Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 12/2023

08-11-2023 | Osteoarthrosis | KNEE

Marrow stimulation procedures for high-grade cartilage lesions during surgical repair of medial meniscus root tear yielded suboptimal outcomes, whilst small lesions showed surgical eligibility

Authors: Hyun-Soo Moon, Min Jung, Chong-Hyuk Choi, Je-Hyun Yoo, Bum-Joon Nam, Seung-Hun Lee, Seung-Hwan Shin, Dong-Ki Kim, Sung-Hwan Kim

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 12/2023

Login to get access

Abstract

Purpose

To investigate the surgical outcomes of arthroscopic pull-out repair for medial meniscus root tear (MMRT) combined with the marrow stimulation procedures (MSP) for accompanying high-grade cartilage lesions.

Methods

Patients who underwent arthroscopic pull-out repair for MMRT between 2010 and 2019 were retrospectively reviewed. Patients who had at least 3 years of follow-up were included and classified into two groups according to whether MSP (microfracture or microdrilling) were performed on cartilage lesions in the medial tibiofemoral joint (group 1, patients with International Cartilage Repair Society [ICRS] grade 0–3a lesions and did not undergo MSP; group 2, patients with ICRS grade 3b–3d lesions and underwent MSP). Comparative analyses, including non-inferiority trials, were conducted between groups for subjective and objective outcomes. In addition, group 2 was further divided into two subgroups according to cartilage lesion size and compared with group 1 (group S, ≤ 2.0 cm2; group L, > 2.0 cm2).

Results

A total of 94 patients were included (group 1, 68 patients; group 2, 26 patients). There were no significant differences in clinical scores at postoperative 3 years and final follow-up between groups 1 and 2, but group 2 failed to satisfy the non-inferiority criteria compared to group 1 overall. In objective outcomes, group 2 did not meet the non-inferiority criteria for the rate of osteoarthritis progression compared to group 1, and it also showed a significantly higher proportion of high-grade osteoarthritis at final follow-up (P = 0.044) and a higher degree of osteoarthritis progression than group 1 (P = 0.03 for pre- to postoperative 3 years, and P = 0.006 for pre- to final follow-up). In additional evaluations comparing the subgroups of group 2 and group 1, group S showed relatively favourable results compared to group L in objective outcomes at final follow-up.

Conclusion

Patients who underwent arthroscopic pull-out repair for MMRT combined with MSP for accompanying high-grade cartilage lesions showed suboptimal outcomes compared to those with no or low-grade lesions at mid-term follow-up. High-grade cartilage lesions ≤ 2.0 cm2 may be candidates for the surgical repair of MMRT if MSP are performed, but those with larger lesions may require alternative treatment strategies.

Level of evidence

III.
Appendix
Available only for authorised users
Literature
1.
Ahn JH, Jeong HJ, Lee YS, Park JH, Lee JW, Park JH et al (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 Jt Surg Am 90:1922–1931CrossRef
3.
Briggs KK, Kocher MS, Rodkey WG, Steadman JR (2006) Reliability, validity, and responsiveness of the Lysholm knee score and Tegner activity scale for patients with meniscal injury of the knee. J Bone Jt Surg Am 88:698–705
4.
Choi HU, Kim DH, Lee SW, Choi BC, Bae KC (2022) Comparison of lower-limb alignment in patients with advanced knee osteoarthritis: EOS biplanar stereoradiography versus conventional scanography. Clin Orthop Surg 14:370–376CrossRefPubMedPubMedCentral
5.
6.
Chung KS, Ha JK, Ra HJ, Kim JG (2016) Prognostic factors in the midterm results of pullout fixation for posterior root tears of the medial meniscus. Arthroscopy 32:1319–1327CrossRefPubMed
7.
Chung KS, Ha JK, Ra HJ, Nam GW, Kim JG (2017) Pullout fixation of posterior medial meniscus root tears: correlation between meniscus extrusion and midterm clinical results. Am J Sports Med 45:42–49CrossRefPubMed
8.
Chung KS, Ha JK, Ra HJ, Yu WJ, Kim JG (2020) Root repair versus partial meniscectomy for medial meniscus posterior root tears: comparison of long-term survivorship and clinical outcomes at minimum 10-year follow-up. Am J Sports Med 48:1937–1944CrossRefPubMed
9.
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
10.
Dekker TJ, Aman ZS, DePhillipo NN, Dickens JF, Anz AW, LaPrade RF (2021) Chondral lesions of the knee: an evidence-based approach. J Bone Jt Surg Am 103:629–645CrossRef
11.
Ding C, Garnero P, Cicuttini F, Scott F, Cooley H, Jones G (2005) Knee cartilage defects: association with early radiographic osteoarthritis, decreased cartilage volume, increased joint surface area and type II collagen breakdown. Osteoarthritis Cartilage 13:198–205CrossRefPubMed
12.
Feucht MJ, Kühle J, Bode G, Mehl J, Schmal H, Südkamp NP et al (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
13.
Guermazi A, Hayashi D, Jarraya M, Roemer FW, Zhang Y, Niu J et al (2013) Medial posterior meniscal root tears are associated with development or worsening of medial tibiofemoral cartilage damage: the multicenter osteoarthritis study. Radiology 268:814–821CrossRefPubMedPubMedCentral
14.
Henry S, Mascarenhas R, Kowalchuk D, Forsythe B, Irrgang JJ, Harner CD (2012) Medial meniscus tear morphology and chondral degeneration of the knee: is there a relationship? Arthroscopy 28:1124-1134.e1122CrossRefPubMed
15.
Hiranaka T, Furumatsu T, Okazaki Y, Tanaka T, Ozawa M, Masuda K et al (2021) Postoperative clinical outcomes of unicompartmental knee arthroplasty in patients with isolated medial compartmental osteoarthritis following medial meniscus posterior root tear. Asia Pac J Sports Med Arthrosc Rehabil Technol 26:15–20PubMedPubMedCentral
16.
Irrgang JJ, Anderson AF, Boland AL, Harner CD, Neyret P, Richmond JC et al (2006) Responsiveness of the International Knee Documentation Committee subjective knee form. Am J Sports Med 34:1567–1573CrossRefPubMed
17.
Itou J, Kuwashima U, Itoh M, Okazaki K (2022) High tibial osteotomy for medial meniscus posterior root tears in knees with moderate varus alignment can achieve favorable clinical outcomes. J Exp Orthop 9:65CrossRefPubMedPubMedCentral
18.
Kim JG, Lee YS, Bae TS, Ha JK, Lee DH, Kim YJ et al (2013) Tibiofemoral contact mechanics following posterior root of medial meniscus tear, repair, meniscectomy, and allograft transplantation. Knee Surg Sports Traumatol Arthrosc 21:2121–2125CrossRefPubMed
19.
Kim JS, Lee MK, Choi MY, Kong DH, Ha JK, Kim JG et al (2023) Rehabilitation after repair of medial meniscus posterior root tears: a systematic review of the literature. Clin Orthop Surg 15:740–751CrossRefPubMed
20.
Kim SB, Ha JK, Lee SW, Kim DW, Shim JC, Kim JG et al (2011) Medial meniscus root tear refixation: comparison of clinical, radiologic, and arthroscopic findings with medial meniscectomy. Arthroscopy 27:346–354CrossRefPubMed
21.
22.
23.
Lee DW, Kim MK, Jang HS, Ha JK, Kim JG (2014) Clinical and radiologic evaluation of arthroscopic medial meniscus root tear refixation: comparison of the modified Mason–Allen stitch and simple stitches. Arthroscopy 30:1439–1446CrossRefPubMed
24.
25.
26.
Marzo JM, Gurske-DePerio J (2009) Effects of medial meniscus posterior horn avulsion and repair on tibiofemoral contact area and peak contact pressure with clinical implications. Am J Sports Med 37:124–129CrossRefPubMed
27.
Medina J, Garcia-Mansilla I, Fabricant PD, Kremen TJ, Sherman SL, Jones K (2021) Microfracture for the treatment of symptomatic cartilage lesions of the knee: a survey of International Cartilage Regeneration & Joint Preservation Society. Cartilage 13:1148s–1155sCrossRefPubMed
28.
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
29.
Moon HS, Choi CH, Jung M, Chung K, Jung SH, Kim YH et al (2023) Medial meniscus posterior root tear: how far have we come and what remains? Medicina (Kaunas) 59:1181CrossRefPubMed
30.
Moon HS, Choi CH, Jung M, Lee DY, Eum KS, Kim SH (2020) Medial meniscal posterior horn tears are associated with increased posterior tibial slope: a case-control study. Am J Sports Med 48:1702–1710CrossRefPubMed
31.
Moon HS, Choi CH, Jung M, Lee DY, Hong SP, Kim SH (2020) Early surgical repair of medial meniscus posterior root tear minimizes the progression of meniscal extrusion: 2-year follow-up of clinical and radiographic parameters after arthroscopic transtibial pull-out repair. Am J Sports Med 48:2692–2702CrossRefPubMed
32.
Moon HS, Choi CH, Yoo JH, Jung M, Lee TH, Jeon BH et al (2021) Mild to moderate varus alignment in relation to surgical repair of a medial meniscus root tear: a matched-cohort controlled study with 2 years of follow-up. Am J Sports Med 49:1005–1016CrossRefPubMed
33.
34.
Park JY, Kim BH, Ro DH, Lee MC, Han HS (2019) Characteristic location and rapid progression of medial femoral condylar chondral lesions accompanying medial meniscus posterior root tear. Knee 26:673–678CrossRefPubMed
35.
Schreiner MM, Raudner M, Röhrich S, Zalaudek M, Weber M, Kaiser G et al (2021) Reliability of the MOCART (Magnetic Resonance Observation of Cartilage Repair Tissue) 2.0 knee score for different cartilage repair techniques-a retrospective observational study. Eur Radiol 31:5734–5745CrossRefPubMedPubMedCentral
36.
Shah SS, Lee S, Mithoefer K (2021) Next-generation marrow stimulation technology for cartilage repair: basic science to clinical application. JBJS Rev 9(e20):00090
37.
Weber AE, Locker PH, Mayer EN, Cvetanovich GL, Tilton AK, Erickson BJ et al (2018) Clinical outcomes after microfracture of the knee: midterm follow-up. Orthop J Sports Med 6:2325967117753572CrossRefPubMedPubMedCentral
38.
Wluka AE, Ding C, Jones G, Cicuttini FM (2005) The clinical correlates of articular cartilage defects in symptomatic knee osteoarthritis: a prospective study. Rheumatology (Oxford) 44:1311–1316CrossRefPubMed
39.
40.
Zhang X, Furumatsu T, Okazaki Y, Hiranaka T, Kodama Y, Xue H et al (2021) High body mass index is a risk factor for unfavorable clinical outcomes after medial meniscus posterior root repair in well-aligned knees. J Orthop Sci 26:430–434CrossRefPubMed
Metadata
Title
Marrow stimulation procedures for high-grade cartilage lesions during surgical repair of medial meniscus root tear yielded suboptimal outcomes, whilst small lesions showed surgical eligibility
Authors
Hyun-Soo Moon
Min Jung
Chong-Hyuk Choi
Je-Hyun Yoo
Bum-Joon Nam
Seung-Hun Lee
Seung-Hwan Shin
Dong-Ki Kim
Sung-Hwan Kim
Publication date
08-11-2023
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 12/2023
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-023-07642-2

Other articles of this Issue 12/2023

Knee Surgery, Sports Traumatology, Arthroscopy 12/2023 Go to the issue

ANKLE

The use of deep learning enables high diagnostic accuracy in detecting syndesmotic instability on weight-bearing CT scanning

SPORTS TRAUMATOLOGY

Applying additional autologous platelet-rich fibrin matrix or serial platelet-rich plasma to microfracture technique increases the quality of the repaired cartilage

KNEE

Effect of posteromedial vertical capsulotomy with medial collateral ligament liberation on intraoperative medial component gap mismatch between extension and mid-flexion during total knee arthroplasty

KNEE

Quadriceps tendon malalignment is an independent anatomical deformity which is the primary abnormality associated with lateral facet patellofemoral joint osteoarthritis

KNEE

Subchondral bone remodeling patterns in larger animal models of meniscal injuries inducing knee osteoarthritis – a systematic review

ANKLE

Limited evidence in support of bone marrow aspirate concentrate as an additive to the bone marrow stimulation for osteochondral lesions of the talus: a systematic review and meta-analysis