Arthroscopic direct meniscal extrusion reduction: surgical tips to reduce persistent meniscal extrusion in meniscal root repair

C้hernchujit, Bancha; Prasetia, Renaldi

doi:10.1007/s00590-018-2138-6

Cited by 17 publications

(10 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…36 Recent studies demonstrated promising results using surgical techniques such as arthroscopic pullout suture for meniscal root tears [37][38][39] or arthroscopic direct extrusion reduction to treat meniscal extrusion. 40,41 Studies comparing different approaches to treat posterior medial meniscal root tears found that anatomic transtibial pull-out root repair (with and without centralization suture into the posterior medial tibial plateau) best restored contact mechanics in the knee, compared with nonanatomic repair states, 42 while partial meniscectomy surgery or nonoperative management was associated with poor clinical outcomes and high arthroplasty rates. 43,44 Previous studies demonstrated that meniscal damage could be an important morphological risk factor for AKOA development: Roemer et al 13 identified meniscal extrusion and presence of meniscal abnormalities as risk factors for slow and fast tibiofemoral cartilage loss over 30 months comparing both types of cartilage loss to a reference group of knees without cartilage loss.…”

Section: Discussionmentioning

confidence: 99%

Meniscal Root Tears and Extrusion Are Significantly Associated with the Development of Accelerated Knee Osteoarthritis: Data from the Osteoarthritis Initiative

et al. 2020

View full text Add to dashboard Cite

Objective To identify joint structural risk factors, measured using quantitative compositional and semiquantitative magnetic resonance imaging (MRI) scoring, associated with the development of accelerated knee osteoarthritis (AKOA) compared with a more normal rate of knee osteoarthritis (OA) development. Design From the Osteoarthritis Initiative we selected knees with no radiographic OA (Kellgren-Lawrence grade [KL] 0/1) that developed advanced-stage OA (KL 3/4; AKOA) within a 4-year timeframe and a comparison group with a more normal rate of OA development (KL 0/1 to KL 2 in 4 years). MRIs at the beginning of the 4-year timeframe were assessed for cartilage T2 values and structural abnormalities using a modified Whole-Organ Magnetic Resonance Imaging Score (WORMS). Associations of MRI findings with AKOA versus normal OA were assessed using multivariable logistic regression models. Results A total of 106 AKOA and 168 subjects with normal OA development were included. Mean cartilage T2 values were not significantly associated with AKOA (odds ratio [OR] 1.06; 95% confidence interval [CI] 0.82-1.36). Risk factors for AKOA development included higher meniscus maximum scores (OR 1.37; 95% CI 1.11-1.68), presence of meniscal extrusion (OR 6.30; 95% CI 2.57-15.49), presence of root tears (OR 4.64; 95% CI 1.61-13.34), and higher medial tibia cartilage lesion scores (OR 1.96; 95% CI 1.19-3.24). Conclusions We identified meniscal damage, especially meniscal extrusion and meniscal root tears as risk factors for AKOA development. These findings contribute to identifying subjects at risk of AKOA at an early stage when preventative measures targeting modifiable risk factors such as meniscal repair surgery could still be effective.

show abstract

Section: Discussionmentioning

confidence: 99%

Meniscal Root Tears and Extrusion Are Significantly Associated with the Development of Accelerated Knee Osteoarthritis: Data from the Osteoarthritis Initiative

et al. 2020

View full text Add to dashboard Cite

show abstract

“…A transtibial suture pull-out technique has been described by Chernchujit and Prasetia. 7 The technique is in many ways similar to the transtibial suture pull-out technique for root repair. Comparative studies showing the results of transtibial suture pullout and all-inside meniscus root repair with suture anchor fail to demonstrate whether any technique has better results than the other.…”

Section: Discussionmentioning

confidence: 99%

“…A transtibial suture pull-out technique has been described by Chernchujit and Prasetia 7 . The technique is in many ways similar to the transtibial suture pull-out technique for root repair.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Arthroscopic All-Inside Medial Meniscus Extrusion Reduction

C้hernchujit

Agrawal

2019

Arthroscopy Techniques

Self Cite

View full text Add to dashboard Cite

Medial meniscus extrusion is commonly seen in patients who have medial meniscus posterior root tear. Extruded meniscus results in faster progression of knee arthrosis. Thus, it is important to reduce the extrusion as well as treat the cause of extrusion. This Technical Note describes an all-inside arthroscopic technique to reduce the meniscus extrusion. An additional medial portal has to be made along with the standard anteromedial and anterolateral portals. A double-loaded suture anchor is used to secure the extrusion of the meniscus in its native position. Thus, making a transosseous tibial tunnel is not required. It is easy to perform and is an efficient technique.

show abstract

“…However, a critical challenge to be resolved is the recapitulation of native meniscus function and prevention of knee OA [ 8 – 10 ]. There have been considerable efforts to minimize meniscus extrusion by improving surgical techniques and fixation strength of the suture repair; however, there remains a high rate of postoperative meniscus extrusion [ 4 , 11 – 14 ].…”

Section: Introductionmentioning

confidence: 99%

Quantifying the differential functional behavior between the medial and lateral meniscus after posterior meniscus root tears

et al. 2021

View full text Add to dashboard Cite

Meniscus tears of the knee are among the most common orthopedic knee injury. Specifically, tears of the posterior root can result in abnormal meniscal extrusion leading to decreased function and progressive osteoarthritis. Despite contemporary surgical treatments of posterior meniscus root tears, there is a low rate of healing and an incidence of residual meniscus extrusion approaching 30%, illustrating an inability to recapitulate native meniscus function. Here, we characterized the differential functional behavior of the medial and lateral meniscus during axial compression load and dynamic knee motion using a cadaveric model. We hypothesized essential differences in extrusion between the medial and lateral meniscus in response to axial compression and knee range of motion. We found no differences in the amount of meniscus extrusion between the medial and lateral meniscus with a competent posterior root (0.338mm vs. 0.235mm; p-value = 0.181). However, posterior root detachment resulted in a consistently increased meniscus extrusion for the medial meniscus compared to the lateral meniscus (2.233mm vs. 0.4705mm; p-value < 0.0001). Moreover, detachment of the posterior root of the medial meniscus resulted in an increase in extrusion at all angles of knee flexion and was most pronounced (4.00mm ± 1.26mm) at 30-degrees of knee flexion. In contrast, the maximum mean extrusion of the lateral meniscus was 1.65mm ± 0.97mm, occurring in full extension. Furthermore, only the medial meniscus extruded during dynamic knee flexion after posterior root detachment. Given the differential functional behaviors between the medial and lateral meniscus, these findings suggest that posterior root repair requires reducing overall meniscus extrusion and recapitulating the native functional responses specific to each meniscus.

show abstract

Arthroscopic direct meniscal extrusion reduction: surgical tips to reduce persistent meniscal extrusion in meniscal root repair

Cited by 17 publications

References 9 publications

Meniscal Root Tears and Extrusion Are Significantly Associated with the Development of Accelerated Knee Osteoarthritis: Data from the Osteoarthritis Initiative

Meniscal Root Tears and Extrusion Are Significantly Associated with the Development of Accelerated Knee Osteoarthritis: Data from the Osteoarthritis Initiative

Arthroscopic All-Inside Medial Meniscus Extrusion Reduction

Quantifying the differential functional behavior between the medial and lateral meniscus after posterior meniscus root tears

Contact Info

Product

Resources

About