Skip to main content
Top
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 8/2019

01-08-2019 | KNEE

Meniscal tear morphology independently affects pain relief following arthroscopic partial meniscectomy in middle-aged patients

Authors: Masayuki Kamimura, Jutaro Umehara, Atsushi Takahashi, Yu Mori, Daisuke Chiba, Yoshiyuki Kuwahara, Eiji Itoi

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 8/2019

Login to get access

Abstract

Purpose

To analyze the influence of meniscal tear pattern on clinical outcomes following arthroscopic partial meniscectomy in middle-aged patients with medial meniscal tears.

Methods

A total of 123 patients (130 knees) aged ≥ 50 years who underwent arthroscopic partial meniscectomy for medial meniscal tears were evaluated. Inclusion criteria were none to moderate medial knee osteoarthritis [Kellgren–Lawrence (KL) grade ≤ 3] and a minimum of 2-year follow-up (median 4.6 years; range 2.1–8.0 years). Meniscal tears observed during arthroscopic examination were classified into six types: radial tear of the middle segment, posterior root tear, horizontal tear of the posterior segment, flap tear, minor tear, and complex tear. Postoperative outcomes were classified into effective (group 1) and non-effective (group 2) according to the pain relief administered 1 month postoperatively and at the final follow-up. Demographic variables, KL grade, type of meniscal tear, and postoperative follow-up period were evaluated.

Results

Forty knees (38%) were classified into group 1. Of the six types of tears, radial tear of the middle segment [odds ratio (OR) 4.1, 95% confidence interval (CI) 1.1–20.9] and flap tear (OR 12.9, 95% CI 1.8–140.7) were significant predictors of good outcome on multivariate logistic regression analysis.

Conclusions

In middle-aged patients with medial meniscal tears, radial tear of the middle segment was independently associated with less pain following arthroscopic meniscectomy. Arthroscopic partial meniscectomy may be indicated in patients with radial tear if conservative treatment fails.

Level of evidence

Case–control study, Level III.
Appendix
Available only for authorised users
Literature
1.
go back to reference Abrams GD, Frank RM, Gupta AK, Harris JD, McCormick FM, Cole BJ (2013) Trends in meniscus repair and meniscectomy in the United States, 2005–2011. Am J Sports Med 41:2333–2339CrossRefPubMed Abrams GD, Frank RM, Gupta AK, Harris JD, McCormick FM, Cole BJ (2013) Trends in meniscus repair and meniscectomy in the United States, 2005–2011. Am J Sports Med 41:2333–2339CrossRefPubMed
2.
go back to reference Adelani MA, Harris AHS, Bowe TR, Giori NJ (2016) Arthroscopy for knee osteoarthritis has not decreased after a clinical trial. Clin Orthop Relat Res 474:489–494CrossRefPubMed Adelani MA, Harris AHS, Bowe TR, Giori NJ (2016) Arthroscopy for knee osteoarthritis has not decreased after a clinical trial. Clin Orthop Relat Res 474:489–494CrossRefPubMed
3.
go back to reference Bae J-H, Paik NH, Park G-W, Yoon J-R, Chae D-J, Kwon JH, Kim JI, Nha K-W (2013) Predictive value of painful popping for a posterior root tear of the medial meniscus in middle-aged to older Asian patients. Arthroscopy 29:545–549CrossRefPubMed Bae J-H, Paik NH, Park G-W, Yoon J-R, Chae D-J, Kwon JH, Kim JI, Nha K-W (2013) Predictive value of painful popping for a posterior root tear of the medial meniscus in middle-aged to older Asian patients. Arthroscopy 29:545–549CrossRefPubMed
4.
go back to reference Bhattacharyya T, Gale D, Dewire P, Totterman S, Gale ME, McLaughlin S, Einhorn TA, Felson DT (2003) The clinical importance of meniscal tears demonstrated by magnetic resonance imaging in osteoarthritis of the knee. J Bone Jt Surg Am 85A:4–9CrossRef Bhattacharyya T, Gale D, Dewire P, Totterman S, Gale ME, McLaughlin S, Einhorn TA, Felson DT (2003) The clinical importance of meniscal tears demonstrated by magnetic resonance imaging in osteoarthritis of the knee. J Bone Jt Surg Am 85A:4–9CrossRef
5.
go back to reference Bin S-I, Lee S-H, Kim C-W, Kim T-H, Lee D-H (2008) Results of arthroscopic medial meniscectomy in patients with grade IV osteoarthritis of the medial compartment. Arthroscopy 24:264–268CrossRefPubMed Bin S-I, Lee S-H, Kim C-W, Kim T-H, Lee D-H (2008) Results of arthroscopic medial meniscectomy in patients with grade IV osteoarthritis of the medial compartment. Arthroscopy 24:264–268CrossRefPubMed
6.
go back to reference Christoforakis J, Pradhan R, Sanchez-Ballester J, Hunt N, Strachan RK (2005) Is there an association between articular cartilage changes and degenerative meniscus tears? Arthroscopy 21:1366–1369CrossRefPubMed Christoforakis J, Pradhan R, Sanchez-Ballester J, Hunt N, Strachan RK (2005) Is there an association between articular cartilage changes and degenerative meniscus tears? Arthroscopy 21:1366–1369CrossRefPubMed
7.
go back to reference Chung KS, Ha JK, Yeom CH, Ra HJ, Jang HS, Choi SH, Kim JG (2015) Comparison of clinical and radiologic results between partial meniscectomy and refixation of medial meniscus posterior root tears: a minimum 5-year follow-up. Arthroscopy 31:1941–1950CrossRefPubMed Chung KS, Ha JK, Yeom CH, Ra HJ, Jang HS, Choi SH, Kim JG (2015) Comparison of clinical and radiologic results between partial meniscectomy and refixation of medial meniscus posterior root tears: a minimum 5-year follow-up. Arthroscopy 31:1941–1950CrossRefPubMed
8.
go back to reference Crema MD, Guermazi A, Li L, Nogueira-Barbosa MH, Marra MD, Roemer FW, Eckstein F, Le Graverand MPH, Wyman BT, Hunter DJ (2010) The association of prevalent medial meniscal pathology with cartilage loss in the medial tibiofemoral compartment over a 2-year period. Osteoarthr Cartil 18:336–343CrossRefPubMed Crema MD, Guermazi A, Li L, Nogueira-Barbosa MH, Marra MD, Roemer FW, Eckstein F, Le Graverand MPH, Wyman BT, Hunter DJ (2010) The association of prevalent medial meniscal pathology with cartilage loss in the medial tibiofemoral compartment over a 2-year period. Osteoarthr Cartil 18:336–343CrossRefPubMed
9.
go back to reference Crevoisier X, Munzinger U, Drobny T (2001) Arthroscopic partial meniscectomy in patients over 70 years of age. Arthroscopy 17:732–736CrossRefPubMed Crevoisier X, Munzinger U, Drobny T (2001) Arthroscopic partial meniscectomy in patients over 70 years of age. Arthroscopy 17:732–736CrossRefPubMed
11.
go back to reference Demange MK, Gobbi RG, Camanho GL (2016) “Fatigue meniscal tears”: a description of the lesion and the results of arthroscopic partial meniscectomy. Int Orthop 40:399–405CrossRefPubMed Demange MK, Gobbi RG, Camanho GL (2016) “Fatigue meniscal tears”: a description of the lesion and the results of arthroscopic partial meniscectomy. Int Orthop 40:399–405CrossRefPubMed
12.
go back to reference Dervin GF, Stiell IG, Rody K, Grabowski J (2003) Effect of arthroscopic débridement for osteoarthritis of the knee on health-related quality of life. J Bone Jt Surg Am 85A:10–19CrossRef Dervin GF, Stiell IG, Rody K, Grabowski J (2003) Effect of arthroscopic débridement for osteoarthritis of the knee on health-related quality of life. J Bone Jt Surg Am 85A:10–19CrossRef
13.
go back to reference Englund M, Guermazi A, Gale D, Hunter DJ, Aliabadi P, Clancy M, Felson DT (2008) Incidental meniscal findings on knee MRI in middle-aged and elderly persons. N Engl J Med 359:1108–1115CrossRefPubMedPubMedCentral Englund M, Guermazi A, Gale D, Hunter DJ, Aliabadi P, Clancy M, Felson DT (2008) Incidental meniscal findings on knee MRI in middle-aged and elderly persons. N Engl J Med 359:1108–1115CrossRefPubMedPubMedCentral
14.
go back to reference Erdil M, Bilsel K, Sungur M, Dikmen G, Tuncer N, Polat G, Elmadag NM, Tuncay I, Asik M (2013) Does obesity negatively affect the functional results of arthroscopic partial meniscectomy? A retrospective cohort study. Arthroscopy 29:232–237CrossRefPubMed Erdil M, Bilsel K, Sungur M, Dikmen G, Tuncer N, Polat G, Elmadag NM, Tuncay I, Asik M (2013) Does obesity negatively affect the functional results of arthroscopic partial meniscectomy? A retrospective cohort study. Arthroscopy 29:232–237CrossRefPubMed
15.
16.
go back to reference Habata T, Uematsu K, Hattori K, Takakura Y, Fujisawa Y (2004) Clinical features of the posterior horn tear in the medial meniscus. Arch Orthop Trauma Surg 124:642–645CrossRefPubMed Habata T, Uematsu K, Hattori K, Takakura Y, Fujisawa Y (2004) Clinical features of the posterior horn tear in the medial meniscus. Arch Orthop Trauma Surg 124:642–645CrossRefPubMed
17.
go back to reference Han SB, Shetty GM, Lee DH, Chae DJ, Seo SS, Wang KH, Yoo SH, Nha KW (2010) Unfavorable 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 Han SB, Shetty GM, Lee DH, Chae DJ, Seo SS, Wang KH, Yoo SH, Nha KW (2010) Unfavorable 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
18.
go back to reference Haviv B, Bronak S, Kosashvili Y, Thein R (2016) Which patients are less likely to improve during the first year after arthroscopic partial meniscectomy? A multivariate analysis of 201 patients with prospective follow-up. Knee Surg Sports Traumatol Arthrosc 24:1427–1431CrossRefPubMed Haviv B, Bronak S, Kosashvili Y, Thein R (2016) Which patients are less likely to improve during the first year after arthroscopic partial meniscectomy? A multivariate analysis of 201 patients with prospective follow-up. Knee Surg Sports Traumatol Arthrosc 24:1427–1431CrossRefPubMed
19.
go back to reference Haviv B, Bronak S, Kosashvili Y, Thein R (2017) Does timing of arthroscopic partial meniscectomy in stable knees matter? J Knee Surg 30:47–50PubMed Haviv B, Bronak S, Kosashvili Y, Thein R (2017) Does timing of arthroscopic partial meniscectomy in stable knees matter? J Knee Surg 30:47–50PubMed
20.
go back to reference Herrlin SV, Wange PO, Lapidus G, Hållander M, Werner S, Weidenhielm L (2013) Is arthroscopic surgery beneficial in treating non-traumatic, degenerative medial meniscal tears? A five year follow-up. Knee Surg Sports Traumatol Arthrosc 21:358–364CrossRefPubMed Herrlin SV, Wange PO, Lapidus G, Hållander M, Werner S, Weidenhielm L (2013) Is arthroscopic surgery beneficial in treating non-traumatic, degenerative medial meniscal tears? A five year follow-up. Knee Surg Sports Traumatol Arthrosc 21:358–364CrossRefPubMed
21.
go back to reference Higuchi H, Kimura M, Shirakura K, Terauchi M, Takagishi K (2000) Factors affecting long-term results after arthroscopic partial meniscectomy. Clin Orthop Relat Res 377:161–168CrossRef Higuchi H, Kimura M, Shirakura K, Terauchi M, Takagishi K (2000) Factors affecting long-term results after arthroscopic partial meniscectomy. Clin Orthop Relat Res 377:161–168CrossRef
22.
go back to reference 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 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
24.
go back to reference Katz JN, Brophy RH, Chaisson CE, de Chaves L, Cole BJ, Dahm DL, Donnell-Fink LA, Guermazi A, Haas AK, Jones MH, Levy BA, Mandl LA, Martin SD, Marx RG, Miniaci A, Matava MJ, Palmisano J, Reinke EK, Richardson BE, Rome BN, Safran-Norton CE, Skoniecki DJ, Solomon DH, Smith MV, Spindler KP, Stuart MJ, Wright J, Wright RW, Losina E (2013) Surgery versus physical therapy for a meniscal tear and osteoarthritis. N Engl J Med 368:1675–1684CrossRefPubMedPubMedCentral Katz JN, Brophy RH, Chaisson CE, de Chaves L, Cole BJ, Dahm DL, Donnell-Fink LA, Guermazi A, Haas AK, Jones MH, Levy BA, Mandl LA, Martin SD, Marx RG, Miniaci A, Matava MJ, Palmisano J, Reinke EK, Richardson BE, Rome BN, Safran-Norton CE, Skoniecki DJ, Solomon DH, Smith MV, Spindler KP, Stuart MJ, Wright J, Wright RW, Losina E (2013) Surgery versus physical therapy for a meniscal tear and osteoarthritis. N Engl J Med 368:1675–1684CrossRefPubMedPubMedCentral
25.
go back to reference Khan M, Evaniew N, Bedi A, Ayeni OR, Bhandari M (2014) Arthroscopic surgery for degenerative tears of the meniscus: a systematic review and meta-analysis. CMAJ 186:1057–1064CrossRefPubMedPubMedCentral Khan M, Evaniew N, Bedi A, Ayeni OR, Bhandari M (2014) Arthroscopic surgery for degenerative tears of the meniscus: a systematic review and meta-analysis. CMAJ 186:1057–1064CrossRefPubMedPubMedCentral
26.
go back to reference Kise NJ, Risberg MA, Stensrud S, Ranstam J, Engebretsen L, Roos EM (2016) Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients: randomised controlled trial with two year follow-up. Br J Sports Med 50:1473–1480CrossRefPubMedPubMedCentral Kise NJ, Risberg MA, Stensrud S, Ranstam J, Engebretsen L, Roos EM (2016) Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients: randomised controlled trial with two year follow-up. Br J Sports Med 50:1473–1480CrossRefPubMedPubMedCentral
27.
go back to reference LaPrade CM, James EW, Cram TR, Feagin JA, Engebretsen L, LaPrade RF (2015) Meniscal root tears: a classification system based on tear morphology. Am J Sports Med 43:363–369CrossRefPubMed LaPrade CM, James EW, Cram TR, Feagin JA, Engebretsen L, LaPrade RF (2015) Meniscal root tears: a classification system based on tear morphology. Am J Sports Med 43:363–369CrossRefPubMed
28.
go back to reference Matsusue Y, Thomson NL (1996) Arthroscopic partial medial meniscectomy in patients over 40 years old: a 5- to 11-year follow-up study. Arthroscopy 12:39–44CrossRefPubMed Matsusue Y, Thomson NL (1996) Arthroscopic partial medial meniscectomy in patients over 40 years old: a 5- to 11-year follow-up study. Arthroscopy 12:39–44CrossRefPubMed
29.
go back to reference Metcalf MH, Barrett GR (2004) Prospective evaluation of 1485 meniscal tear patterns in patients with stable knees. Am J Sports Med 32:675–680CrossRefPubMed Metcalf MH, Barrett GR (2004) Prospective evaluation of 1485 meniscal tear patterns in patients with stable knees. Am J Sports Med 32:675–680CrossRefPubMed
30.
go back to reference 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 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
31.
go back to reference Niu NN, Losina E, Martin SD, Wright J, Solomon DH, Katz JN (2011) Development and preliminary validation of a meniscal symptom index. Arthritis Care Res (Hoboken) 63:208–215CrossRef Niu NN, Losina E, Martin SD, Wright J, Solomon DH, Katz JN (2011) Development and preliminary validation of a meniscal symptom index. Arthritis Care Res (Hoboken) 63:208–215CrossRef
32.
go back to reference Noyes FR, Stabler CL (1989) A system for grading articular cartilage lesions at arthroscopy. Am J Sports Med 17:505–513CrossRefPubMed Noyes FR, Stabler CL (1989) A system for grading articular cartilage lesions at arthroscopy. Am J Sports Med 17:505–513CrossRefPubMed
33.
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 16:849–854CrossRefPubMed 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.
go back to reference Pearse EO, Craig DM (2003) Partial meniscectomy in the presence of severe osteoarthritis does not hasten the symptomatic progression of osteoarthritis. Arthroscopy 19:963–968CrossRefPubMed Pearse EO, Craig DM (2003) Partial meniscectomy in the presence of severe osteoarthritis does not hasten the symptomatic progression of osteoarthritis. Arthroscopy 19:963–968CrossRefPubMed
35.
go back to reference Rosenberger PH, Dhabhar FS, Epel E, Jokl P, Ickovics JR (2010) Sex differences in factors influencing recovery from arthroscopic knee surgery. Clin Orthop Relat Res 468:3399–3405CrossRefPubMedPubMedCentral Rosenberger PH, Dhabhar FS, Epel E, Jokl P, Ickovics JR (2010) Sex differences in factors influencing recovery from arthroscopic knee surgery. Clin Orthop Relat Res 468:3399–3405CrossRefPubMedPubMedCentral
36.
go back to reference Sihvonen R, Paavola M, Malmivaara A, Itälä A, Joukainen A, Nurmi H, Kalske J, Järvinen TLN (2013) Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear. N Engl J Med 369:2515–2524CrossRefPubMed Sihvonen R, Paavola M, Malmivaara A, Itälä A, Joukainen A, Nurmi H, Kalske J, Järvinen TLN (2013) Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear. N Engl J Med 369:2515–2524CrossRefPubMed
37.
go back to reference Sung JH, Ha JK, Lee DW, Seo WY, Kim JG (2013) Meniscal extrusion and spontaneous osteonecrosis with root tear of medial meniscus: comparison with horizontal tear. Arthroscopy 29:726–732CrossRefPubMed Sung JH, Ha JK, Lee DW, Seo WY, Kim JG (2013) Meniscal extrusion and spontaneous osteonecrosis with root tear of medial meniscus: comparison with horizontal tear. Arthroscopy 29:726–732CrossRefPubMed
38.
go back to reference Thorlund JB, Juhl CB, Roos EM, Lohmander LS (2015) Arthroscopic surgery for degenerative knee: systematic review and meta-analysis of benefits and harms. Br J Sports Med 49:1229–1235CrossRefPubMedPubMedCentral Thorlund JB, Juhl CB, Roos EM, Lohmander LS (2015) Arthroscopic surgery for degenerative knee: systematic review and meta-analysis of benefits and harms. Br J Sports Med 49:1229–1235CrossRefPubMedPubMedCentral
39.
go back to reference 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 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
40.
go back to reference Yim J-H, Seon J-K, Song E-K, Choi J-I, Kim M-C, Lee K-B, Seo H-Y (2013) A comparative study of meniscectomy and nonoperative treatment for degenerative horizontal tears of the medial meniscus. Am J Sports Med 41:1565–1570CrossRefPubMed Yim J-H, Seon J-K, Song E-K, Choi J-I, Kim M-C, Lee K-B, Seo H-Y (2013) A comparative study of meniscectomy and nonoperative treatment for degenerative horizontal tears of the medial meniscus. Am J Sports Med 41:1565–1570CrossRefPubMed
41.
go back to reference Zanetti M, Pfirrmann CWA, Schmid MR, Romero J, Seifert B, Hodler J (2003) Patients with suspected meniscal tears: prevalence of abnormalities seen on MRI of 100 symptomatic and 100 contralateral asymptomatic knees. AJR Am J Roentgenol 181:635–641CrossRefPubMed Zanetti M, Pfirrmann CWA, Schmid MR, Romero J, Seifert B, Hodler J (2003) Patients with suspected meniscal tears: prevalence of abnormalities seen on MRI of 100 symptomatic and 100 contralateral asymptomatic knees. AJR Am J Roentgenol 181:635–641CrossRefPubMed
Metadata
Title
Meniscal tear morphology independently affects pain relief following arthroscopic partial meniscectomy in middle-aged patients
Authors
Masayuki Kamimura
Jutaro Umehara
Atsushi Takahashi
Yu Mori
Daisuke Chiba
Yoshiyuki Kuwahara
Eiji Itoi
Publication date
01-08-2019
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 8/2019
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-018-5238-2

Other articles of this Issue 8/2019

Knee Surgery, Sports Traumatology, Arthroscopy 8/2019 Go to the issue