Correlation of factors affecting correction of meniscal extrusion and outcome after medial meniscus root repair

Sundararajan, Silvampatti Ramasamy; Ramakanth, Rajagopalakrishnan; Sethuraman, Arvinth Shivaa; Kannan, Muhil; Rajasekaran, Shanmuganathan

doi:10.1007/s00402-021-03870-8

Cited by 27 publications

(24 citation statements)

References 46 publications

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“…Moreover, the present study showed that age < 46 years would help prevent the progression of MME. Sundararajan et al [28] observed similar results, they investigated 54 patients with isolated Laprade type 2 root tear who underwent arthroscopic transtibial tunnel suture pull‐out repair and indicated that older age was a major factor significantly correlated with correction of MME.…”

Section: Discussionmentioning

confidence: 76%

“…Moon et al [23] found that there was increased meniscus extrusion postoperatively in 74% of their patients and correction of extrusion was found in the minority of patients. On the contrary, Sundararajan et al [28] analyzed patients ( n = 54) who underwent arthroscopic transtibial tunnel suture pull‐out repair MMPRTs and showed that 57.4% of patients had good correction of MME. Interestingly, in the present study, the correction of MME rate in patients who underwent arthroscopically assisted tendon graft reconstruction of the meniscal root was demonstrated at approximately 60.4% on postoperative knee MRI at the end of follow‐up.…”

Section: Discussionmentioning

confidence: 99%

“…Varus alignment may potentially influence the healing of the fixed meniscus root. According to the HKA angle on weight‐bearing radiographs and Sundararajan [28] divided patients into two groups: varus less than 2.5 degrees or varus between 2.5 and 5 degrees, and confirmed that preoperative varus alignment is a risk factor with significant association with Lysholm score and meniscus extrusion. Studies investigated patients who underwent arthroscopic pull‐out repair for a posterior root tear of the medial meniscus and concluded that preoperative varus alignment greater than 5° played a significant role associated with inferior clinical outcomes [2, 5, 23].…”

Section: Discussionmentioning

confidence: 99%

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Younger patients, lower BMI, complete meniscus root healing, lower HKA degree and shorter preoperative symptom duration were the independent risk factors correlated with the good correction of MME in patients with repaired MMPRTs

Nie

Liao

et al. 2023

Knee Surg Sports Traumatol Arthrosc

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Purpose To evaluate the clinical and radiological outcomes of arthroscopically assisted tendon graft anatomic reinforced reconstruction of the medial meniscus posterior root tears (MMPRTs) and identify relevant factors afecting the correction of medial meniscal extrusion (MME). Methods Fifty-three MMPRTs patients who underwent arthroscopically assisted tendon graft reconstruction of the meniscal root between 2018 and 2020 were evaluated retrospectively. the patients were divided into 2 groups according to the correction of MME (maintained MME group: 32 cases vs. increased MME group: 21 cases). The clinical and radiological outcomes of arthroscopically assisted tendon graft reconstruction of the meniscal root, including postoperative correction of MME and functional recovery of the knee were assessed in this study, and potential independent risk factors that could inluence the correction of MME were also evaluated. ResultsThe functional recovery of the knee was signiicantly improved at the end of follow-up (P < 0.001; respectively), furthermore, a comparison of the inal functional outcomes between the groups showed that the mean Lysholm score and IKDC score of the maintained MME group were signiicantly improved than those of increased MME group. 60.4% had good correction of MME, and patients with complete healing had better extrusion correction than those with partial healing and non-healing. Binary logistic regression models analysis indicated that the age (OR = 1.053, P = 0.048), BMI (OR = 1.376, P = 0.004), meniscus root healing status (OR = 7.701, P = 0.005), HKA degree (OR = 1.891, P = 0.011) and preoperative symptom duration (OR = 1.055, P = 0.013) were the independent risk factors correlated with correction of MME. Additionally, the ROC curve demonstrated the cut-of values of the Age, BMI, HKA degree and preoperative symptom duration were 46.0 years, 22.5 kg/m2, 3.2° and 9.5 months, respectively, Conclusions The arthroscopically assisted tendon graft anatomic reinforced reconstruction of the meniscal root showed clinical improvement and prevented the progression of postoperative MME. Additionally, younger patients, lower BMI, complete meniscus root healing, lower HKA degree and shorter preoperative symptom duration were the independent risk factors correlated with the good correction of MME in patients with repaired MMPRTs. Level of Evidence Level IV.

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Section: Discussionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Younger patients, lower BMI, complete meniscus root healing, lower HKA degree and shorter preoperative symptom duration were the independent risk factors correlated with the good correction of MME in patients with repaired MMPRTs

Nie

Liao

et al. 2023

Knee Surg Sports Traumatol Arthrosc

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“…); these were satisfactory results. Sundararajan et al demonstrated the clinical outcomes of isolated type 2 MMPRTs following transtibial pullout repair [27]. They reported an improvement in the mean IKDC score to 78.7 and Lysholm score to 83.2 at 34.6 months post‐operatively.…”

Section: Discussionmentioning

confidence: 99%

“…Sixth, in this study, different types of suture configurations during transtibial pullout repairs were used at the time of surgery, which could have introduced possible bias, although there were no significant differences in post‐operative outcomes between repair types. Finally, we did not consider the influence of the tibial tunnel aperture, which may have affected the clinical results [10, 14, 27].…”

Section: Discussionmentioning

confidence: 99%

The clinical and radiographic outcomes of type 2 medial meniscus posterior root tears following transtibial pullout repair

Hiranaka

Kamatsuki

Yokoyama

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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Purpose The aim of this study was to compare the clinical outcomes of diferent subtypes of type 2 medial meniscus posterior root tears following transtibial pullout repair. Methods In total, 147 patients (mean age: 66.2 ± 8.3 years) who were diagnosed with type 2 medial meniscus posterior root tears and underwent transtibial pullout repair were included. Patients were divided into 2A (n = 31), 2B (n = 90), and 2C (n = 26) groups according to tear type. Clinical outcomes were assessed pre-operatively and at second-look arthroscopy using the Knee injury and Osteoarthritis Outcome Score. The meniscal healing status was evaluated at second-look arthroscopy. Medial meniscus extrusion was calculated using magnetic resonance imaging pre-operatively and at second-look arthroscopy. ResultsNo signiicant diferences in pre-operative or post-operative clinical scores were observed between each subtype, although clinical scores improved post-operatively for each subtype. Signiicant diferences were noted in the anteroposterior width of the bridging tissues at second-look arthroscopy (2A, 7.1 ± 1.2; 2B, 6.2 ± 1.7; and 2C, 6.2 ± 1.7 mm; p = 0.045); type 2A tears were the widest. There was a signiicant diference in post-operative medial meniscus extrusion (2A, 3.2 ± 0.9; 2B, 4.0 ± 1.2; and 2C, 4.0 ± 1.4 mm; p = 0.004) and its progression (2A, 0.7 ± 0.6; 2B, 1.2 ± 0.8; and 2C, 1.2 ± 0.8 mm; p = 0.008), and type 2A tears were the shortest. Conclusion Although there was no signiicant diference in the post-operative clinical scores among diferent type 2 tears in the short term, type 2A tears showed better healing and medial meniscus extrusion progression prevention, thus indicating the usefulness of classifying tear type in estimating post-operative outcomes. Level of Evidence III.

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Accurate tibial tunnel position in transtibial pullout repair for medial meniscus posterior root tears delays the progression of medial joint space narrowing

Kawada,

Okazaki,

Tamura

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThis study aimed to evaluate the association between the progression of medial joint space (MJS) narrowing, medial meniscus extrusion (MME) and clinical scores and the tibial tunnel position in pullout repairs for medial meniscus posterior root tears (MMPRTs).MethodsThis retrospective study examined 54 patients. Changes in MJS (ΔMJS), MME (ΔMME) and clinical scores and their relationship with the tibial tunnel position were evaluated using correlation coefficients. The distance from the anatomical to technical attachment position in the tibial tunnel position was measured in the anterior and medial directions, and the direct distance was measured using the Pythagorean theorem.ResultsThe mean ΔMJS and ΔMME were 0.6 ± 0.8 and 1.3 ± 1.3 mm, respectively, and the mean anterior, medial and direct distances were 1.4 ± 2.3, 2.2 ± 1.7 and 3.4 ± 1.7 mm, respectively. ΔMJS had a significant positive correlation with the medial (r = 0.580, p < 0.001) and direct (r = 0.559, p < 0.001) distances, while ΔMME had a significant positive correlation with direct distance (r = 0.295, p = 0.030). Several clinical scores were significantly negatively correlated with these distances.ConclusionIn transtibial pullout repair for MMPRTs, accurate tibial tunnel position delayed the progression of MJS narrowing and MME, leading to improved clinical outcomes. The progression of MJS narrowing was associated with the mediolateral direction of the tibial tunnel position, while the clinical scores were associated with the anteroposterior direction of the tibial tunnel position. These findings indicate the need to orient the tip of the guide in a more posterolateral direction when creating the tibial tunnel.Level of EvidenceLevel IV.

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Correlation of factors affecting correction of meniscal extrusion and outcome after medial meniscus root repair

Cited by 27 publications

References 46 publications

Younger patients, lower BMI, complete meniscus root healing, lower HKA degree and shorter preoperative symptom duration were the independent risk factors correlated with the good correction of MME in patients with repaired MMPRTs

Younger patients, lower BMI, complete meniscus root healing, lower HKA degree and shorter preoperative symptom duration were the independent risk factors correlated with the good correction of MME in patients with repaired MMPRTs

The clinical and radiographic outcomes of type 2 medial meniscus posterior root tears following transtibial pullout repair

Accurate tibial tunnel position in transtibial pullout repair for medial meniscus posterior root tears delays the progression of medial joint space narrowing

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