Arthroscopic scoring system of meniscal healing following medial meniscus posterior root repair

Furumatsu, Takayuki; Miyazawa, Shinichi; Fujii, Masataka; Tanaka, Takaaki; Kodama, Yuya; Ozaki, Toshifumi

doi:10.1007/s00264-018-4071-z

Cited by 35 publications

(63 citation statements)

References 28 publications

(33 reference statements)

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“…An outside-in pie-crusting technique involving a release of the deep medial collateral ligament was usually performed by using a standard 18-gauge needle [18]. The torn end of the MM posterior root/horn was grasped and repaired using the two-simple-stitches configuration [18,23]. A knee Scorpion TM suture passer (Arthrex) was used to pass No.…”

Section: Surgical Proceduresmentioning

confidence: 99%

The accuracy of a newly developed guide system in medial meniscus posterior root repair: a comparison between two aiming guides

Furumatsu

Kodama

Okazaki

et al. 2019

Knee Surg & Relat Res

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Purpose: Posterior root repair of the medial meniscus (MM) can prevent rapid progression of knee osteoarthritis in patients with a MM posterior root tear (MMPRT). The anatomic reattachment of the MM posterior root is considered to be critical in a transtibial pullout repair. However, tibial tunnel creation at the anatomic attachment is technically difficult. We hypothesized that a newly developed point-contact aiming guide [Unicorn Meniscal Root (UMR) guide] can create the tibial tunnel at a better position rather than a previously designed MMPRT guide. The aim of this study was to compare the position of the created tibial tunnel between the two meniscal root repair guides. Materials and methods: Thirty-eight patients underwent transtibial pullout repairs. Tibial tunnel creation was performed using the UMR guide (19 cases) or MMPRT guide (19 cases). Three-dimensional computed tomography images of the tibial surface were evaluated using the Tsukada's measurement method postoperatively. The expected anatomic center of the MM posterior root attachment was defined as the center of three tangential lines referring to three anatomic bony landmarks (anterior border of the posterior cruciate ligament, lateral margin of the medial tibial plateau, and retro-eminence ridge). The expected anatomic center and tibial tunnel center were evaluated using the percentage-based posterolateral location on the tibial surface. The distance between the anatomic center and tunnel center was calculated. Results: The anatomic center of the MM posterior root footprint was located at a position of 79.2% posterior and 39.5% lateral. The mean of the tunnel center in the UMR guide was similar to that in the MMPRT guide (posterior direction, P = 0.096; lateral direction, P = 0.280). The mean distances between the tunnel center and the anatomic center were 4.06 and 3.99 mm in the UMR and MMPRT guide group, respectively (P = 0.455). Conclusions: The UMR guide, as well as the MMPRT guide, is a useful device to create favorable tibial tunnels at the MM posterior root attachment for pullout repairs in patients with MMPRTs.

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Section: Surgical Proceduresmentioning

confidence: 99%

The accuracy of a newly developed guide system in medial meniscus posterior root repair: a comparison between two aiming guides

Furumatsu

Kodama

Okazaki

et al. 2019

Knee Surg & Relat Res

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“…We consider that the reason why improvements in clinical scores showed no association with arthroscopic meniscal healing status in several literatures may depend on qualitative second-look evaluation systems involved in three-or four-staged classification such as complete/incomplete/no healing and complete/lax/scar tissue/failed healing [22,23]. On the other hand, Furumatsu et al demonstrate that the semi-quantitative arthroscopic score of meniscal healing shows significant correlations with the KOOS QOL and VAS pain scores at second-look arthroscopy following transtibial pullout repairs in patients with MMPRTs [10]. The Furumatsu meniscal healing score was a useful scale to compare the superiority between these two transtibial pullout repair techniques by evaluating the healing status of the MM posterior root.…”

Section: Discussionmentioning

confidence: 99%

“…Types of the MMPRT were determined by careful arthroscopic examinations according to the meniscal root tear classification [20]. Second-look arthroscopic evaluation of meniscal healing [10] and fixation device removal were performed in all patients at 1 year postoperatively.…”

Section: Methodsmentioning

confidence: 99%

“…The healing status of the MM following transtibial pullout repair was assessed by second-look arthroscopy according to the Furumatsu scoring system [10]. A semi-quantitative arthroscopic scoring system was composed of 3 evaluation criteria: (i) anteroposterior width of bridging tissues between the MM posterior horn and root attachment (0, 2, and 4 points), (ii) stability of the repaired MM posterior root (0, 1, 2, 3, and 4 points), and (iii) synovial coverage of the sutures (0, 1, and 2 points) [10]. A perfect score on the meniscal healing set at 10 points.…”

Section: Arthroscopic Meniscal Healing Scoresmentioning

confidence: 99%

“…FasT-Fix all-inside meniscal suture device (Smith & Nephew, Andover, MA, USA) [9]. The FasT-Fix pullout repair technique seems to have an advantage in preserving meniscal position by stabilizing the unstable MM with posterior joint capsule if the pullout thread is broken or worn out during postoperative follow-up period [10]. Several authors demonstrate the superiority of a modified Mason-Allen (MMA) suture configuration in a load-to-failure test using porcine menisci compared with two simple stiches [11][12][13].…”

Section: Introductionmentioning

confidence: 99%

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Pullout repair using modified Mason-Allen suture induces better meniscal healing and superior clinical outcomes: A comparison between two surgical methods

et al. 2019

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Background: Pullout repairs of medial meniscus posterior root tears (MMPRTs) have many surgical options. However, there is no reliable clinical study to compare the superiority of each pullout repair technique. We hypothesized that pullout repairs using a modified Mason-Allen suture with FasT-Fix (F-MMA) would have several advantages in postoperative clinical outcomes and meniscal healing compared with the single FasT-Fix pullout repairs. The aim of this study was to investigate the clinical usefulness of these two techniques in the treatment of MMPRTs. Methods: Thirty-eight patients who had complete MMPRTs were included. All patients underwent transtibial pullout 2 repairs. We divided the patients into two groups to compare the clinical usefulness between pullout repairs using single FasT-Fix and F-MMA techniques. Second-look arthroscopic evaluations of meniscal healing were performed at 1 year postoperatively. We assessed clinical outcomes using the Lysholm, visual analogue scale (VAS) pain scores, and Knee Injury and Osteoarthritis Outcome Score (KOOS).

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Intercondylar notch width and osteophyte width impact meniscal healing and clinical outcomes following transtibial pullout repair of medial meniscus posterior root tears

Hiranaka,

Furumatsu,

Yokoyama

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThis retrospective study aimed to investigate the relationship between intercondylar notch width (ICNW), osteophyte width (OW), and the healing of medial meniscus posterior root tears (MMPRTs) following arthroscopic pullout repair.MethodsThe study included 155 patients diagnosed with MMPRTs who underwent transtibial pullout repair. Meniscal healing status was evaluated on second‐look arthroscopy using a previously reported meniscus healing score. Patients were divided into two groups based on this score: the high healing score (group HH, healing score ≥ 8 points) and suboptimal healing score (group SO, healing score ≤ 6 points) groups. Computed tomography scans were performed on patients 1 week postsurgery. ICNW and OW widths were measured and relatively evaluated based on their ratio to the intercondylar distance (ICD), represented as the ICNW/ICD ratio (%) and OW/ICD ratio (%), respectively. Patient‐reported outcomes were assessed preoperatively and on second‐look arthroscopy using the Knee injury and Osteoarthritis Outcome Score (KOOS) and visual analogue scale (VAS).ResultsThere were no significant demographic differences between the SO and HH group (n = 35 and 120 patients, respectively). Regarding radiographic measurements, significant differences were observed in the ICNW/ICD ratio (group SO, 24.2%; group HH, 25.2%; p = 0.024), OW (group SO, 2.6 mm; group HH, 2.0 mm; p < 0.001), and OW/ICD ratio (group SO, 3.5%; group HH, 2.7%; p < 0.001). Both groups had similar preoperative clinical scores, but postoperative clinical scores, including KOOS‐activities of daily living (group SO, 83.4; group HH, 88.7; p = 0.035) and VAS (group SO, 19.1; group HH, 11.3; p = 0.005), were significantly better in group HH.ConclusionThe study suggests that ICNW and OW may play a crucial role in MMPRT healing following arthroscopic pullout repair, as evidenced by the worse clinical outcomes associated with a narrower ICNW and wider OW. These findings highlight the potential significance of ICNW and OW assessments when evaluating meniscal repair indications.Level of EvidenceLevel III.

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Arthroscopic scoring system of meniscal healing following medial meniscus posterior root repair

Cited by 35 publications

References 28 publications

The accuracy of a newly developed guide system in medial meniscus posterior root repair: a comparison between two aiming guides

The accuracy of a newly developed guide system in medial meniscus posterior root repair: a comparison between two aiming guides

Pullout repair using modified Mason-Allen suture induces better meniscal healing and superior clinical outcomes: A comparison between two surgical methods

Intercondylar notch width and osteophyte width impact meniscal healing and clinical outcomes following transtibial pullout repair of medial meniscus posterior root tears

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