Medial Meniscus Posterior Root Tear Treatment: A Matched Cohort Comparison of Nonoperative Management, Partial Meniscectomy, and Repair

Bernard, Christopher D.; Kennedy, Nicholas I.; Tagliero, Adam J.; Camp, Christopher L.; Saris, Daniël B.F.; Levy, Bruce A.; Stuart, Michael J.; Krych, Aaron J.

doi:10.1177/0363546519888212

Cited by 114 publications

(172 citation statements)

References 30 publications

(49 reference statements)

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“…2 The root repair group had significantly less arthritic progression, as measured by changes in K-L grade from the preoperative to the postoperative state. 2 Until now, there has been no convincing long-term evidence that such root repair protects the knee against osteoarthritis, maintains favorable clinical outcomes, and increases survivorship in comparison with meniscectomy.…”

Section: Discussionmentioning

confidence: 86%

Root Repair Versus Partial Meniscectomy for Medial Meniscus Posterior Root Tears: Comparison of Long-term Survivorship and Clinical Outcomes at Minimum 10-Year Follow-up

Chung

Jong

et al. 2020

Am J Sports Med

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Background: The importance of repair in medial meniscus posterior root tears (MMPRTs) has been increasingly recognized because it restores hoop tension. However, no study has compared the long-term outcomes between meniscectomy and repair. Hypothesis: Survivorship and clinical outcomes of repair would be better than those of meniscectomy after long-term follow-up. Study Design: Cohort study; Level of evidence, 3. Methods: Between 2005 and 2009, patients with MMPRTs who had been followed up for at least 10 years after partial meniscectomy (n = 18) or pullout repair (n = 37) were recruited. Clinical assessments, including the Lysholm score and International Knee Documentation Committee (IKDC) subjective score, were evaluated preoperatively and at the final follow-up. The final results in each group were compared with the preoperative results, and the final results of the groups were compared. Clinical failure was defined as conversion to total knee arthroplasty (TKA), and the final clinical scores were assessed just before TKA. Kaplan-Meier survival analysis was used to investigate the survival rates of surgical procedures. Results: Mean ± SD follow-up period was 101.4 ± 45.9 and 125.9 ± 21.2 months in the meniscectomy and repair groups, respectively ( P = .140). The mean Lysholm and IKDC scores, respectively, in the meniscectomy group were 50.8 ± 7.7 and 37.6 ± 7.0 preoperatively and 58.2 ± 22.1 and 44.4 ± 19.0 postoperatively ( P = .124; P = .240). In the repair group, the mean Lysholm score and IKDC score, respectively, significantly increased from 52.3 ± 10.9 and 41.0 ± 9.6 preoperatively to 77.1 ± 24.0 and 63.7 ± 20.6 postoperatively ( P < .001; P < .001). The final Lysholm and IKDC scores in the repair group were significantly better than those in the meniscectomy group ( P = .004; P = .003). In cases of clinical failure, 10 patients (56%) in the meniscectomy group and 8 patients (22%) in the repair group converted to TKA in the follow-up period ( P = .016). According to Kaplan-Meier analysis, the 10-year survival rates for the meniscectomy and repair groups were 44.4% and 79.6%, respectively ( P = .004). Conclusion: In MMPRTs, root repair was superior to partial meniscectomy in terms of clinical results for at least 10 years of follow-up. From a long-term perspective, repair with restoration of hoop tension is more effective management than meniscectomy.

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Section: Discussionmentioning

confidence: 86%

Root Repair Versus Partial Meniscectomy for Medial Meniscus Posterior Root Tears: Comparison of Long-term Survivorship and Clinical Outcomes at Minimum 10-Year Follow-up

Chung

Jong

et al. 2020

Am J Sports Med

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“…The normal meniscus morphology plays an important role in protection of the knee joint; it can relieve knee pressure, absorb shocks, and cushion during weight-bearing activities [ 5 ]. Morphological changes of the meniscus significantly contribute to the pathogenesis of knee OA [ 6 , 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…On the contrary, the width of the medial meniscus changes remarkably from AH to PH, and our results are consistent with Karola’s review [ 15 ]. Meanwhile, we found the PH of the medial meniscus was significantly wider than AH and BD, which contributed to a larger area of contact during axial loading and flexion, and this could potentially explain the high incidence of medial meniscus posterior root tears and posterior horn tears [ 5 , 16 – 18 ]. Additionally, the meniscal width plays a similar role as CA in reflecting the meniscal coverage on articular cartilage of the knee joint.…”

Section: Discussionmentioning

confidence: 99%

Morphological Analysis of Normal Meniscus on Magnetic Resonance Imaging (MRI)-Based Three-Dimensional Reconstruction Models in Healthy Chinese Adults

Shen

Zuo

et al. 2020

Med Sci Monit

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Background The purpose of this cross-sectional observational study was to determine the morphological meniscus characteristics in a normal Chinese population and assess possible relationships between demographic data and meniscal morphological parameters. Material/Methods We examined 116 menisci (58 lateral and 58 medial) from 29 healthy Chinese volunteers (10 men, 19 women, mean age 26 years [range, 20–33 years]) with MRI and three-dimensional reconstruction using Mimics software. The width, thickness, anteroposterior distance (APD), lateral-medial distance (LMD), and covering angle (CA) were measured on reconstructed models. Univariate analysis was used to evaluate the differences of morphological parameters between the medial and lateral menisci, between sides, and between males and females. Pearson correlation analysis was used to evaluate the correlation between meniscal morphological parameters and body height, weight, and body mass index (BMI). Results Univariate analysis demonstrated that the width, thickness, APD, LMD, and CA were significantly different between lateral and medial menisci. The LMD and APD of menisci in men were significantly larger than in women. There was no significant difference in meniscal thickness and CA between males and females. The lateral meniscus dimensions were slightly larger in the right knee. According to Pearson correlation analysis, the APDs of both lateral and medial menisci were strongly correlated with height and weight (lateral: r=0.596, r=0.500; medial: r=0.684, r=0.680). Conclusions The morphologies of medial and lateral menisci were different and were not significantly correlation with each other. The meniscal width and diameter were correlated with demographic data, but the thickness and CA did not significantly differ by sex, height, or BMI.

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“…Meniscus tear, a common condition in young and middle-aged adults, has a mean annual incidence of 9.0 per 10,000 in men, and 4.2 per 10,000 in women [ 1 ]. The avulsion of the posterior medial meniscus root (PMMR) occurs more often than that in the AMMR, and therefore most of the available studies have focused on PMMR avulsion [ 2 – 5 ]. So far, only a few cases of AMMR avulsion have been reported that were caused by iatrogenic factors [ 6 ], or anatomical variation and combined with anterior cruciate ligament (ACL) injury [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Traumatic avulsion of the anterior medial meniscus root combined with PCL injury: a case report

Wang

2020

BMC Musculoskelet Disord

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Background Avulsion of the anterior medial meniscus root (AMMR) has a low incidence rate, especially when it is combined with posterior cruciate ligament (PCL) injury, which hasn’t been reported in any literature to date. The aim of this study was to share our experience in the diagnosis and treatment of a patient with traumatic avulsion of AMMR combined with PCL injury. Case presentation This article reports a 26-year-old male patient diagnosed with traumatic avulsion of the AMMR with PCL injury. After arthroscopic surgery, he achieved remission of symptoms and recovery of functions. Conclusions Anterior meniscus root injuries are relatively rare. Its diagnosis can be made preliminarily based on clinical manifestations, physical examinations, and magnetic resonance imaging (MRI), and then confirmed by arthroscopic exploration. Arthroscopic suture anchor fixation of the injured anterior meniscus horn shows a good therapeutic effect.

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Medial Meniscus Posterior Root Tear Treatment: A Matched Cohort Comparison of Nonoperative Management, Partial Meniscectomy, and Repair

Cited by 114 publications

References 30 publications

Root Repair Versus Partial Meniscectomy for Medial Meniscus Posterior Root Tears: Comparison of Long-term Survivorship and Clinical Outcomes at Minimum 10-Year Follow-up

Root Repair Versus Partial Meniscectomy for Medial Meniscus Posterior Root Tears: Comparison of Long-term Survivorship and Clinical Outcomes at Minimum 10-Year Follow-up

Morphological Analysis of Normal Meniscus on Magnetic Resonance Imaging (MRI)-Based Three-Dimensional Reconstruction Models in Healthy Chinese Adults

Traumatic avulsion of the anterior medial meniscus root combined with PCL injury: a case report

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