Trans-Posterior Cruciate Ligament All-Inside Root Repair Versus Partial Meniscectomy for Medial Meniscus Posterior Root Tears: Comparison of Semiquantitative and Quantitative MRI Outcomes in Cartilage Degeneration and Osteoarthritic Progression

Abstract

Objective To perform conventional, morphological, and T2 mapping compositional MRI imaging to assess the cartilage degeneration and osteoarthritic progression in patients with medial meniscus posterior root tears (MMPRTs) who underwent trans-posterior cruciate ligament (PCL) all-inside repair or partial meniscectomy. Design Patients with MMPRTs after trans-PCL all-inside repair (group AR) or partial meniscectomy (group PM) between 2015 and 2018 were retrospectively identified. Preoperative and postoperative conventional MRI were collected to assess medial meniscus extrusion (MME) and the whole-organ magnetic resonance imaging score (WORMS). Postoperative morphological MRI and T2 mapping compositional MRI were collected to evaluate the quantitative cartilage thickness/volume and cartilage composition. Results The final cohort consisted of 21 patients in group AR and 22 patients in group PM, with no differences in demographic data and baseline patient characteristics between the 2 groups. Group AR demonstrated less progression of articular cartilage wear ( P < 0.05) and decreased meniscal extrusion ( P = 0.008) than group PM at the final follow-up. In addition, group AR demonstrated less extracellular matrix degeneration in the cartilage subregion of the medial compartment ( P < 0.05) than group PM with lower T2 relaxation times in the superficial layer of the articular cartilage. Conclusion Trans-PCL all-inside repair of MMPRTs could delay the initial cartilage deterioration and morphological cartilage degeneration compared with partial meniscectomy. However, the amount of residual meniscal extrusion is clinically important, and an improved root repair fixation method should be investigated.

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

“…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 ].…”

“…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 ]. Another eight studies included tears of both medial and lateral meniscus [ 36 , 49 , 50 , 75 , 76 , 83 , 85 , 92 ].…”

“…Stein et al [ 87 ], Shelbourne et al [ 81 ], and Hoshino et al [ 36 ] reported tears in the red–red and red–white zones, whereas ruptures in the white–white zones underwent partial meniscectomy. The remaining studies do not describe in detail the tear location in relation to the vascular zones [ 12 , 17 , 23 , 25 , 45 , 46 , 82 – 85 , 88 , 92 ]. Although removal or partial resection of the meniscus is preferred for tears located in the less vascularised zones, there are increasing reports of successful repairs in the critical zones as well [ 18 , 77 ].…”

“…Stein et al [ 87 ] and Shelbourne et al [ 81 , 82 ] used the standard inside-out method. In four studies [ 49 , 50 , 83 , 88 ], the outside-in or all-inside technique was used, depending on the location of the tear. Three studies considered all common repair techniques [ 23 , 75 , 92 ].…”

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

“…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].…”