
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 9/2015
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-015-2269-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Introduction

Materials and methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Materials and methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 9/2015

Arthroscopically assisted stabilization of displaced lateral clavicle fractures with coracoclavicular instability

Comparison of pain relief between patient-controlled epidural analgesia and patient-controlled intravenous analgesia for patients undergoing spinal fusion surgeries

Acute neck pain caused by atlanto-axial instability secondary to pathologic fracture involving odontoid process and C2 vertebral body: treatment with radiofrequency thermoablation, cement augmentation and odontoid screw fixation

Rotational alignment of tibial components in mobile-bearing TKA: posterior substituted vs. PCL retaining

The compliance with and knowledge about radiation protection in operating room personnel: a cross-sectional study with a questionnaire

A rare case of bilateral proximal femoral insufficiency fractures after interlocking IM nailing for bilateral atypical femoral shaft fractures