Clinical, Radiographic, and Arthroscopic Outcomes of Surgical Repair for Radial and Avulsed Lesions on the Lateral Meniscus Posterior Root During ACL Reconstruction: A Systematic Review

Zheng, Tong; Song, Gonghua; Li, Yue; Zhang, Zhijun; Ni, Qiankun; Cao, Yanwei; Zheng, Feng; Zhang, Hui; Feng, Hao

doi:10.1177/2325967121989678

Cited by 28 publications

(36 citation statements)

References 33 publications

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“…For example, after medial meniscus repair, MRI evaluation has demonstrated continued meniscus extrusion [ 24 ] and low healing rates [ 25 ]. Similarly, the paucity of research regarding the clinical implications of PRTs of the lateral meniscus demonstrates lax healing of up to 21% [ 26 ], and a recent systematic review was unable to conclude whether root repair restored the functional hoop stress characteristics required of the meniscus to distribute compression forces across the knee evenly [ 27 ]. Furthermore, a recent study found characteristic clinical differences between the medial and lateral meniscus PRTs, including the association of trauma in lateral meniscus PRTs, and older age and higher grade of OA changes of the knee in medial meniscus PRTs [ 1 ].…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2021

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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.

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Section: Resultsmentioning

confidence: 99%

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

et al. 2021

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“…A level 4 systematic review of 9 nonrandomized studies with 215 patients reported favorable functional outcome after combined ACLR and LMPRT repair with a meniscus healing rate >90%. 42 However, in a long-term study, Shelbourne et al 34 reported that subjective outcomes were not significantly different in patients whose LMPRT was left untreated compared with a matched control group with intact menisci. The mean IKDC score after 10 years was 84.6 ± 14 in the LMPRT group.…”

Section: Discussionmentioning

confidence: 97%

Outcomes of Combined Lateral Meniscus Posterior Root Repair and Anterior Cruciate Ligament Reconstruction

Shekhar¹,

Tapasvi²,

Williams³

2022

Orthopaedic Journal of Sports Medicine

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Background: Lateral meniscus posterior root tears (LMPRTs) almost always occur in association with anterior cruciate ligament (ACL) tears. Their repair is advocated to restore the stabilizing and load-sharing functions of the meniscus. Purpose: To study the functional outcomes of combined arthroscopic repair of LMPRTs and ACL reconstruction (ACLR). Study Design: Case series; Level of evidence, 4. Methods: The authors evaluated patients who underwent simultaneous arthroscopic ACLR and LMPRT repair. All patients had chronic injuries, with a mean time since ACL rupture of 7.9 months. Patient characteristics, Lachman and pivot-shift test results, type of LMPRT, associated injuries, and surgery details were documented. Pre- and postoperative functional status was assessed using the International Knee Documentation Committee (IKDC) score, Knee injury and Osteoarthritis Outcome Score (KOOS), and Lysholm score. An independent single-tunnel transtibial repair using 2 SutureTapes was performed for Forkel type 1 and 3 tear root avulsions, while side-to-side suture repair was performed for type 2 radial/oblique tears. The Wilcoxon signed rank test and minimal clinically important difference (MCID) of the IKDC score were used for statistical analysis. Results: Included were 25 patients with a mean age of 29.6 ± 6.5 years. Of these, 22 patients (88%; 95% CI, 73.1%-100%) had a high-grade (grade 2 or 3) preoperative pivot shift. Diagnosis of the LMPRT on magnetic resonance imaging (MRI) scans was possible only in 5 patients (20%). At final evaluation, performed at 37.4 ± 7.1 months postoperatively, all functional scores had improved significantly from preoperatively: IKDC score, from 47.6 ± 9.5 to 81.8 ± 11.5; KOOS, from 45.5 ± 10.9 to 86.5 ± 10.3, and Lysholm score, from 49.0 ± 11.5 to 88.8 ± 7.6 ( P < .001 for all). Twenty-four patients (96%) achieved the MCID for the IKDC score. All knees had a negative pivot shift at final analysis, and no patient underwent revision ACLR or LMPRT repair. Conclusion: LMPRT repair combined with ACLR led to good short-term clinical outcomes in this study. An LMPRT may frequently go undetected on preoperative MRI scans, but a high-grade pivot shift is present in a large majority of these patients.

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“…In addition, we have excluded those with a partial tear or healing tear at the time of arthroscopy, which led to the limited sample size. A recent systematic review about “clinical outcomes of surgical repairs for LMPR tears in patients undergoing ACLR” published by Zheng T et al [ 43 ] contained 9 studies with a total of 215 knees only (mean = 19.5, range = 8–41). The present study’s sample size is still larger than the mean of the reported studies.…”

Section: Discussionmentioning

confidence: 99%

Large lateral tibial slope and lateral-to-medial slope difference are risk factors for poorer clinical outcomes after posterolateral meniscus root tear repair in anterior cruciate ligament reconstruction

Wong

Man

et al. 2022

BMC Musculoskelet Disord

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Background Meniscus root tear is an uncommon but detrimental injury of the knee. Hoop stress is lost during meniscus root tear, which can lead to excessive tibiofemoral contact pressure and early development of osteoarthritis. Posterolateral meniscus root tears (PLRT) are more commonly associated with anterior cruciate ligament (ACL) tears. As the lateral compartment is less congruent than the medial compartment, it is more susceptible to a shearing force, which is increased in the ACL-deficient knee. In accordance with the compressive axial load, the increase in the tibial slope would generate a greater shearing force. The additional lateral compartment mobility caused by ACL tear should be reduced after ACL reconstruction (ACLR). However, there is a lack of evidence to conclude that ACLR can sufficiently limit the effect of large tibial slope (LTS) on the healing after PLRT repair. This study aimed to evaluate whether a steep LTS would be a risk factor for poorer clinical outcomes after PLRT repair concomitant with ACLR. Methods In this retrospective study, a chart review was conducted to identify patients with concomitant unilateral primary ACLR and PLRT repair. Patients with a partial tear or healed tear were excluded. Postoperative MRI and clinical assessments were performed at a mean follow up of 35 months. MRI data was used to measure the LTS, medial tibial slope (MTS), coronal tibial slope (CTS), the lateral-to-medial slope difference (LTS-MTS) and meniscus healing and extrusion. Functional outcomes were evaluated by patient-reported outcomes (International Knee Documentation Committee [IKDC], Lysholm and Tegner scores) and KT-1000 arthrometer assessment. Interobserver reproducibility was assessed by two reviewers. Results Twenty-five patients were identified for the analysis. Patients with larger LTS and larger LTS-MTS differences were shown to be correlated with poorer IKDC scores after surgery (R = -0.472, p = 0.017 and R = -0.429, p = 0.032, respectively). Herein, patients with LTS ≥ 6° or LTS-MTS ≥ 3° demonstrated poorer IKDC scores. Conclusion A large LTS (≥ 6°) and a large difference of LTS-MTS (≥ 3°) were shown to be risk factors for poorer functional and radiological outcomes for PLRT repair in patients after ACLR. Clinically, closer monitoring and a more stringent rehabilitation plan for patients with LTS ≥ 6° or LTS-MTS ≥ 3° would be recommended.

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Clinical, Radiographic, and Arthroscopic Outcomes of Surgical Repair for Radial and Avulsed Lesions on the Lateral Meniscus Posterior Root During ACL Reconstruction: A Systematic Review

Cited by 28 publications

References 33 publications

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

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

Outcomes of Combined Lateral Meniscus Posterior Root Repair and Anterior Cruciate Ligament Reconstruction

Large lateral tibial slope and lateral-to-medial slope difference are risk factors for poorer clinical outcomes after posterolateral meniscus root tear repair in anterior cruciate ligament reconstruction

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