Radial tears in the root of the posterior horn of the medial meniscus

Abstract

The purpose of this study is to define the clinical features and characteristics of radial tears in the root of the posterior horn of the medial meniscus and to report the outcome of arthroscopic treatment. Arthroscopic meniscus surgery was performed on 7,148 knees. Of those, 722 (10.1%) were radial tear in the root of the posterior horn of the medial meniscus. We reviewed the medical records from a random sample of 67 subjects studied (mean age 55.8 years, range 38-72, mean follow-up period 56.7 months, range, 8-123), which included surgical notes and detailed arthroscopic photographs of 70 knees. All patients were treated with arthroscopic partial meniscectomy. The age distribution, preoperative physical signs, results of magnetic resonance imaging , body mass index, and surgical findings of the study subjects were analyzed and the clinical results were graded with the Lysholm knee scoring scale and a questionnaire. Radiologic evaluation consisted of preoperative and at the latest follow-up radiographs. Eighty percent of the patients were older than 50 years, and 80.6% were either obese or morbidly obese. The mean Lysholm score improved from a preoperative value of 53 to a value of 67. The average preoperative Kellgren-Lawrence radiograph grade was 2 (range 0-3 points), a value that increased to 3 (range 2-4) at the latest follow-up, which showed a significant worsening. The preoperative MRI was reevaluated after the arthroscopic confirmation of a medial meniscal root tear. A tear could be demonstrated in only 72.9% of the patients, the rest of whom demonstrated degeneration and/or fluid accumulation at the posterior horn without a visible meniscal tear. Radial tears in the root of the medial meniscal posterior horn, which may not be visible in about one-third of the preoperative MRI scans, are common. That type of meniscal tear is strongly associated with obesity and older age and is morphologically different from the degenerative tears that often occur in the posterior horn. Partial meniscectomy provides symptomatic relief in most cases but does not arrest the progression of radiographically revealed osteoarthritis.

Effect of partial meniscectomy at the medial posterior horn on tibiofemoral contact mechanics and meniscal hoop strains in human knees

“…Radial tears of the posterior horn are frequent injuries of the medial meniscus. 1,2 Radial tears in the avascular zone requires partial meniscectomy. 3 Total meniscectomy increases the risk of premature osteoarthritis, so partial meniscectomy has proven the better choice after meniscal lesions.…”

MRI of the Knee: What Do We Miss?

“…8) [22,23]. These tend to be degenerative in origin in the medial meniscus and trauma-related in the lateral meniscus [22].…”

“…Tears can appear as truncation of the meniscus, a cleft or ''ghost'' meniscus and are associated with meniscal extrusion and accelerated osteoarthritis (Fig. 9) [18,23,24]. Thin axial slices on 3 T have been shown to be helpful in diagnosis since the conspicuity of the tear is better with decreased slice thickness (Fig.…”

Medial Meniscus Radial Tear: A Transtibial 2-Tunnel Technique

“…1 Because of their resultant inability to withstand meniscal hoop stresses, complete radial tears have been described as functionally similar to a total meniscectomy, predisposing patients to early osteoarthritis and rapid joint degeneration when left untreated. [2][3][4][5][6] Historically, the gold-standard treatment for patients with radial tears of the medial meniscus was a partial or total meniscectomy to alleviate symptoms of pain but this often led to accelerated articular cartilage degenerative consequences. 1 Given the suboptimal outcomes and high reoperation rates, especially in high-demand individuals, there has been increased interest in repairing radial meniscus tears over the past several years.…”