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Published in: Knee Surgery, Sports Traumatology, Arthroscopy 4/2021

01-04-2021 | KNEE

Steep medial tibial slope and prolonged delay to surgery are associated with bilateral medial meniscus posterior root tear

Authors: Takaaki Hiranaka, Takayuki Furumatsu, Yuki Okazaki, Tadashi Yamawaki, Yoshiki Okazaki, Yuya Kodama, Yusuke Kamatsuki, Toshifumi Ozaki

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 4/2021

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Abstract

Purpose

Contralateral medial meniscus posterior root tear (MMPRT) can sometimes occur after primary surgeries for MMPRT and lead to unsatisfactory outcomes. The incidence rate and risk factors for contralateral MMPRT have not been well investigated, despite their clinical importance. Therefore, the incidence and predictors of bilateral MMPRT were aimed to be evaluated.

Methods

Fourteen patients with bilateral MMPRT (group B) and 169 patients with unilateral MMPRT (group U) were enrolled in this study. Sex, age, body mass index, time between injury and surgery, and medial tibial slope angle (MTSA) were compared between the groups. MTSA was measured using lateral radiographs.

Results

The incidence rate of bilateral MMPRT was 6.2% among all patients with MMPRTs. Multivariate logistic regression analysis showed that a prolonged time between injury and surgery (odds ratio [OR], 1.0; 95% confidence interval [CI] 1.00–1.01; P < 0.05) and steeper MTSA (OR, 1.85; 95% CI 1.21–2.64; P < 0.01) were significantly associated with the development of bilateral MMPRT. Receiver operating characteristic curve analysis showed that MTSA > 10.0° was associated with bilateral MMPRT, with a sensitivity of 93% and specificity of 69%.

Conclusion

A longer time between injury and surgery and steeper MTSA were risk factors for the development of bilateral MMPRT. Surgeons need to pay close attention to the contralateral knee in addition to the primary injured knees when treating knees with steep MTSA. Besides, early meniscal repair of primary MMPRT would be important to prevent the events of contralateral MMPRT.

Level of evidence

III.
Literature
1.
go back to reference Bae JH, Paik NH, Park GW, Yoon JR, Chae DJ, Kwon JH et al (2013) Predictive value of painful popping for a posterior root tear of the medial meniscus in middle-aged to older Asian patients. Arthroscopy 29:545–549CrossRef Bae JH, Paik NH, Park GW, Yoon JR, Chae DJ, Kwon JH et al (2013) Predictive value of painful popping for a posterior root tear of the medial meniscus in middle-aged to older Asian patients. Arthroscopy 29:545–549CrossRef
2.
go back to reference Barber FA, Getelman MH, Berry KL (2017) Complex medial meniscus tears are associated with a biconcave medial Tibial Plateau. Arthroscopy 33:783–789CrossRef Barber FA, Getelman MH, Berry KL (2017) Complex medial meniscus tears are associated with a biconcave medial Tibial Plateau. Arthroscopy 33:783–789CrossRef
3.
go back to reference Bhatia S, LaPrade CM, Ellman MB, LaPrade RF (2014) Meniscal root tears: significance, diagnosis, and treatment. Am J Sports Med 42:3016–3030CrossRef Bhatia S, LaPrade CM, Ellman MB, LaPrade RF (2014) Meniscal root tears: significance, diagnosis, and treatment. Am J Sports Med 42:3016–3030CrossRef
4.
go back to reference Bin SI, Kim JM, Shin SJ (2004) Radial tears of the posterior horn of the medial meniscus. Arthroscopy 20:373–378CrossRef Bin SI, Kim JM, Shin SJ (2004) Radial tears of the posterior horn of the medial meniscus. Arthroscopy 20:373–378CrossRef
5.
go back to reference Brandon ML, Haynes PT, Bonamo JR, Flynn MI, Barrett GR, Sherman MF (2006) The association between posterior-inferior tibial slope and anterior cruciate ligament insufficiency. Arthroscopy 22:894–899CrossRef Brandon ML, Haynes PT, Bonamo JR, Flynn MI, Barrett GR, Sherman MF (2006) The association between posterior-inferior tibial slope and anterior cruciate ligament insufficiency. Arthroscopy 22:894–899CrossRef
6.
go back to reference Choi SH, Bae S, Ji SK, Chang MJ (2012) The MRI findings of meniscal root tear of the medial meniscus: emphasis on coronal, sagittal and axial images. Knee Surg Sports Traumatol Arthrosc 20:2098–2103CrossRef Choi SH, Bae S, Ji SK, Chang MJ (2012) The MRI findings of meniscal root tear of the medial meniscus: emphasis on coronal, sagittal and axial images. Knee Surg Sports Traumatol Arthrosc 20:2098–2103CrossRef
7.
go back to reference Dejour H, Bonnin M (1994) Tibial translation after anterior cruciate ligament rupture. Two radiological tests compared. J Bone Jt Surg Br 76:745–749CrossRef Dejour H, Bonnin M (1994) Tibial translation after anterior cruciate ligament rupture. Two radiological tests compared. J Bone Jt Surg Br 76:745–749CrossRef
8.
go back to reference Eitzen I, Grindem H, Nilstad A, Moksnes H, Risberg MA (2016) Quantifying quadriceps muscle strength in patients with ACL injury, focal cartilage lesions, and degenerative meniscus tears: differences and clinical implications. Orthop J Sports Med 4:2325967116667717CrossRef Eitzen I, Grindem H, Nilstad A, Moksnes H, Risberg MA (2016) Quantifying quadriceps muscle strength in patients with ACL injury, focal cartilage lesions, and degenerative meniscus tears: differences and clinical implications. Orthop J Sports Med 4:2325967116667717CrossRef
9.
go back to reference Ericsson YB, Roos EM, Owman H, Dahlberg LE (2019) Association between thigh muscle strength four years after partial meniscectomy and radiographic features of osteoarthritis 11 years later. BMC Musculoskelet Disord 20:512CrossRef Ericsson YB, Roos EM, Owman H, Dahlberg LE (2019) Association between thigh muscle strength four years after partial meniscectomy and radiographic features of osteoarthritis 11 years later. BMC Musculoskelet Disord 20:512CrossRef
10.
go back to reference Ernst GP, Saliba E, Diduch DR, Hurwitz SR, Ball DW (2000) Lower extremity compensations following anterior cruciate ligament reconstruction. Phys Ther 80:251–260CrossRef Ernst GP, Saliba E, Diduch DR, Hurwitz SR, Ball DW (2000) Lower extremity compensations following anterior cruciate ligament reconstruction. Phys Ther 80:251–260CrossRef
11.
go back to reference Fening SD, Kovacic J, Kambic H, McLean S, Scott J, Miniaci A (2008) The effects of modified posterior tibial slope on anterior cruciate ligament strain and knee kinematics: a human cadaveric study. J Knee Surg 21:205–211CrossRef Fening SD, Kovacic J, Kambic H, McLean S, Scott J, Miniaci A (2008) The effects of modified posterior tibial slope on anterior cruciate ligament strain and knee kinematics: a human cadaveric study. J Knee Surg 21:205–211CrossRef
12.
go back to reference Furumatsu T, Fujii M, Kodama Y, Ozaki T (2017) A giraffe neck sign of the medial meniscus: a characteristic finding of the medial meniscus posterior root tear on magnetic resonance imaging. J Orthop Sci 22:731–736CrossRef Furumatsu T, Fujii M, Kodama Y, Ozaki T (2017) A giraffe neck sign of the medial meniscus: a characteristic finding of the medial meniscus posterior root tear on magnetic resonance imaging. J Orthop Sci 22:731–736CrossRef
13.
go back to reference Furumatsu T, Kamatsuki Y, Fujii M, Kodama Y, Okazaki Y, Masuda S et al (2017) Medial meniscus extrusion correlates with disease duration of the sudden symptomatic medial meniscus posterior root tear. Orthop Traumatol Surg Res 103:1179–1182CrossRef Furumatsu T, Kamatsuki Y, Fujii M, Kodama Y, Okazaki Y, Masuda S et al (2017) Medial meniscus extrusion correlates with disease duration of the sudden symptomatic medial meniscus posterior root tear. Orthop Traumatol Surg Res 103:1179–1182CrossRef
15.
go back to reference Giffin JR, Vogrin TM, Zantop T, Woo SL, Harner CD (2004) Effects of increasing tibial slope on the biomechanics of the knee. Am J Sports Med 32:376–382CrossRef Giffin JR, Vogrin TM, Zantop T, Woo SL, Harner CD (2004) Effects of increasing tibial slope on the biomechanics of the knee. Am J Sports Med 32:376–382CrossRef
17.
go back to reference Hwang BY, Kim SJ, Lee SW, Lee HE, Lee CK, Hunter DJ et al (2012) Risk factors for medial meniscus posterior root tear. Am J Sports Med 40:1606–1610CrossRef Hwang BY, Kim SJ, Lee SW, Lee HE, Lee CK, Hunter DJ et al (2012) Risk factors for medial meniscus posterior root tear. Am J Sports Med 40:1606–1610CrossRef
18.
go back to reference Khan N, McMahon P, Obaid H (2014) Bony morphology of the knee and non-traumatic meniscal tears: is there a role for meniscal impingement? Skelet Radiol 43:955–962CrossRef Khan N, McMahon P, Obaid H (2014) Bony morphology of the knee and non-traumatic meniscal tears: is there a role for meniscal impingement? Skelet Radiol 43:955–962CrossRef
19.
go back to reference Liu W, Maitland ME (2003) Influence of anthropometric and mechanical variations on functional instability in the ACL-deficient knee. Ann Biomed Eng 31:1153–1161CrossRef Liu W, Maitland ME (2003) Influence of anthropometric and mechanical variations on functional instability in the ACL-deficient knee. Ann Biomed Eng 31:1153–1161CrossRef
20.
go back to reference Mansori AE, Lording T, Schneider A, Dumas R, Servien E, Lustig S (2018) Incidence and patterns of meniscal tears accompanying the anterior cruciate ligament injury: possible local and generalized risk factors. Int Orthop 42:2113–2121CrossRef Mansori AE, Lording T, Schneider A, Dumas R, Servien E, Lustig S (2018) Incidence and patterns of meniscal tears accompanying the anterior cruciate ligament injury: possible local and generalized risk factors. Int Orthop 42:2113–2121CrossRef
21.
go back to reference Marouane H, Shirazi-Adl A, Hashemi J (2015) Quantification of the role of tibial posterior slope in knee joint mechanics and ACL force in simulated gait. J Biomech 48:1899–1905CrossRef Marouane H, Shirazi-Adl A, Hashemi J (2015) Quantification of the role of tibial posterior slope in knee joint mechanics and ACL force in simulated gait. J Biomech 48:1899–1905CrossRef
22.
go back to reference Napier RJ, Garcia E, Devitt BM, Feller JA, Webster KE (2019) Increased radiographic posterior tibial slope is associated with subsequent injury following revision anterior cruciate ligament reconstruction. Orthop J Sports Med 7:2325967119879373CrossRef Napier RJ, Garcia E, Devitt BM, Feller JA, Webster KE (2019) Increased radiographic posterior tibial slope is associated with subsequent injury following revision anterior cruciate ligament reconstruction. Orthop J Sports Med 7:2325967119879373CrossRef
23.
go back to reference Neitzel JA, Kernozek TW, Davies GJ (2002) Loading response following anterior cruciate ligament reconstruction during the parallel squat exercise. Clin Biomech (Bristol, Avon) 17:551–554CrossRef Neitzel JA, Kernozek TW, Davies GJ (2002) Loading response following anterior cruciate ligament reconstruction during the parallel squat exercise. Clin Biomech (Bristol, Avon) 17:551–554CrossRef
25.
go back to reference 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 16:849–854CrossRef 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 16:849–854CrossRef
26.
go back to reference Paterno MV, Rauh MJ, Schmitt LC, Ford KR, Hewett TE (2012) Incidence of contralateral and ipsilateral anterior cruciate ligament (ACL) injury after primary ACL reconstruction and return to sport. Clin J Sport Med 22:116–121CrossRef Paterno MV, Rauh MJ, Schmitt LC, Ford KR, Hewett TE (2012) Incidence of contralateral and ipsilateral anterior cruciate ligament (ACL) injury after primary ACL reconstruction and return to sport. Clin J Sport Med 22:116–121CrossRef
27.
go back to reference Salem GJ, Salinas R, Harding FV (2003) Bilateral kinematic and kinetic analysis of the squat exercise after anterior cruciate ligament reconstruction. Arch Phys Med Rehabil 84:1211–1216CrossRef Salem GJ, Salinas R, Harding FV (2003) Bilateral kinematic and kinetic analysis of the squat exercise after anterior cruciate ligament reconstruction. Arch Phys Med Rehabil 84:1211–1216CrossRef
28.
go back to reference Shelburne KB, Kim HJ, Sterett WI, Pandy MG (2011) Effect of posterior tibial slope on knee biomechanics during functional activity. J Orthop Res 29:223–231CrossRef Shelburne KB, Kim HJ, Sterett WI, Pandy MG (2011) Effect of posterior tibial slope on knee biomechanics during functional activity. J Orthop Res 29:223–231CrossRef
29.
go back to reference Stijak L, Herzog RF, Schai P (2008) Is there an influence of the tibial slope of the lateral condyle on the ACL lesion? A case-control study. Knee Surg Sports Traumatol Arthrosc 16:112–117CrossRef Stijak L, Herzog RF, Schai P (2008) Is there an influence of the tibial slope of the lateral condyle on the ACL lesion? A case-control study. Knee Surg Sports Traumatol Arthrosc 16:112–117CrossRef
30.
go back to reference Thorlund JB, Felson DT, Segal NA, Nevitt MC, Niu J, Neogi T et al (2016) Effect of knee extensor strength on incident radiographic and symptomatic knee osteoarthritis in individuals with meniscal pathology: data from the multicenter osteoarthritis study. Arthritis Care Res (Hoboken) 68:1640–1646CrossRef Thorlund JB, Felson DT, Segal NA, Nevitt MC, Niu J, Neogi T et al (2016) Effect of knee extensor strength on incident radiographic and symptomatic knee osteoarthritis in individuals with meniscal pathology: data from the multicenter osteoarthritis study. Arthritis Care Res (Hoboken) 68:1640–1646CrossRef
31.
go back to reference Todd MS, Lalliss S, Garcia E, DeBerardino TM, Cameron KL (2010) The relationship between posterior tibial slope and anterior cruciate ligament injuries. Am J Sports Med 38:63–67CrossRef Todd MS, Lalliss S, Garcia E, DeBerardino TM, Cameron KL (2010) The relationship between posterior tibial slope and anterior cruciate ligament injuries. Am J Sports Med 38:63–67CrossRef
32.
go back to reference Toman CV, Dunn WR, Spindler KP, Amendola A, Andrish JT, Bergfeld JA et al (2009) Success of meniscal repair at anterior cruciate ligament reconstruction. Am J Sports Med 37:1111–1115CrossRef Toman CV, Dunn WR, Spindler KP, Amendola A, Andrish JT, Bergfeld JA et al (2009) Success of meniscal repair at anterior cruciate ligament reconstruction. Am J Sports Med 37:1111–1115CrossRef
33.
go back to reference Westermann RW, Wright RW, Spindler KP, Huston LJ, Group MK, Wolf BR (2014) Meniscal repair with concurrent anterior cruciate ligament reconstruction: operative success and patient outcomes at 6-year follow-up. Am J Sports Med 42:2184–2192CrossRef Westermann RW, Wright RW, Spindler KP, Huston LJ, Group MK, Wolf BR (2014) Meniscal repair with concurrent anterior cruciate ligament reconstruction: operative success and patient outcomes at 6-year follow-up. Am J Sports Med 42:2184–2192CrossRef
Metadata
Title
Steep medial tibial slope and prolonged delay to surgery are associated with bilateral medial meniscus posterior root tear
Authors
Takaaki Hiranaka
Takayuki Furumatsu
Yuki Okazaki
Tadashi Yamawaki
Yoshiki Okazaki
Yuya Kodama
Yusuke Kamatsuki
Toshifumi Ozaki
Publication date
01-04-2021
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 4/2021
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-020-06079-1

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