Can the Reparability of Meniscal Tears Be Predicted With Magnetic Resonance Imaging?

Bernthal, Nicholas M.; Seeger, Leanne L.; Motamedi, Kambiz; Stavrakis, Alexandra I.; Kremen, Thomas J.; McAllister, David R.; Motamedi, Ali

doi:10.1177/0363546510387507

Cited by 18 publications

(31 citation statements)

References 15 publications

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“…This is likely because of a long-held belief that older patients have worse outcomes compared with younger patients after meniscal repair. 8,10 However, more recent studies have suggested that age may not play as significant a role in outcomes as previously believed. 21,31,36 Additionally, the role of obesity in meniscal repair outcomes has conflicting results in the literature, with a study by Brophy et al 9 showing significantly worse outcomes and higher rates of subsequent surgery rates in obese patients undergoing posterior medial root repairs.…”

Section: Discussionmentioning

confidence: 97%

Comparing Meniscectomy and Meniscal Repair: A Matched Cohort Analysis Utilizing a National Insurance Database

et al. 2020

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Background: Meniscal repair leads to improved patient outcomes compared with meniscectomy in small case series. Purpose: To compare the reoperation rates, 30-day complication rates, and cost differences between meniscectomy and meniscal repair in a large insurance database. Study Design: Cohort study; Level of evidence, 3. Methods: A national insurance database was queried for patients who underwent meniscectomy (Current Procedural Terminology [CPT] code 29880 or 29881) or meniscal repair (CPT code 29882 or 29883) in the outpatient setting and who had a minimum 2-year follow-up. Patients without confirmed laterality and patients who underwent concomitant ligament reconstruction were excluded. Reoperation was defined by ipsilateral knee procedure after the index surgery. The 30-day postoperative complication rates were assessed using the International Classification of Diseases, 9th Revision, Clinical Modification codes. The cost of the procedures per patient was calculated. Propensity score matching was utilized to create matched cohorts with similar characteristics. Statistical comparisons of cohort characteristics, reoperations, postoperative complications, and payments were made. All P values were reported with significance set at P < .05. Results: A total of 27,580 patients (22,064 meniscectomy and 5516 meniscal repair; mean age, 29.9 ± 15.1 years; 41.2% female) were included in this study with a mean follow-up of 45.6 ± 21.0 months. The matched groups were similar with regard to characteristics and comorbidities. There were significantly more patients who required reoperation after index meniscectomy compared with meniscal repair postoperatively (5.3% vs 2.1%; P < .001). Patients undergoing meniscectomy were also significantly more likely to undergo any ipsilateral meniscal surgery ( P < .001), meniscal transplantation ( P = .005), or total knee arthroplasty ( P = .001) postoperatively. There was a significantly higher overall 30-day complication rate after meniscal repair (1.2%) compared with meniscectomy (0.82%; P = .011). The total day-of-surgery payments was significantly higher in the repair group compared with the meniscectomy group ($7094 vs $5423; P < .001). Conclusion: Meniscal repair leads to significantly lower rates of reoperation and higher rates of early complications with a higher total cost compared with meniscectomy in a large database study.

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Section: Discussionmentioning

confidence: 97%

Comparing Meniscectomy and Meniscal Repair: A Matched Cohort Analysis Utilizing a National Insurance Database

et al. 2020

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“…17 Probably for this reason, a maximum distance of 3 mm from tear to meniscosynovial junction was chosen as criterion in other studies. 3,18,19 If we would have used this cut-off point of 3 mm in our study population, only 42.2% of the patients would have met this criterion. Matava and coworkers were uncertain about reparability of meniscal tears having a peripheral rim width of 3 to 5 mm, but they did not find those tears irreparable.…”

Section: Discussionmentioning

confidence: 99%

Intraobserver and Interobserver Agreement of Magnetic Resonance Imaging for Reparability of Peripheral Meniscal Tears: What Criteria Really Matter?

et al. 2016

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The objective of the study was the determination of the intra- and interobserver agreement of three magnetic resonance imaging (MRI) criteria for reparability: a peripheral rim smaller than 4 mm, a tear longer than 10 mm, and homogenous aspect of meniscal tissue. In two rounds with an interval of at least 6 weeks, three orthopedic surgeons and three musculoskeletal radiologists studied the preoperative MRI scans of 63 patients with a longitudinal full-thickness medial or lateral meniscal tear. All patients had an arthroscopic meniscal repair. The blinded images were evaluated measuring the tear length and rim width and meniscal aspect was classified. Agreement was calculated using the linear-weighted kappa coefficient () and the intraclass correlation coefficient (ICC). Examiner agreement strength was defined according to the guidelines of Landis and Koch. Intraobserver agreement was poor to good (, 0.12-0.72) for the classification of the meniscal aspect and decreased in lateral meniscal tears. The interobserver agreement for meniscal aspect was mainly poor to fair (, 0.09-0.53). The intraobserver reliability for measurement of the length of the meniscal tear was moderate to excellent (ICC, 0.51-0.80) for all observers in both rounds and moderate to good (ICC, 0.59-0.73) for measurement of the peripheral rim width. The interobserver agreement on tear length and rim width was moderate in both rounds (ICC, 0.58 and 0.50 in round 1; 0.50 and 0.50 in round 2, respectively). Tear length and rim width are the only two measurements with moderate to good agreement. However, these measurements do not predict reparability of longitudinal meniscal tears on MRI images.

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“…Surgical criteria for meniscal repair include meniscal tears greater than 10 mm in length, unstable on probing, located within 3 mm of the meniscosynovial junction, involvement of greater than 50% of the thickness of the meniscus, and an intact peripheral body or inner meniscal fragment (37). With the above criteria, MR imaging yielded a mean accuracy of 60%-74%, sensitivity of 29%-47%, and specificity of 74%-89% in predicting whether a meniscal tear is reparable at surgery (37,38).…”

Section: Anterior Cruciate Ligament Injuriesmentioning

confidence: 99%

Imaging of Athletic Injuries of Knee Ligaments and Menisci: Sports Imaging Series

Naraghi¹,

White²

2016

Radiology

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Acute knee injuries are a common source of morbidity in athletes and if overlooked may result in chronic functional impairment. Magnetic resonance (MR) imaging of the knee has become the most commonly performed musculoskeletal MR examination and is an indispensable tool in the appropriate management of the injured athlete. Meniscal and ligamentous tearing are the most frequent indications for surgical intervention in sports injuries and an understanding of the anatomy, biomechanics, mechanisms of injury, and patterns of injury are all critical to accurate diagnosis and appropriate management. These will be discussed in reference to meniscal tears and injuries of the cruciate ligaments as well as injuries of the posterolateral and posteromedial corners of the knee. (©) RSNA, 2016.

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Can the Reparability of Meniscal Tears Be Predicted With Magnetic Resonance Imaging?

Cited by 18 publications

References 15 publications

Comparing Meniscectomy and Meniscal Repair: A Matched Cohort Analysis Utilizing a National Insurance Database

Comparing Meniscectomy and Meniscal Repair: A Matched Cohort Analysis Utilizing a National Insurance Database

Intraobserver and Interobserver Agreement of Magnetic Resonance Imaging for Reparability of Peripheral Meniscal Tears: What Criteria Really Matter?

Imaging of Athletic Injuries of Knee Ligaments and Menisci: Sports Imaging Series

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