The purpose of this study is to define the clinical features and characteristics of radial tears in the root of the posterior horn of the medial meniscus and to report the outcome of arthroscopic treatment. Arthroscopic meniscus surgery was performed on 7,148 knees. Of those, 722 (10.1%) were radial tear in the root of the posterior horn of the medial meniscus. We reviewed the medical records from a random sample of 67 subjects studied (mean age 55.8 years, range 38-72, mean follow-up period 56.7 months, range, 8-123), which included surgical notes and detailed arthroscopic photographs of 70 knees. All patients were treated with arthroscopic partial meniscectomy. The age distribution, preoperative physical signs, results of magnetic resonance imaging , body mass index, and surgical findings of the study subjects were analyzed and the clinical results were graded with the Lysholm knee scoring scale and a questionnaire. Radiologic evaluation consisted of preoperative and at the latest follow-up radiographs. Eighty percent of the patients were older than 50 years, and 80.6% were either obese or morbidly obese. The mean Lysholm score improved from a preoperative value of 53 to a value of 67. The average preoperative Kellgren-Lawrence radiograph grade was 2 (range 0-3 points), a value that increased to 3 (range 2-4) at the latest follow-up, which showed a significant worsening. The preoperative MRI was reevaluated after the arthroscopic confirmation of a medial meniscal root tear. A tear could be demonstrated in only 72.9% of the patients, the rest of whom demonstrated degeneration and/or fluid accumulation at the posterior horn without a visible meniscal tear. Radial tears in the root of the medial meniscal posterior horn, which may not be visible in about one-third of the preoperative MRI scans, are common. That type of meniscal tear is strongly associated with obesity and older age and is morphologically different from the degenerative tears that often occur in the posterior horn. Partial meniscectomy provides symptomatic relief in most cases but does not arrest the progression of radiographically revealed osteoarthritis.

The purposes of this multi-center study were: (a) to document the location and type of meniscal and chondral lesions that accompany anterior cruciate ligament (ACL) tears, and (b) to test for possible relationships between these lesions and patient age, time from initial injury (TFI), and sports level (i.e., recreation, amateur, professional, and national). The cases of 764 patients with ACL tears who underwent arthroscopy for the first time were retrospectively analyzed. The group included 684 males and 80 females of mean age 27 years (range 14-59 years). The mean TFI was 19.8 months (range 0.2-360 months). Eighty-seven percent of the group engaged in regular sporting activity. Thirty-seven percent had medial meniscal tears, 16% had lateral meniscal tears, and 20% had tears of both menisci. The most common tear types were longitudinal tears in the posterior and middle horns of both menisci. Tears of the lateral meniscus were more centrally located than those of the medial meniscus. Incomplete tears and radial tears were significantly more common in the lateral meniscus. Nineteen percent of the knees had one or more chondral lesions. Sixty percent of the chondral lesions were located in the medial tibio-femoral compartment. Patient age was statistically associated with presence of a medial meniscal tear, presence of a grade 3 or 4 chondral lesion, and presence of a complex tear of the medial meniscus. Sports level was not statistically related to any of the parameters studied. The odds of having a medial meniscal tear at 2 to 5 years TFI were 2.2 times higher than the odds in the first year post-injury, and the odds at >5 years were 5.9 times higher than at 0 to 12 months TFI. The frequency of lateral meniscal tear remained fairly constant at 2 years TFI. The odds of having a grade 3 or 4 chondral lesion were 2.7 times greater at 2 to 5 years TFI than they were at 1 year post-injury, and these odds increased to 4.7 when patients at >5 years TFI were compared to those in the 2 to 5 years category. Multivariate analysis demonstrated that TFI and age were equally important predictors of lateral meniscal tears and of grade 3 or 4 chondral lesions; however, TFI was the better predictor of medial meniscal tear.

No abstract

Although it is an extremely rare complication, remote cerebellar hemorrhage should be kept in mind as a possible complication of spinal surgery, especially in operations complicated by dural tears.

No abstract