Top

Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

15-02-2023 | KNEE

Younger patients, lower BMI, complete meniscus root healing, lower HKA degree and shorter preoperative symptom duration were the independent risk factors correlated with the good correction of MME in patients with repaired MMPRTs

Authors: Si Nie, Hongbo Li, Xingen Liao, Qing Liu, Min Lan

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 9/2023

Abstract

Purpose

To evaluate the clinical and radiological outcomes of arthroscopically assisted tendon graft anatomic reinforced reconstruction of the medial meniscus posterior root tears (MMPRTs) and identify relevant factors affecting the correction of medial meniscal extrusion (MME).

Methods

Fifty-three MMPRTs patients who underwent arthroscopically assisted tendon graft reconstruction of the meniscal root between 2018 and 2020 were evaluated retrospectively. the patients were divided into 2 groups according to the correction of MME (maintained MME group: 32 cases vs. increased MME group: 21 cases). The clinical and radiological outcomes of arthroscopically assisted tendon graft reconstruction of the meniscal root, including postoperative correction of MME and functional recovery of the knee were assessed in this study, and potential independent risk factors that could influence the correction of MME were also evaluated.

Results

The functional recovery of the knee was significantly improved at the end of follow-up (P < 0.001; respectively), furthermore, a comparison of the final functional outcomes between the groups showed that the mean Lysholm score and IKDC score of the maintained MME group were significantly improved than those of increased MME group. 60.4% had good correction of MME, and patients with complete healing had better extrusion correction than those with partial healing and non-healing. Binary logistic regression models analysis indicated that the age (OR = 1.053, P = 0.048), BMI (OR = 1.376, P = 0.004), meniscus root healing status (OR = 7.701, P = 0.005), HKA degree (OR = 1.891, P = 0.011) and preoperative symptom duration (OR = 1.055, P = 0.013) were the independent risk factors correlated with correction of MME. Additionally, the ROC curve demonstrated the cut-off values of the Age, BMI, HKA degree and preoperative symptom duration were 46.0 years, 22.5 kg/m2, 3.2° and 9.5 months, respectively,

Conclusions

The arthroscopically assisted tendon graft anatomic reinforced reconstruction of the meniscal root showed clinical improvement and prevented the progression of postoperative MME. Additionally, younger patients, lower BMI, complete meniscus root healing, lower HKA degree and shorter preoperative symptom duration were the independent risk factors correlated with the good correction of MME in patients with repaired MMPRTs.

Level of Evidence

Level IV.

Available only for authorised users

Ghouri A, Muzumdar S, Barr AJ, Robinson E, Murdoch C, Kingsbury SR et al (2022) The relationship between meniscal pathologies, cartilage loss, joint replacement and pain in knee osteoarthritis: a systematic review. Osteoarthr Cartilage 30(10):1287–1327CrossRef

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

Bansal S, Floyd ER, AKowalski M, Aikman E, Elrod P, BurkeyK, et al (2021) Meniscal repair: the current state and recent advances in augmentation. J Orthop Res 39:1368–1382https://doi.org/10.1002/jor.25021CrossRefPubMedPubMedCentral

Chiba D, Sasaki T, Ishibashi Y (2022) Greater medial meniscus extrusion seen on ultrasonography indicates the risk of MRI-detected complete medial meniscus posterior root tear in a Japanese population with knee pain. Sci Rep 12(1):4756. https://doi.org/10.1038/s41598-022-08604-3CrossRefPubMedPubMedCentral

Chung KS, Ha JK, Ra HJ, Kim JG (2021) Preoperative varus alignment and postoperative meniscus extrusion are the main long-term predictive factors of clinical failure of meniscal root repair. Knee Surg Sports Traumatol Arthrosc 29(12):4122–4130CrossRefPubMed

Chung KS, Ha JK, Ra HJ, Nam GW, Jin GK (2017) Pullout fixation of posterior medial meniscus root tears: correlation between meniscus extrusion and midterm clinical results. Am J Sports Med 45:42–49CrossRefPubMed

Wong CK, Man GCW, He X, Ng JP, Ng AWH, Ong MTY et al (2022) Large lateral tibial slope and lateral-to-medial slope difference are risk factors for poorer clinical outcomes after posterolateral meniscus root tear repair in anterior cruciate ligament reconstruction. BMC Musculoskelet Disord 23(1):247. https://doi.org/10.1186/s12891-022-05174-3CrossRefPubMedPubMedCentral

De Leissègues T, Vieira TD, Fayard JM, Thaunat M (2022) Low reoperation rate following lateral meniscus root repair: clinical outcomes at 2 years follow-up. Knee Surg Sports Traumatol Arthrosc 27(2):247–250

Foreman SC, Liu Y, Nevitt MC, Neumann J, Link TM (2020) Meniscal root tears and extrusion are significantly associated with the development of accelerated knee osteoarthritis: data from the osteoarthritis initiative. Cartilage 13:239S-248SCrossRefPubMedPubMedCentral

10.

Holmes SW, Huff LW, Barnes AJ, Baier AJ (2019) Anatomic reinforced medial meniscal root reconstruction with gracilis autograft. Arthrosc Tech 8:e209–e213CrossRefPubMedPubMedCentral

11.

Su J, Wan H, Pang Y, Lu Y, Liang J, Yan Z et al (2022) Trans-posterior cruciate ligament all-inside root repair versus partial meniscectomy for medial meniscus posterior root tears: comparison of semiquantitative and quantitative mri outcomes in cartilage degeneration and osteoarthritic progression. Cartilage 13(3):19476035221114240. https://doi.org/10.1177/19476035221114242CrossRefPubMedPubMedCentral

12.

Jeon SW, Min J, Chong HC, Kim SG, Factors KSH (2021) Related to meniscal extrusion and cartilage lesions in medial meniscus root tears. J Knee Surg 34(2):178–186CrossRefPubMed

13.

Kaplan DJ, Bloom D, Alaia EF, Walter WR, Meislin RJ, Strauss EJ et al (2021) ICRS scores worsen between 2-year short term and 5-year mid-term follow-up after transtibial medial meniscus root repair despite maintained functional outcomes. Knee Surg Sports Traumatol Arthrosc 30(7):2235–2243CrossRefPubMed

14.

Kim YM, Joo YB, Lee WY, Kim YK (2021) Remodified Mason-Allen suture technique concomitant with high tibial osteotomy for medial meniscus posterior root tears improved the healing of the repaired root and suppressed osteoarthritis progression. Knee Surg Sports Traumatol Arthrosc 29(4):1258–1268CrossRefPubMed

15.

Kintaka K, Furumatsu T, Okazaki Y, Masuda S, Hiranaka T, Kodama Y et al (2021) Comparison of two simple stitches and modified Mason-Allen suture for medial meniscus posterior root tear based on the progression of meniscal posterior extrusion: a retrospective cohort study. J Orthop Surg 29:1872685153CrossRef

16.

Krych AJ, Song BM, Nauert RF, Cook CS, Levy BA, Camp CL et al (2022) Prospective consecutive clinical outcomes after transtibial root repair for posterior meniscal root tears: a multicenter study. Orthop J Sports Med 10:951684850CrossRef

17.

Krych AJ, Nauert RF, Song BM, Cook CS, Johnson AC, Smith PA (2021) Association between transtibial meniscus root repair and rate of meniscal healing and extrusion on postoperative magnetic resonance imaging: a prospective multicenter study. Orthop J Sports Med 9(8):1536771939CrossRef

18.

Dzidzishvili L, López-Torres II, Arguello JM, Sáez D, Calvo E (2022) Prognostic factors and midterm clinical outcome of transtibial pullout and partial meniscectomy for medial meniscus posterior root tears in middle-aged patients. Indian J Orthop 56(8):1457–1463CrossRefPubMedPubMedCentral

19.

Li C, Hu X, Meng Q, Zhang X, Zhu J, Dai L et al (2017) The potential of using semitendinosus tendon as autograft in rabbit meniscus reconstruction. Sci Rep 7(1):7033CrossRefPubMedPubMedCentral

20.

Li HB, Nie S, Lan M, Tang ZM, Liao XG (2020) The risk factors for early conversion to total knee arthroplasty after high tibial osteotomy. Comput Methods Biomech Biomed Engin 24:1–7. https://doi.org/10.1080/10255842.2020.1849155

21.

Kim MS, Koh IJ, Kim CK, Choi KY, Kang KH, In Y (2020) Preoperative medial meniscal extrusion is associated with patient-reported outcomes after medial opening wedge high tibial osteotomy. Am J Sports Med 48(10):2048900039CrossRef

22.

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

23.

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 Sport Med 40(11):1138CrossRef

24.

Moon HS, Choi CH, Yoo JH, Jung M, Lee TH, Jeon BH (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 Sport Med 49(4):985781848CrossRef

25.

Novaretti JV, Astur DC, Cavalcante ELB, Kaleka CC, Amaro JT, Cohen M (2022) Preoperative meniscal extrusion predicts unsatisfactory clinical outcomes and progression of osteoarthritis after isolated partial medial meniscectomy: A 5-year follow-up study. J Knee Surg 35(4):393–400CrossRefPubMed

26.

Nejima S, Kumagai K, Yamada S, Sotozawa M, Kumagai D, Yamane H et al (2022) Risk of interference between the tibial tunnel and locking screws in medial meniscus posterior root repair and open wedge high tibial osteotomy. J Exp Orthop 9(1):25. https://doi.org/10.1186/s40634-022-00464-0CrossRefPubMedPubMedCentral

27.

Shota T, Takayuki F, Yuki O, Takaaki H, Keisuke K, Yuya K et al (2022) Medial meniscus posterior root repair using a modified mason-allen suture can prevent the progression of cartilage degeneration on the loading surface of the medial compartment: a second-look arthroscopic evaluation. Acta Med Okayama 75(4):423–430

28.

Sundararajan SR, Ramakanth R, Sethuraman AS, Kannan M, Rajasekaran S (2021) Correlation of factors affecting correction of meniscal extrusion and outcome after medial meniscus root repair. Arch Orthop Trauma Surg 142(5):823–834CrossRefPubMed

29.

Furumatsu T, Miyazawa S, Kodama Y, Kamatsuki Y, Okazaki Y, Hiranaka T et al (2022) Clinical outcomes of medial meniscus posterior root repair: a midterm follow-up study. Knee 38:141–147CrossRefPubMed

30.

Xue H, Furumatsu T, Okazaki Y, Hiranaka T, Ozaki T (2021) Knee Flexion-induced translation of pullout sutures used in the repair of medial meniscus posterior root tears. Acta Med Okayama 75(2):147–152PubMed

31.

Okazaki Y, Furumatsu T, Hiranaka T, Zhang X, Kintaka K, Higashihara N et al (2022) Arthroscopic meniscal healing following medial meniscus posterior root repair: a comparison between two suture materials. J Knee Surg 56(4):147–152

32.

Zhang X, Furumatsu T, Okazaki Y, Hiranaka T, Ozaki T (2020) 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(3):430–434CrossRefPubMed

33.

Zhang X, Furumatsu T, Okazaki Y, Hiranaka T, Kintaka K, Xue H et al (2021) Semi-quantitative arthroscopic scoring system is related to clinical outcomes in patients after medial meniscus posterior root repair. J Orthop Sci 134(5):22–27

34.

Zhuo H, Pan L, Xu Y, Li J (2021) Functional, magnetic resonance imaging, and second-look arthroscopic outcomes after pullout repair for avulsion tears of the posterior lateral meniscus root. Am J Sports Med 49(2):450–458CrossRefPubMed

Title: Younger patients, lower BMI, complete meniscus root healing, lower HKA degree and shorter preoperative symptom duration were the independent risk factors correlated with the good correction of MME in patients with repaired MMPRTs
Authors: Si Nie
Hongbo Li
Xingen Liao
Qing Liu
Min Lan
Publication date: 15-02-2023
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 9/2023
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-023-07330-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Younger patients, lower BMI, complete meniscus root healing, lower HKA degree and shorter preoperative symptom duration were the independent risk factors correlated with the good correction of MME in patients with repaired MMPRTs

Abstract

Purpose

Methods

Results

Conclusions

Level of Evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Level of Evidence

Please log in to get access to this content

Other articles of this Issue 9/2023

Inverse kinematic alignment accommodates native coronal knee alignment better in comparison to adjusted mechanical alignment and restricted kinematic alignment

Comparable accuracy of femoral joint line reconstruction in different kinematic and functional alignment techniques

The trochlear sulcus of the native knee is consistently orientated close to the sagittal plane despite variation in distal condylar anatomy

Targeting the neutral hip-to-calcaneus axis in kinematically aligned total knee arthroplasty is feasible with fewer alignment outliers for varus osteoarthritic patients

Health-economic evaluation of meniscus tear treatments: a systematic review

Routine use of antibiotic-laden bone cement in total knee arthroplasty is a cost-effective practice in the single-payer healthcare system