Prognostic Factors and Midterm Clinical Outcome of Transtibial Pullout and Partial Meniscectomy for Medial Meniscus Posterior Root Tears in Middle-Aged Patients

Dzidzishvili, Lika; López-Torres, Irene Isabel; Argüello, Jose Manuel; Sáez, David; Calvo, Emílio

doi:10.1007/s43465-022-00650-3

Cited by 8 publications

(21 citation statements)

References 13 publications

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“…Six studies reported data on the rate of progression to total knee arthroplasty [ 12 , 17 , 24 , 46 , 84 , 92 ] at a mean of 48.0 ± 14.7 months follow-up. The repair group evidenced a lower rate of progression to TKA (OR0.51; 95% CI 0.39–0.69; P = 0.0001).…”

Section: Resultsmentioning

confidence: 99%

“…However, the location of meniscal injury varies among the studies included in the present investigation. Eight studies exclusively investigated injuries of the medial meniscus [ 12 , 17 , 24 , 45 , 46 , 81 , 87 , 88 ], and two, those of the lateral meniscus [ 23 , 82 ]. Six of the studies that focus on medial injuries specify the location, including only injuries at the posterior root of the medial meniscus [ 12 , 17 , 24 , 45 , 46 , 88 ].…”

Section: Discussionmentioning

confidence: 99%

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Meniscectomy is associated with a higher rate of osteoarthritis compared to meniscal repair following acute tears: a meta‐analysis

Migliorini,

Schäfer,

Bell

et al. 2023

Knee surg. sports traumatol. arthrosc.

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Purpose Meniscal tears are common and may impair knee function and biomechanics. This meta-analysis compared meniscal repair versus resection in patients with symptomatic meniscal tears in terms of patient-reported outcomes measures (PROMs), joint width, surgical failure, and rate of progression to osteoarthritis (OA) at conventional radiography. Methods This study was conducted according to the 2020 PRISMA statement. In August 2023, the following databases were accessed: PubMed, Web of Science, Google Scholar, and Embase. Two reviewers independently performed the analysis and a methodological quality assessment of the included studies. All the clinical investigations which compared repair versus resection of meniscal tears were accessed. Results Data from 20 studies (31,783 patients) were collected. The mean BMI was 28.28 ± 3.2 kg/m2, and the mean age was 37.6 ± 14.0 years. The mean time elapsed from injury to surgery was 12.1 ± 10.2 months and the mean medial joint width was 4.9 ± 0.8 mm. Between studies comparability at baseline was found in age, women, BMI, time from injury to surgery and length of the follow-up, PROMs, medial joint width, and stage of OA. The resection group demonstrated a greater Lysholm score (P = 0.02). No difference was found in the International Knee Documentation Committee (P = 0.2). Nine studies reported data on the rate of failures at a mean of 63.00 ± 24.7 months. No difference was found between the two groups in terms of persistent meniscal symptoms (P = 0.8). Six studies reported data on the rate of progression to total knee arthroplasty at a mean of 48.0 ± 14.7 months follow-up. The repair group evidenced a lower rate of progression to knee arthroplasty (P = 0.0001). Six studies reported data on the rate of advanced knee OA at a mean of 48.0 ± 14.7 months of follow-up. The repair group evidenced a lower rate of advanced knee OA (P = 0.0001). No difference was found in the mean joint space width (P = 0.09). Conclusion Meniscal repair is associated with a lower progression to knee osteoarthritis at approximately six years of follow-up compared to partial meniscectomy. No difference in PROMs, medial joint width, and failures were evidenced. Level of evidence Level III, meta-analysis.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Meniscectomy is associated with a higher rate of osteoarthritis compared to meniscal repair following acute tears: a meta‐analysis

Migliorini,

Schäfer,

Bell

et al. 2023

Knee surg. sports traumatol. arthrosc.

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“…Moreover, significantly better outcomes in terms of radiologic measures were reported in patients with meniscus root repair compared with those with partial meniscectomy. 11,17 Although clinical outcomes improved, patients with meniscal repair showed Kellgren-Lawrence grade progression and medial joint space narrowing. 11 Chung et al 10 conducted a meta-analysis including studies that evaluated radiographic progression after meniscus root repair.…”

Section: Discussionmentioning

confidence: 99%

Medial Meniscus Posterior Root Repair Reduces but Does Not Avoid Histologic Progression of Osteoarthritis: Randomized In Vivo Experimental Study in a Rabbit Model

Dzidzishvili,

Calvo,

López-Torres

2023

Am J Sports Med

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Background: The optimal treatment option for meniscus root tears is still challenging, and whether the meniscus root repair ultimately can arrest or delay osteoarthritic changes is still a concern. Purpose/Hypothesis: The purpose of this study was 2-fold: (1) to describe and compare histopathologic findings of 3 different therapeutic options for medial meniscus posterior root tear: nonoperative management, partial meniscectomy, and meniscus root repair; and (2) to test the hypothesis that meniscus root tears treated nonoperatively predispose to a lower risk of osteoarthritic progression compared with partial meniscectomy. Study Design: Controlled laboratory study. Methods: Posteromedial meniscus root tears were carried out in 39 New Zealand White rabbits. Animals were randomly assigned into 3 experimental groups: partial meniscectomy after root tear (PM; n = 13), root tears treated conservatively (CT; n = 13), and transtibial root repair (RR; n = 13). Contralateral limbs were used as healthy controls. The animals were euthanized at 16 weeks postoperatively; tissue samples of femoral and tibial articular cartilage were collected and processed for macro- and microscopic assessment to detect signs of early osteoarthritis (OA). Each sample was histopathologically assessed using the Osteoarthritis Research Society International grading and staging system. Results: Osteoarthritic changes were the hallmark in all 3 experimental groups. The RR group had the lowest scores for cartilage damage (mean, 2.5; range, 2-3), and the PM group exhibited higher and more severe signs of OA (mean, 16; range, 9-16) compared with the CT group (mean, 5; range, 4-6). The between-group comparison revealed significant differences, as the PM group showed a significantly higher rate of macro- and microscopic osteoarthritic changes compared with the RR ( P < .001) and CT ( P < .001) groups. The weightbearing area of the medial femoral condyle was the most severely affected, and tidemark disruption was evident in all tissue samples. Conclusion: Meniscus root repair cannot completely arrest the histopathologic progression of knee OA but leads to significantly less severe degenerative changes than partial meniscectomy and nonoperative treatment. Partial meniscectomy leads to the most severe osteoarthritic progression, while stable radial tears left in situ have lower progression compared with partial meniscectomy. Clinical Relevance: Histologic assessment is an essential tool and metric for guiding and understanding osteoarthritic features, providing insight into the disease development and progression. This study provides histopathologic evidence on osteoarthritic progression after medial meniscus posterior root repair. This knowledge can help to set more realistic expectations and can lead to the future development of augmented techniques.

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“…Compared with partial meniscectomy, there is more evidence indicating that various repair surgical strategies, not only restore hoop tension of the medial meniscus but also prevent the progression of knee degenerative [11, 16, 33]. Arthroscopic transtibial pullout is the most widely used surgical method and has been reported associated with satisfactory outcomes [18, 31], however, results of MRI or second‐look arthroscopy studies evaluating the repaired meniscus have shown higher rates of incomplete healing or increased medial meniscal extrusion (MME) [27]. Holmes et al[10] present an arthroscopic reconstructive technique using gracilis autograft with suture reinforcement for MMPRTs is expected to yield improved healing rates compared with direct repair techniques.…”

Section: Introductionmentioning

confidence: 99%

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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Prognostic Factors and Midterm Clinical Outcome of Transtibial Pullout and Partial Meniscectomy for Medial Meniscus Posterior Root Tears in Middle-Aged Patients

Cited by 8 publications

References 13 publications

Meniscectomy is associated with a higher rate of osteoarthritis compared to meniscal repair following acute tears: a meta‐analysis

Meniscectomy is associated with a higher rate of osteoarthritis compared to meniscal repair following acute tears: a meta‐analysis

Medial Meniscus Posterior Root Repair Reduces but Does Not Avoid Histologic Progression of Osteoarthritis: Randomized In Vivo Experimental Study in a Rabbit Model

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

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