Association between tears of the posterior root of the medial meniscus and far posterior femoral condyle osteoarthritis

Abstract

We aimed to evaluate whether tears of the posterior horn of the medial meniscus root ligament (PHMM RL) are associated with osteoarthritis of the far posterior femoral condyles (FPFC). METHODSRetrospective review of 1158 patients who underwent arthroscopy identified 49 patients with confirmed tears of the medial meniscus posterior root ligament attachment. Preoperative magnetic resonance imaging (MRI) studies were reviewed to identify advanced osteoarthritis involving the medial and lateral FPFC. Control patients (n=48) had no meniscal tears confirmed by arthroscopy. Cases and controls were age-and sex-matched exactly 1:1. One case patient was excluded since there was no age-and sex-matched control available. The International Cartilage Research Society (ICRS) MRI cartilage grade was recorded for the medial and lateral FPFC. Associations were evaluated using univariate and multivariable conditional logistic regression analyses. RESULTSThere were 48 case and 48 control patients (10 men in each group, 20.8%) with median age 53 years (range, 21-67). Medial FPFC ICRS Grade 2 or higher lesions were present in 34 (70.8%) of case patients and 16 (33.3%) of control patients. Lateral FPFC ICRS Grade 2 or higher lesions were present in 24 (50%) of case patients and 14 (28.2%) of control patients. Increased body mass index (BMI) was associated with PHMM RL tears (OR=1.11, 95% CI [1.01, 1.22], P = 0.020). MRI was 81.2% (39/48) sensitive and 91.2% (44/48) specific for detection of PHMM RL tears. PHMM RL tears were associated with Grade 2 or higher medial FPFC osteoarthritis (OR=10.00, 95% CI (2.34, 42.78), P < 0.001). This association remained after adjusting for BMI (OR=11.79, 95% CI [2.46, 56.53], P = 0.002). There was also an association between PHMM RL tears and lateral FPFC osteoarthritis, which persisted after adjusting for BMI (OR =3.00, 95% CI [1.07, 8.37], P = 0.036). CONCLUSIONPHMM RL tears are associated with advanced osteoarthritis of the FPFC. Radiologists identifying FPFC osteoarthritis should look carefully for PHMM RL tears.

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

“…The medial meniscus posterior root has been shown to be a biomechanically integral structure that prevents the development of OA. 6 , 8 MMPRTs have been associated with the development of OA of the far posterior femoral condyle. 6 Previous clinical studies have demonstrated that nonoperative management and partial meniscectomy for complete MMPRTs provide no benefit in halting arthritis with poor clinical and radiographic outcomes, as well as a high arthroplasty rate at 5-year follow-up.…”

“… 6 , 8 MMPRTs have been associated with the development of OA of the far posterior femoral condyle. 6 Previous clinical studies have demonstrated that nonoperative management and partial meniscectomy for complete MMPRTs provide no benefit in halting arthritis with poor clinical and radiographic outcomes, as well as a high arthroplasty rate at 5-year follow-up. 12 , 13 To restore the anchoring structure of the meniscal horn and prevent post-traumatic OA, arthroscopic repair was proven to be an effective technique in MMPRT patients with satisfactory clinical outcomes and a lower rate of TKA.…”

“… 1 - 3 MMPRTs disrupt the circumferential fibers of the meniscus, leading to increases in peak contact pressure in the medial compartment to a functionally total meniscectomized condition, 4 , 5 resulting in accelerated knee osteoarthritis. 6 - 11 Previous studies have demonstrated that conservative treatment and partial meniscectomy provide no benefit for MMPRTs with total knee arthroplasty (TKA) conversion rates of 31% 12 and 54%, 13 respectively. On account of unsatisfactory outcomes of conservative treatment and meniscectomy, 12 , 13 arthroscopic meniscal repair methods, including transtibial pull-out repair, anchor suture, and all-inside repair, have been developed to restore the integrity and hoop tension of the meniscus to prevent further joint degeneration.…”

Medial meniscus posterior root tears and partial meniscectomy significantly increase stress in the knee joint during dynamic gait

“…The incidence of MMPRTs is approximately 10–27.6% among medial meniscus tears [16]. MMPRTs are often accompanied by osteoarthritis (OA) [38] and significantly increase the contact stress of the medial compartment [2], which may further aggravate the progression of OA.…”

Medial Meniscus Posterior Root Tears Lead to Changes in Joint Contact Mechanics at Low Flexion Angles During Simulated Gait

“…11,17,22 Consequently, injuries to the MMPR are associated with accelerated progression of osteoarthritis. 9,26,21 To date, the biomechanical consequences of MMPRTs remain inadequately defined. Allaire et al 1 found that an MMPRT leads to a loss of load transmissibility across the meniscus at femoral flexion angles from 30°to 90°, resulting in joint biomechanics similar to those after a total meniscectomy.…”