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Nishino K, Hashimoto Y, Kinoshita T, Iida K, Tsumoto S, Nakamura H. Anterior bone tunnel position increases meniscus migration in medial meniscus posterior root repair: A cadaveric study of suture length changes. J Exp Orthop 2024; 11:e70028. [PMID: 39355537 PMCID: PMC11440485 DOI: 10.1002/jeo2.70028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 07/17/2024] [Accepted: 07/24/2024] [Indexed: 10/03/2024] Open
Abstract
Purpose This study investigated differences in the migration of meniscus sutured with pull-out sutures for treating medial meniscus posterior root tears (MMPRTs) according to the bone tunnel position, using cadaveric knees. Methods Six knees of three donors fixed using Thiel's method were included in this study. The MMPRTs were created, and a single suture was performed at the torn meniscus using an arthroscopic procedure. The suture was pulled out through the tibial bone tunnel, and the meniscus displacement was measured as the change in length during 0-120° of knee flexion. Three types of bone tunnels (anatomical, anterior and posterior) were created for each knee, and the sutures were pulled out of each tunnel three times. After completing all measurements, the proximal tibia was extracted and micro-computed tomography was performed to evaluate the tunnel position. Results A significantly smaller change in suture length was observed in the posterior group compared to the other two groups (anatomical group, 5.17 ± 1.8 mm; anterior group, 7.50 ± 3.2 mm; posterior group, 1.17 ± 1.0 mm; p > 0.01). In addition, a significant correlation between the anteroposterior tunnel position and suture length change was observed (r = -0.720; p = 0.001). Conclusions When pull-out sutures were used to repair MMPRTs, the suture length change was approximately 5 mm during knee flexion and extension when the bone tunnel was located at the anatomical attachment site. This change was larger when the tunnel position was anterior, and smaller when the tunnel position was posterior. Level of Evidence LEVEL Ⅲ case-control study.
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Affiliation(s)
- Kazuya Nishino
- Department of Orthopaedic SurgeryOsaka Metropolitan University Graduate School of MedicineOsakaJapan
| | - Yusuke Hashimoto
- Osaka University of Health and Sport SciencesGraduate School of Sport SciencesOsakaJapan
| | - Takuya Kinoshita
- Department of Orthopaedic SurgerySaiseikai Nakatsu hospitalOsakaJapan
| | - Ken Iida
- Department of Orthopaedic SurgeryOsaka Metropolitan University Graduate School of MedicineOsakaJapan
| | - Shuko Tsumoto
- Department of Orthopaedic SurgeryOsaka Metropolitan University Graduate School of MedicineOsakaJapan
| | - Hiroaki Nakamura
- Department of Orthopaedic SurgeryOsaka Metropolitan University Graduate School of MedicineOsakaJapan
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Takigami J, Hashimoto Y, Tomihara T, Taniuchi M, Takahashi D, Katsuda H. Combined Procedure of Arthroscopic Pullout Medial Meniscal Root Repair From Lateral Tibia and Open-Wedge Distal Tibial Tubercle Osteotomy. Arthrosc Tech 2024; 13:103031. [PMID: 39308562 PMCID: PMC11411304 DOI: 10.1016/j.eats.2024.103031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 04/01/2024] [Indexed: 09/25/2024] Open
Abstract
Pullout repair of medial meniscal posterior root tears (MMPRTs) is generally recommended for patients with well-aligned knees, whereas open-wedge high tibial osteotomy (OWHTO) is often recommended for patients with MMPRTs and varus osteoarthritis. Although the management of MMPRTs with OWHTO has been controversial, retaining meniscal function can be expected through pullout repair. Conventionally, bone tunnels in pullout repair are created from the proximal anteromedial tibia. However, this technique could cause a killer angle of the repaired meniscus and could have a risk of turning the guidewire toward the neurovascular band. Therefore, we create a bone tunnel from the proximal anterolateral tibia combined with open-wedge distal tibial tubercle osteotomy, which can prevent an increase in postoperative patellofemoral contact stress; moreover, the bone tunnel can be created easily from the lateral tibia compared with OWHTO. This Technical Note describes the combined surgical procedure for patients with MMPRTs and varus osteoarthritis, which has advantages including physiological pullout direction of the repaired meniscus, lower risk of neurovascular damage, and placement of a longer plate screw that could interfere with the bone tunnel. We highlight the meticulous consideration given to the interference of the bone tunnel between the osteotomy line and plate screw.
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Affiliation(s)
- Junsei Takigami
- Department of Orthopaedic Surgery, Shimada Hospital, Kashiyama, Japan
| | - Yusuke Hashimoto
- Department of Health and Sport Management, Graduate School of Sport and Exercise Science, Osaka University of Health and Sports Science, Sennan, Japan
| | - Tomohiro Tomihara
- Department of Orthopaedic Surgery, Shimada Hospital, Kashiyama, Japan
| | | | - Daichi Takahashi
- Department of Orthopaedic Surgery, Shimada Hospital, Kashiyama, Japan
| | - Hiroshi Katsuda
- Department of Orthopaedic Surgery, Shimada Hospital, Kashiyama, Japan
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Yoon KH, Bae BS, Ahn JH, Hwang SH. More than 3 mm of preoperative medial meniscal extrusion is identified as a key risk factor for varus progression in limb alignment after arthroscopic repair of medial meniscus posterior root tear. Knee Surg Sports Traumatol Arthrosc 2024; 32:2239-2247. [PMID: 38751080 DOI: 10.1002/ksa.12232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 04/06/2024] [Accepted: 04/24/2024] [Indexed: 09/03/2024]
Abstract
PURPOSE To investigate the risk factors for varus progression after arthroscopic medial meniscal posterior root tear (MMPRT) repair and to compare the clinical outcomes between two groups: one with more varus progression and the other with less varus progression. METHODS Patients who underwent isolated arthroscopic repair of MMPRT between 2015 and 2020 were enroled, and 2-year follow-up data were collected. Participants were categorized into two groups based on preoperative values of the weight-bearing line (WBL) ratio: group A with <5.9% increase and group B with ≥5.9% increase. Various factors, including demographic features and radiological findings, were analysed and compared between the two groups. Intra-meniscal signal intensity, meniscal healing, medial meniscal extrusion (MME), and articular cartilage grade were assessed preoperatively and 1-year postoperatively using coronal magnetic resonance imaging. RESULTS The final cohort consisted of 34 patients in group A and 46 in group B, with a mean age of 55.8 ± 11.2 and 59.8 ± 6.6 years, respectively. Preoperative WBL ratio and cartilage lesions in the medial compartment did not differ between the groups. Preoperative MME were significantly lower in group A than those in group B (2.6 ± 0.6 mm in group A and 3.5 ± 0.7 mm in group B, p < 0.05). Patient-reported outcomes at the 2-year follow-up did not differ between the two groups (n. s.). In a logistic analysis, the odds ratio of MME was 2.1 (p < 0.05), and the cutoff value of MME was 3.02 mm. CONCLUSION Preoperative MME is a risk factor for varus progression. However, no differences in patient-reported outcomes were observed at 2-year follow-up, even in the group with greater varus progression. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Kyoung Ho Yoon
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Bo Seung Bae
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Jun Hyeong Ahn
- Department of Orthopedic Surgery, Pohang St. Mary's Hospital, Pohang-si, Gyeongsangbuk-do, Republic of Korea
| | - Sung Hyun Hwang
- Department of Orthopedic Surgery, Pohang St. Mary's Hospital, Pohang-si, Gyeongsangbuk-do, Republic of Korea
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Horita K, Okada Y, Shiwaku K, Yamakawa S, Mori Y, Kamiya T, Emori M, Watanabe K, Fujie H, Teramoto A. High Tibial Osteotomy Alone Does Not Decrease Medial Meniscus Extrusion in the Setting of Medial Meniscus Posterior Root Tear: A Cadaveric Study. Arthroscopy 2024:S0749-8063(24)00486-9. [PMID: 38986854 DOI: 10.1016/j.arthro.2024.06.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 06/06/2024] [Accepted: 06/18/2024] [Indexed: 07/12/2024]
Abstract
PURPOSE To investigate whether inducing valgus alignment and shifting the load laterally through high tibial osteotomy (HTO) alone decreases the extent of medial meniscus extrusion (MME) in the setting of medial meniscus posterior root tear (MMPRT) using ultrasound evaluation. METHODS Eight fresh-frozen human cadaveric knee specimens were tested using a 6-degree-of-freedom robotic testing system and ultrasound. Each specimen was tested in 5 conditions: (1) intact, (2) MMPRT, (3) medial meniscus repair (MMR), (4) combined medial open-wedge HTO + MMR, and (5) HTO + MMPRT. Measurements were obtained over the medial collateral ligament (central image) and posterior to the medial collateral ligament (posterior image) with a 250-N axial load at 0°, 30°, and 90° of knee flexion. Statistical analysis was performed using a 2-factor repeated-measures analysis of variance. RESULTS MME was significantly greater in HTO + MMPRT (0°: 2.44 ± 0.41 mm, 30°: 2.47 ± 0.37 mm, 90°: 2.41 ± 0.28 mm) than HTO + MMR in central images (mean difference +0.83 mm, P < .001). No significant difference was found between HTO + MMPRT and MMPRT in MME. MMR had significantly less MME than MMPRT (mean difference -0.58 mm, P < .001, posterior image at 0° and central image at 90°, P = .002). HTO + MMR showed significantly less MME than MMR alone at 30° and 90° of knee flexion in the central image (30°: -0.38 ± 0.05 mm, 90°: -0.45 ± 0.06 mm, P < .001) and 90° of knee flexion in the posterior image (-0.38 ± 0.08 mm, P = .004). CONCLUSIONS HTO alone did not decrease MME in the setting of MMPRT, while MMR alone decreased MME after MMPRT. Additionally, HTO + MMR decreased MME after MMPRT compared to MMR alone, although the clinical significance was uncertain. CLINICAL RELEVANCE The findings of this study provide clinicians with valuable insights for improving MME. HTO alone does not decrease MME in cases of MMPRT.
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Affiliation(s)
- Kazushi Horita
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Yohei Okada
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan.
| | - Kousuke Shiwaku
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Satoshi Yamakawa
- Department of Sports Medical Biomechanics, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Yuta Mori
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Tomoaki Kamiya
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Makoto Emori
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Kota Watanabe
- Department of Public Health, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Hiromichi Fujie
- Department of Mechanical Engineering, Graduate School of Science, Tokyo Metropolitan University, Tokyo, Japan
| | - Atsushi Teramoto
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
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Guo H, Li Q, Zhang Z, Feng A, Qin S, Liu L, Sun R, Wang X. Better clinical outcomes and return to sport rates with additional medial meniscus root tear repair in high tibial osteotomy for medial compartmental knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2024; 32:1753-1765. [PMID: 38643405 DOI: 10.1002/ksa.12180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/31/2023] [Accepted: 01/03/2024] [Indexed: 04/22/2024]
Abstract
PURPOSE This retrospective study aimed to investigate whether the repair of medial meniscus posterior root tears (MMPRTs) is effective for improving clinical outcomes and return to sports rates in young patients (50 years old or younger) with medial compartment knee osteoarthritis (KOA) and MMPRTs. METHODS Between 2016 and 2019, 153 patients with KOA and MMPRTs who underwent open-wedge high tibial osteotomy (OWHTO) were retrospectively included. The patients were divided into OWHTO combined with MMPRT repair (n = 73) and isolated OWHTO (n = 80) groups. Lysholm scores, Hospital for Special Surgery (HHS) scores, Tegner scores, flexion contracture, range of knee flexion, return to sports rates and postoperative complications were compared. Radiological outcomes, including hip-knee-ankle angle (HKA), medial proximal tibial angle (MPTA), joint line convergence angle (JLCA) and Kellgren-Lawrence (K-L) grade, were compared between the two groups. RESULTS After a mean follow-up of 30.1 ± 3.0 months, the OWHTO + Repair group observed better clinical outcomes compared with the OWHTO group (Lysholm score: 86.7 ± 7.4 vs. 81.6 ± 6.9, p = 0.023. HHS score: 85.4 ± 8.20 vs. 80.5 ± 7.1, p = 0.039). The OWHTO + Repair group had higher Tegner scores and return to sports rates than the OWHTO group (Tegner score: 6 vs. 5, p = 0.020; return to sports rates: 38% vs. 15%, p = 0.001). No fracture or major complications occurred. Radiological outcomes showed no significant differences between the two groups (HKA: 181.1 ± 2.7 vs. 180.1 ± 1.5 n.s; MPTA: 90.1 ± 1.8 vs. 89.2 ± 1.4, n.s; JLCA:1.9 ± 0.7 vs. 2.1 ± 0.7, n.s). CONCLUSIONS Additional MMPRT repair during OWHTO was associated with better clinical outcomes and higher rates of return to sports in young patients with medial compartment KOA and MMPRTs. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Hailong Guo
- Department of Orthopaedic Surgery, Hebei Medical University Third Hospital, Shijiazhuang, Hebei, China
| | - Qingyu Li
- Department of Orthopaedic Surgery, Hebei Medical University Third Hospital, Shijiazhuang, Hebei, China
| | - Zirui Zhang
- Department of Orthopaedic Surgery, Hebei Medical University Third Hospital, Shijiazhuang, Hebei, China
| | - Ao Feng
- Department of Orthopaedic Surgery, Hebei Medical University Third Hospital, Shijiazhuang, Hebei, China
| | - Shiqi Qin
- Department of Orthopaedic Surgery, Hebei Medical University Third Hospital, Shijiazhuang, Hebei, China
| | - Lei Liu
- Department of Orthopaedic Surgery, Hebei Medical University Third Hospital, Shijiazhuang, Hebei, China
| | - Ran Sun
- Department of Orthopaedic Surgery, Hebei Medical University Third Hospital, Shijiazhuang, Hebei, China
| | - Xiaofeng Wang
- Department of Orthopaedic Surgery, Hebei Medical University Third Hospital, Shijiazhuang, Hebei, China
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Okamura H, Ishikawa H, Ohno T, Fujita S, Yamamoto S, Yamakami S, Nagasaki K, Kudo Y. Medial Meniscus Posterior Root Reconstruction and Open-Wedge High-Tibial Osteotomy for Medial Meniscus Posterior Root Tear With Varus Knee Alignment: A Retrospective Study on Short-Term Outcomes. Cureus 2024; 16:e57170. [PMID: 38681336 PMCID: PMC11056034 DOI: 10.7759/cureus.57170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2024] [Indexed: 05/01/2024] Open
Abstract
PURPOSE We describe 13 cases of medial meniscus posterior root tear (MMPRT) with varus knee alignment treated with medial meniscus posterior root reconstruction (MMPR-R) and open-wedge high-tibial osteotomy (OWHTO) to identify an optimal MMPRT treatment. METHODS We retrospectively reviewed 13 patients (mean age: 66.3 ± 8.0 years) who underwent MMPR-R and OWHTO. The Knee Injury and Osteoarthritis Outcome Score (KOOS), femorotibial angle (FTA), percentage mechanical axis (%MA) on radiography, and medial meniscus extrusion (MME) on magnetic resonance imaging (MRI) between the preoperative period and last follow-up were compared. Moreover, meniscus healing status and the International Cartilage Repair Society (ICRS) classification of the medial femoral condyle and medial tibial plateau on arthroscopy between the initial surgery and second-look arthroscopy were compared. RESULTS The mean follow-up duration was 12.8 ± 2.2 months. At the last follow-up, the KOOS significantly improved (P < 0.01). Based on the FTA and %MA, the varus alignment was predominantly corrected at the last follow-up (P < 0.01). The MME was increased in nine (62.9%) patients, and the mean MME significantly increased at the last follow-up (P = 0.04). Second-look arthroscopy revealed improvements in the ICRS grade for the medial femoral condyle and medial tibial plateau in six (46.2%) patients. However, the results did not significantly differ. Regarding meniscus healing, four (30.8%) patients presented with complete healing, eight (57.1%) with partial healing, and one (7.7%) with failed healing. CONCLUSIONS The MMPRT with varus knee alignment significantly improved with MMPR-R and OWHTO. However, the MME and meniscus healing were unsatisfactory.
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Affiliation(s)
- Hiroki Okamura
- Department of Orthopaedic Surgery, Nihon Koukan Hospital, Kanagawa, JPN
| | - Hiroki Ishikawa
- Department of Orthopaedic Surgery, Nihon Koukan Hospital, Kanagawa, JPN
| | - Takuya Ohno
- Department of Orthopaedic Surgery, Nihon Koukan Hospital, Kanagawa, JPN
| | - Shogo Fujita
- Department of Orthopaedic Surgery, Nihon Koukan Hospital, Kanagawa, JPN
| | - Shota Yamamoto
- Department of Orthopaedic Surgery, Nihon Koukan Hospital, Kanagawa, JPN
| | - Shigeo Yamakami
- Department of Orthopaedic Surgery, Nihon Koukan Hospital, Kanagawa, JPN
| | - Kei Nagasaki
- Department of Orthopaedic Surgery, Showa University School of Medicine, Tokyo, JPN
| | - Yoshifumi Kudo
- Department of Orthopaedic Surgery, Showa University School of Medicine, Tokyo, JPN
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Lee DR, Lu Y, Reinholz AK, Till SE, Lamba A, Saris DBF, Camp CL, Krych AJ. Root Repair Has Superior Radiological and Clinical Outcomes Than Partial Meniscectomy and Nonoperative Treatment in the Management of Meniscus Root Tears: A Systematic Review. Arthroscopy 2024:S0749-8063(24)00152-X. [PMID: 38401664 DOI: 10.1016/j.arthro.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 02/04/2024] [Accepted: 02/15/2024] [Indexed: 02/26/2024]
Abstract
PURPOSE To compile and analyze structural and clinical outcomes after meniscus root tear treatment as currently described in the literature. METHODS A review was conducted to identify studies published since 2011 on efficacy of repair, meniscectomy, and nonoperative management in the treatment of meniscus root tears. Patient cohorts were grouped into treatment categories, with medial and lateral root tears analyzed separately; data were collected on patient demographics, structural outcomes including joint space width, degree of medial meniscal extrusion, progression to total knee arthroplasty, and patient-reported outcome measures. Risk of bias was assessed using the MINORS (methodological index for non-randomized studies) criteria. Heterogeneity was measured using the I-statistic, and outcomes were summarized using forest plots without pooled means. RESULTS The 56 included studies comprised a total of 3,191 patients. Mean age among the included studies ranged from 24.6 to 65.6 years, whereas mean follow-up ranged from 12 to 125.9 months. Heterogeneity analysis identified significant differences between studies. Change in joint space width ranged from -2.4 to -0.6 mm (i.e., decreased space) after meniscectomy (n = 186) and -0.9 to -0.1 mm after root repair (n = 209); change in medial meniscal extrusion ranged from -0.6 to 6.5 mm after root repair (n = 521) and 0.2 to 4.2 mm after meniscectomy (n = 66); and event rate for total knee arthroplasty ranged from 0.00 to 0.22 after root repair (n = 205), 0.35 to 0.60 after meniscectomy (n = 53), and 0.27 to 0.35 after nonoperative treatment (n = 93). Root repair produced the greatest numerical increase in International Knee Documentation Committee and Lysholm scores of the 3 treatment arms. In addition, root repair improvements in Knee Injury and Osteoarthritis Outcome Score Pain (range: 22-32), Sports and Recreational Activities (range: 23-36), Quality of Life (range: 22-42), and Symptoms subscales (range: 10-19), in studies with low risk of bias. CONCLUSIONS The literature reporting on the treatment of meniscus root tears is heterogenous and largely limited to Level III and IV studies. Current evidence suggests root repair may be the most effective treatment strategy in lessening joint space narrowing of the knee and producing improvements in patient-reported outcomes. LEVEL OF EVIDENCE Level IV, systematic review of Level II-IV studies.
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Affiliation(s)
- Dustin R Lee
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Yining Lu
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Anna K Reinholz
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Sara E Till
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Abhinav Lamba
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Daniel B F Saris
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Christopher L Camp
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Aaron J Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A..
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Lin L, Jiang S, Yang S, Yang G, Xie B, Zhang L. Identical clinical outcomes between neutral and classic targeted alignments after high tibial osteotomy in medial meniscus posterior root tear: a prospective randomized study. INTERNATIONAL ORTHOPAEDICS 2024; 48:427-437. [PMID: 37676496 DOI: 10.1007/s00264-023-05960-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/26/2023] [Indexed: 09/08/2023]
Abstract
PURPOSE This study aimed to compare the clinical and radiographic outcomes and arthroscopic findings after high tibial osteotomy (HTO) between neutral and classic targeted coronal alignments in patients with medial meniscus posterior root tears (MMPRTs). METHODS Ninety-eight patients with MMPRT were prospectively enrolled in the final cohort and randomized into two groups. Fifty-two patients with the targeted alignment through the Fujisawa point (60-62.5% of the entire tibial plateau width measured from the medial side) during HTO were included in group A, whereas 46 patients with the targeted alignment through the point at 50-55% of the tibial plateau width were included in group B. The clinical and radiographic outcomes and second-look arthroscopic findings were statistically compared for comprehensive assessments. RESULTS After a mean follow-up of 37.1 months, we found no significant differences between the two groups regarding the final Lysholm (p = 0.205) and Hospital for Special Surgery scores (p = 0.084). However, we only observed significant differences between the two groups in terms of the final hip-knee-ankle angle, weight-bearing line ratio, and medial proximal tibial angle (p < 0.001). Second-look arthroscopy did not reveal a significant difference in meniscal healing rate (p = 0.786). CONCLUSIONS Performing HTO with the aim to achieve neutral alignment leads to similar clinical outcomes in patients with MMPRT compared to classic alignment. Although subsequent research is required, the current study provides clinical evidence for the safety and efficacy of the new targeted alignment during HTO, which may avoid long-term complications associated with overcorrection when using the traditional technique.
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Affiliation(s)
- Lan Lin
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Wenzhou Medical University, Shangcai Village, Ouhai District, Wenzhou, 325000, China
| | - Songli Jiang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Wenzhou Medical University, Shangcai Village, Ouhai District, Wenzhou, 325000, China
| | - Shengwu Yang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Wenzhou Medical University, Shangcai Village, Ouhai District, Wenzhou, 325000, China.
| | - Guojing Yang
- Department of Adult Reconstruction, The Third Affiliated Hospital of Wenzhou Medical University, No.108, Wansong Road, Ruian, Wenzhou, 325200, China
| | - Bingju Xie
- Department of Adult Reconstruction, The Third Affiliated Hospital of Wenzhou Medical University, No.108, Wansong Road, Ruian, Wenzhou, 325200, China.
| | - Lei Zhang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Wenzhou Medical University, Shangcai Village, Ouhai District, Wenzhou, 325000, China.
- Department of Adult Reconstruction, The Third Affiliated Hospital of Wenzhou Medical University, No.108, Wansong Road, Ruian, Wenzhou, 325200, China.
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Choi YS, Chang MJ, Lee JH, Lee JH, D'Lima DD, Kim TW, Chang CB, Kang SB. Repair of medial meniscus posterior root tear is effective for root healing and cartilage regeneration in opening wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2023; 31:5799-5811. [PMID: 37940662 DOI: 10.1007/s00167-023-07637-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 10/13/2023] [Indexed: 11/10/2023]
Abstract
PURPOSE This study aimed to determine whether the repair of a medial meniscus posterior root tear (MMPRT) is effective for MMPRT healing, cartilage regeneration, and clinical outcomes in opening wedge high tibial osteotomy (OWHTO). METHODS This retrospective study included 80 patients who underwent OWHTO and subsequent second-look arthroscopy. The patients were divided into OWHTO-with-MMPRT-repair (n = 40) and OWHTO alone (n = 40) groups, and the healing rates (complete/partial/failure) were compared. Each group was further divided into over- and under-corrected subgroups to compare healing rates. The International Cartilage Repair Society (ICRS) grade, cartilage defect size, Koshino stage, ICRS cartilage repair assessment score of the medial femoral condyle (MFC), and International Knee Documentation Committee (IKDC) scores between the OWHTO-with-MMPRT-repair and OWHTO alone groups were compared according to whether microfracture was performed on the MFC. RESULTS The overall healing rate of the MMPRT was higher in the OWHTO-with-MMPRT-repair group than that in the OWHTO alone group (P < 0.001). In addition, in the subgroup analysis, no difference in the MMPRT healing rate between the over-correction and under-correction groups when MMPRT repair was performed (n.s). In contrast, without MMPRT repair, the healing rate was lower in the under-correction group than that in the over-correction group (P = 0.03). Cartilage regeneration of the OWHTO-with-MMPRT-repair group was superior to that of the OWHTO alone group (P < 0.05). The IKDC subjective scores of the OWHTO-with-MMPRT-repair and OWHTO alone groups were 34.5 and 33.1 before surgery (n.s) and 50 and 47.2 at one year after surgery, respectively (n.s). These differences between the two groups for cartilage regeneration and IKDC subjective scores showed the same pattern regardless of microfractures. CONCLUSIONS MMPRT repair during OWHTO might improve MMPRT healing, even with under-correction, and cartilage regeneration of MFC, regardless of microfracture. However, OWHTO with MMPRT repair might not improve short-term clinical outcomes compared to OWHTO alone. Further randomized clinical trials are necessary. LEVEL OF EVIDENCE III, Retrospective cohort study.
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Affiliation(s)
- Yun Seong Choi
- Department of Orthopaedic Surgery, Veterans Health Service Medical Center, Seoul, South Korea
| | - Moon Jong Chang
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Ji Han Lee
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Jae Hee Lee
- Department of Orthopaedic Surgery, Veterans Health Service Medical Center, Seoul, South Korea
| | - Darryl D D'Lima
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, CA, USA
| | - Tae Woo Kim
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Chong Bum Chang
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Seung-Baik Kang
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea.
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea.
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Omae H, Yanagisawa S, Hagiwara K, Ogoshi A, Omodaka T, Kimura M, Chikuda H. Arthroscopic pullout repair versus suture anchor repair for medial meniscus posterior root tear combined with high tibial osteotomy. Knee 2023; 45:117-127. [PMID: 37925802 DOI: 10.1016/j.knee.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 09/16/2023] [Accepted: 10/17/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND The aim of this study was to compare the outcomes of pullout repair with a metal button and suture anchor repair for medial meniscus posterior root tears in patients undergoing high tibial osteotomy with varus alignment. METHODS Patients who underwent arthroscopic pullout repair (P group) and suture anchor repair (SA group) in combination with open-wedge high tibial osteotomy between 2018 and 2021 were retrospectively examined. Patients who received second-look arthroscopy at 1 year and at least 2 years of follow up were included. Structural healing (complete/partial or failed healing) and chondral lesions at the initial surgery and the second-look arthroscopy, radiographic parameters around the knee, Lysholm score, and Tegner activity scale (before and 2 years after surgery) were compared. RESULTS A total of 88 patients (68 women/20 men, mean age 61.1 ± 7.9 years old) were included in the analysis. Of these, 51 patients underwent pullout repair, while the other 37 underwent suture anchor repair. The SA group showed a significantly higher rate of complete healing (64.9%) than the P group (21.6%, P < 0.001). The Lysholm score significantly improved after surgery in both treatment groups. At the final follow up, the SA group had a significantly higher Lysholm score (89.6 ± 10.7) than the P group (80.9 ± 17.4, P = 0.011). CONCLUSION Arthroscopic suture anchor repair had superior healing status and Lysholm Score in comparison with pullout repair with a metal button, as it achieved better tension adjustment. This result is meaningful particularly when medial meniscus root repair and high tibial osteotomy are performed simultaneously.
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Affiliation(s)
- Hiroaki Omae
- Zenshukai Hospital Gunma Sports Medicine Research Center, Gunma, Japan; Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan.
| | - Shinya Yanagisawa
- Zenshukai Hospital Gunma Sports Medicine Research Center, Gunma, Japan
| | - Keiichi Hagiwara
- Zenshukai Hospital Gunma Sports Medicine Research Center, Gunma, Japan
| | - Atsuko Ogoshi
- Zenshukai Hospital Gunma Sports Medicine Research Center, Gunma, Japan
| | - Takuya Omodaka
- Zenshukai Hospital Gunma Sports Medicine Research Center, Gunma, Japan; Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Masashi Kimura
- Zenshukai Hospital Gunma Sports Medicine Research Center, Gunma, Japan
| | - Hirotaka Chikuda
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
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Kim CW, Lee CR, Son GH. Type of medial meniscus tear does not affect the clinical and radiological outcomes of medial opening-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2023; 31:5025-5033. [PMID: 37676499 DOI: 10.1007/s00167-023-07542-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/04/2023] [Indexed: 09/08/2023]
Abstract
PURPOSE The current study aimed to evaluate the effect of medial meniscus posterior root tear (MMPRT) on radiological and clinical outcomes after medial opening-wedge high tibial osteotomy (MOWHTO). METHODS This retrospective cohort study included patients who underwent MOWHTO (113 knees) at our hospital between September 2012 and June 2020 and who were followed up for > 2 years. The radiological and clinical outcomes were compared between the MMPRT group (52 knees), who included patients with MMPRT, and the non-MMPRT group (61 knees), who comprised patients without meniscal tear or with any type of meniscal tear other than MMPRT. Logistic regression analysis was performed to evaluate factors affecting osteoarthritis (OA) progression after MOWHTO. RESULTS The mean follow-up period was 40.6 ± 14.2 months. The mean ages of the MMPRT and non-MMPRT groups were 56.9 ± 6.4 and 54.4 ± 6.1 years, respectively (p = 0.031). There was no significant difference in the last follow-up radiological and clinical outcomes between the two groups. In the logistic regression analysis, the postoperative hip-knee-ankle angle was a risk factor of OA progression after MOWHTO (odds ratio 0.7; 95% confidence interval 0.5-0.9; p = 0.006), and the type of medial meniscus tear was not associated with OA progression (p = n.s.). CONCLUSIONS In the short- to mid-term follow-up of MOWHTO, the radiological or clinical outcomes of patients with MMPRT were not inferior to those of patients without MMPRT. Postoperative lower extremity alignment, but not MMPRT, was a factor influencing MOWHTO prognosis. Concurrent root repair in HTO will restore the anatomy better; however, its effect on progression of OA is yet to be proven. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Chang-Wan Kim
- Department of Orthopedic Surgery, Inje University Busan Paik Hospital, 75, Bokji-ro, Busanjin-gu, Busan, 47392, Republic of Korea
| | - Chang-Rack Lee
- Department of Orthopedic Surgery, Inje University Busan Paik Hospital, 75, Bokji-ro, Busanjin-gu, Busan, 47392, Republic of Korea.
| | - Gyu-Ha Son
- Department of Orthopedic Surgery, Inje University Busan Paik Hospital, 75, Bokji-ro, Busanjin-gu, Busan, 47392, Republic of Korea
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12
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Farivar D, Hevesi M, Fortier LM, Azua E, LaPrade RF, Chahla J. Meniscal Extrusion Measurements After Posterior Medial Meniscus Root Tears: A Systematic Review and Meta-analysis. Am J Sports Med 2023; 51:3325-3334. [PMID: 36541434 DOI: 10.1177/03635465221131005] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Meniscal extrusion has become increasingly utilized when evaluating meniscus root abnormalities. However, no consensus definition or approach exists on how to measure extrusion. PURPOSE/HYPOTHESIS The purpose of this study was to evaluate the extent of heterogeneity in meniscal extrusion measurement techniques and reported extrusion values in knees with posterior medial meniscus root tears (PMMRTs). We hypothesized that meniscal extrusion measurement techniques would vary considerably throughout reported studies, with resultant wide-ranging published extrusion values. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS A systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. The inclusion criteria consisted of all clinical and cadaveric studies reporting on meniscal extrusion after PMMRTs, excluding studies lacking data in full extension, those presenting only semiquantitative analyses, articles reporting only differences in meniscal extrusion, and review articles. RESULTS A total of 45 studies were included. Imaging modality types included magnetic resonance imaging (89%), 3-dimensional reconstruction with computed tomography (7%), linear displacement transducers (2%), and a combination of magnetic resonance imaging and ultrasound (2%). The 3 most commonly used landmarks to acquire coronal images for meniscal extrusion measurements were the medial collateral ligament (38%), the midpoint of the anterior-posterior length of the medial meniscus (23%), and the middle of the medial femoral condyle (19%). The pooled mean extrusion values according to the measurement location were 3.5 ± 0.7 mm, 3.9 ± 0.8 mm, and 4.5 ± 2.1 mm, respectively, with no significant differences noted between the modality types (P = .23). The pooled mean meniscal extrusion from all included studies was 3.2 ± 2.0 mm. CONCLUSION Substantial variation exists in measurement techniques for meniscal extrusion, particularly as it relates to the coronal cross-sectional reference location. Further studies should aim to provide clear descriptions of the measurement method and have uniform measurement methodology to allow comparisons and pooling between studies.
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Affiliation(s)
| | - Mario Hevesi
- Midwest Orthopaedics at Rush University, Chicago, Illinois, USA
| | - Luc M Fortier
- Midwest Orthopaedics at Rush University, Chicago, Illinois, USA
| | - Eric Azua
- Rush University Medical College, Chicago, Illinois, USA
| | | | - Jorge Chahla
- Midwest Orthopaedics at Rush University, Chicago, Illinois, USA
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Nie S, Li H, Liao X, Liu Q, Lan M. 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. Knee Surg Sports Traumatol Arthrosc 2023; 31:3775-3783. [PMID: 36790456 DOI: 10.1007/s00167-023-07330-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 01/30/2023] [Indexed: 02/16/2023]
Abstract
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 affecting 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 influence the correction of MME were also evaluated. RESULTS The functional recovery of the knee was significantly improved at the end of follow-up (P < 0.001; respectively), furthermore, a comparison of the final functional outcomes between the groups showed that the mean Lysholm score and IKDC score of the maintained MME group were significantly 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-off 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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Affiliation(s)
- Si Nie
- Department of Radiology, Jiangxi Provincial People's Hospital, (The First Affiliated Hospital of Nanchang Medical College), Nanchang, 330006, People's Republic of China
| | - Hongbo Li
- Department of Orthopedics, Jiangxi Provincial People's Hospital, (The First Affiliated Hospital of Nanchang Medical College), No.92 Aiguo Road, Donghu District, Nanchang, Jiangxi Province, 330006, People's Republic of China
| | - Xingen Liao
- Department of Orthopedics, Jiangxi Provincial People's Hospital, (The First Affiliated Hospital of Nanchang Medical College), No.92 Aiguo Road, Donghu District, Nanchang, Jiangxi Province, 330006, People's Republic of China
| | - Qing Liu
- Department of Nursing Science, Jiangxi Provincial People's Hospital, (The First Affiliated Hospital of Nanchang Medical College), Nanchang, 330006, People's Republic of China
| | - Min Lan
- Department of Orthopedics, Jiangxi Provincial People's Hospital, (The First Affiliated Hospital of Nanchang Medical College), No.92 Aiguo Road, Donghu District, Nanchang, Jiangxi Province, 330006, People's Republic of China.
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Yanagisawa S, Kimura M, Hagiwara K, Ogoshi A, Omodaka T, Omae H. Evaluation of the bone tunnel position and state of healing on second-look arthroscopy after pullout repair of medial meniscus posterior root tear during open-wedge high tibial osteotomy. Knee 2023; 42:220-226. [PMID: 37086538 DOI: 10.1016/j.knee.2023.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 02/14/2023] [Accepted: 03/28/2023] [Indexed: 04/24/2023]
Abstract
BACKGROUND The aim of the present study was to evaluate the outcome of pullout repair of medial meniscus posterior root tear during open-wedge high tibial osteotomy, including the bone tunnel position and the state of healing on second-look arthroscopy. METHODS The cohort comprised 22 patients (six men, 16 women) who underwent arthroscopic root fixation by the transtibial pullout technique for medial meniscus posterior root tear during open-wedge high tibial osteotomy. The mean patient age was 63.7 years. The location of the tibial tunnel was assessed using a percentage-dependent method, and the location of a critical point was determined by two coordinates on CT. We defined the distance between the tibial tunnel center and the medial meniscal posterior root anatomic center as the TC-AC distance. The healing state was classified as complete, partial, or failed on second-look arthroscopy. Patients were categorized into those with complete or partial healing (group H) and those with failed healing (group F). The differences in the outcomes and characteristics of groups H and F were evaluated. RESULTS Twelve and 10 knees were classified into groups H and F, respectively. The bone tunnel position was significantly more posterior in group H than in group F. The TC-AC distance was significantly shorter in group H than in group F. CONCLUSIONS In pullout repair of medial meniscus posterior root tear during open-wedge high tibial osteotomy, it was considered important to create a bone tunnel position more posterior to increase the healing rate on second-look arthroscopy. LEVEL OF EVIDENCE Level Ⅳ.
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Affiliation(s)
- Shinya Yanagisawa
- Zensyukai Hospital Gunma Sports Medicine Research Center, Gunma, Japan.
| | - Masashi Kimura
- Zensyukai Hospital Gunma Sports Medicine Research Center, Gunma, Japan
| | - Keiichi Hagiwara
- Zensyukai Hospital Gunma Sports Medicine Research Center, Gunma, Japan
| | - Atsuko Ogoshi
- Zensyukai Hospital Gunma Sports Medicine Research Center, Gunma, Japan
| | - Takuya Omodaka
- Zensyukai Hospital Gunma Sports Medicine Research Center, Gunma, Japan
| | - Hiroaki Omae
- Zensyukai Hospital Gunma Sports Medicine Research Center, Gunma, Japan
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Park HJ, Chang MJ, Cho HJ, Hong E, Kim TW, Chang CB, Bae TS, Kwak DS, Kang SB. Medial Meniscus Posterior Root Repair Restores Contact Pressure and Contact Area to Its Native State Even After Opening-Wedge High Tibial Osteotomy: A Cadaveric Biomechanical Study. Arthroscopy 2023; 39:638-646. [PMID: 36191732 DOI: 10.1016/j.arthro.2022.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 08/30/2022] [Accepted: 09/09/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE To elucidate the effect of medial meniscus posterior root (MMPR) repair during opening-wedge high tibial osteotomy (OWHTO) in terms of contact pressure (CP) and contact area (CA). METHODS Nine fresh-frozen human cadaveric knee specimens were included. Each specimen was tested under 9 conditions comprising 3 different degrees of correction during OWHTO (neutral, 5° of valgus, and 10° of valgus) and 3 different types of MMPR conditions (intact, torn, and repaired). The prepared specimens were attached to a customized tibiofemoral jig in a fully extended state. The CP and CA generated by a tibiofemoral axial load of 650 N was recorded using the Tekscan sensor's pressure mapping software. Statistical analysis was performed using a repeated measures analysis of variance. RESULTS The increased CP and decreased CA in torn MMPR was decreased and increased, respectively, to the intact MMPR after repairing, irrespective of whether OWHTO was performed. The mean CP at a correction angle of 5° of valgus was 0.4067 ± 0.0768 MPa for intact MMPR, which increased to 0.7340 ± 0.1593 MPa for the torn MMPR and decreased to 0.3614 ± 0.0639 MPa for the repaired MMPR. In addition, the proportion of decrease in CP and increase in CA after MMPR repair was constant, compared with the torn MMPR, irrespective of the degree of correction during OWHTO. CONCLUSIONS MMPR repair decreases CP and increases CA, irrespective of whether OWHTO is performed. The biomechanical advantage of repairing torn MMPR is maintained, regardless of the degree of correction during OWHTO. CLINICAL RELEVANCE Both OWHTO and MMPR repair are known to protect the medial compartment of the knee. However, there are concerns in performing 2 procedures simultaneously. Results of our study showed that concurrent repair of the MMPR during OWHTO is useful for protecting the medial compartment of the knee with respect to tibiofemoral contact biomechanics.
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Affiliation(s)
- Hyung Jun Park
- Department of Orthopedic Surgery, Korea University College of Medicine, Ansan Hospital
| | - Moon Jong Chang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Ho-Jung Cho
- Department of Anatomy, Catholic Institute for Applied Anatomy, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Eunah Hong
- Department of Biomedicine & Health Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Tae Woo Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Chong Bum Chang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Tae Soo Bae
- Department of Biomedical Engineering (BME), Jungwon University, Chungcheongbuk-do, Republic of Korea
| | - Dai-Soon Kwak
- Department of Anatomy, Catholic Institute for Applied Anatomy, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Seung-Baik Kang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea.
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16
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Xu Z, Li Y, Rao J, Jin Y, Huang Y, Xu X, Liu Y, Tian S. Biomechanical assessment of disease outcome in surgical interventions for medial meniscal posterior root tears: a finite element analysis. BMC Musculoskelet Disord 2022; 23:1093. [PMID: 36517757 PMCID: PMC9749342 DOI: 10.1186/s12891-022-06069-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The adverse consequences of medial meniscus posterior root tears have become increasingly familiar to surgeons, and treatment strategies have become increasingly abundant. In this paper, the finite element gait analysis method was used to explore the differences in the biomechanical characteristics of the knee joint under different conditions. METHODS Based on CT computed tomography and MR images, (I) an intact knee (IK) model with bone, cartilage, meniscus and main ligaments was established. Based on this model, the posterior root of the medial meniscus was resected, and (ii) the partial tear (PT) model, (iii) the entire radial tear (ERT) model, and (iv) the entire oblique tear (EOT) model were established according to the scope and degree of resection. Then, the (v) meniscus repair (MR) model and (vi) partial meniscectomy (PM) model were developed according to the operation method. The differences in stress, displacement and contact area among different models were evaluated under ISO gait loading conditions. RESULTS Under gait loading, there was no significant difference in the maximum stress of the medial and lateral tibiofemoral joints among the six models. Compared with the medial tibiofemoral joint stress of the IK model, the stress of the PM model increased by 8.3%, while that of the MR model decreased by 18.9%; at the same time, the contact stress of the medial tibiofemoral joint of the ERT and EOT models increased by 17.9 and 25.3%, respectively. The displacement of the medial meniscus in the ERT and EOT models was significantly larger than that in the IK model (P < 0.05), and the tibial and femoral contact areas of these two models were lower than those of the IK model (P < 0.05). CONCLUSIONS The integrity of the posterior root of the medial meniscus plays an important role in maintaining normal tibial-femoral joint contact mechanics. Partial meniscectomy is not beneficial for improving the tibial-thigh contact situation. Meniscal repair has a positive effect on restoring the normal biomechanical properties of the medial meniscus.
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Affiliation(s)
- Zhi Xu
- Department of Orthopaedics, Zhangjiagang Fifth People’s Hospital, Zhangjiagang, 215600 Jiangsu China ,grid.267139.80000 0000 9188 055XCollege of Continuing Education, University of Shanghai for Science and Technology, Shanghai, 200000 China
| | - Yuwan Li
- grid.411642.40000 0004 0605 3760Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, 100191 China
| | - Jingcheng Rao
- grid.428392.60000 0004 1800 1685Department of Orthopaedics, Suqian Hospital of Nanjing Drum Tower Hospital Group, Suqian, 223800 Jiangsu China
| | - Ying Jin
- grid.413390.c0000 0004 1757 6938Department of Orthopaedics, The Affiliated Hospital of Zunyi Medical University, No.149 Dalian Road, Zunyi, 563000 Guizhou China
| | - Yushun Huang
- Department of Orthopaedics, Jen Ching memorial Hospital, Kunshan, 215300 Jiangsu China
| | - Xing Xu
- Department of Medicine, Zhijin People’s Hospital, Zhijin, 552100 Guizhou China
| | - Yi Liu
- grid.413390.c0000 0004 1757 6938Department of Orthopaedics, The Affiliated Hospital of Zunyi Medical University, No.149 Dalian Road, Zunyi, 563000 Guizhou China
| | - Shoujin Tian
- grid.460159.fDepartment of Orthopaedics, Zhangjiagang First People’s Hospital, No.68 Jiyang West Road, Zhangjiagang, 215600 Jiangsu China
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Srimongkolpitak S, Chernchujit B. Posterior Root Medial Meniscus Tear With Medial Opening Wedge High Tibial Osteotomy: A Step-By-Step Systematic Arthroscopic Repair Technique. Arthrosc Tech 2022; 11:e1515-e1523. [PMID: 36185116 PMCID: PMC9519790 DOI: 10.1016/j.eats.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 04/07/2022] [Indexed: 02/03/2023] Open
Abstract
Medial meniscus root repair is often combined with correction of knee varus alignment by performing an opening wedge high tibial osteotomy (HTO) in patients with varus knee malalignment, particularly in those with suspected long-term medial meniscus root tear (MRT). Before planning a corrective alignment treatment, radiographic imaging of the knee alignment is recommended to assess a medial joint space and the tibiofemoral axis. Because HTO can reduce pressure on the repair site, new alignment may promote healing in the attachment of the MR repair. When HTO is used with meniscus root repair (MRR), the tunnel convergence remains a major concern. We describe an arthroscopic technique for treating chronic MRT with knee malalignment using the technique of arthroscopic posterior MRR with HTO. This approach was used to enhance anatomic healing of the meniscus root, decrease the load to the medial knee compartment to achieve MRR, and stop progressive osteoarthritis of the medial knee compartment.
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Affiliation(s)
- Surasak Srimongkolpitak
- Address correspondence to Surasak Srimongkolpitak, M.D., Department of Orthopedics, Faculty of Medicine, Queen Savang Vadhana Memorial Hospital, 209 Jermjormpol Road, Si Racha District, Chon Buri Province, Thailand 20110.
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18
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Itou J, Kuwashima U, Itoh M, Okazaki K. High tibial osteotomy for medial meniscus posterior root tears in knees with moderate varus alignment can achieve favorable clinical outcomes. J Exp Orthop 2022; 9:65. [PMID: 35796797 PMCID: PMC9263016 DOI: 10.1186/s40634-022-00504-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 06/30/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose Favorable clinical results have been reported following high tibial osteotomy (HTO) for medial meniscus posterior root tear (MMPRT) in knees with varus alignment. However, the effect on the preoperative neutral alignment of the knee is not known. This study sought to evaluate the clinical outcomes of medial open-wedge HTO for MMPRT with neutral alignment. Methods We retrospectively reviewed 119 medial open-wedge HTOs and analyzed 22 knees with MMPRT. The knees were divided according to the preoperative hip-knee-ankle angle into a moderate varus alignment group (≤4° of varus alignment) and a varus alignment group (> 4° of varus alignment). The Knee Injury and Osteoarthritis Outcome Score (KOOS) and Forgotten Joint Score-12 (FJS-12) values were evaluated preoperatively and at the latest follow-up. The healing status of MMPRT at the time of second-look arthroscopy, performed at a mean of 15.4 ± 4.2 months, was compared with that after the primary HTO. Results There were 11 knees in the moderate varus alignment group and 11 in the varus alignment group. In terms of perioperative patient-reported outcome measures, there was no significant difference in the preoperative or postoperative KOOS subscale score or FJS-12 score between the moderate varus and varus alignment groups. The healing rate was significantly higher in the moderate varus alignment group. Conclusion Favorable clinical results were obtained by medial open-wedge HTO in knees with MMPRT and moderate varus alignment in the short term. Surgeons should consider the indications for medial open-wedge HTO, even with moderate varus alignment, when planning treatment for MMPRT with persistent knee pain. Level of evidence IV Supplementary Information The online version contains supplementary material available at 10.1186/s40634-022-00504-9.
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Affiliation(s)
- Junya Itou
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Umito Kuwashima
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Masafumi Itoh
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Ken Okazaki
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
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Jin JW, Kim JG, Wang JH, Tae J, Kim JH, Lee BH, Park JY, Lee DK. How to Perform Concomitant Medial Meniscus Pull-Out Repair With Medial Open-Wedge High Tibial Osteotomy Without Technical Failure. Arthrosc Tech 2022; 11:e881-e888. [PMID: 35646577 PMCID: PMC9134484 DOI: 10.1016/j.eats.2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/07/2022] [Indexed: 02/03/2023] Open
Abstract
Varus alignment of the knee joint (varus >5°) is known as a poor prognostic factor for medial meniscus root repair, and alignment correction is recommended in patients with varus deformity and medial meniscus root tears. However, simultaneous medial meniscus pull-out repair and high tibial osteotomy are technically demanding procedures due to the long surgical time, poor visualization, and breaking of the pull-out sutures during high tibial osteotomy procedures. In the present Technical Note, we will introduce a surgical method to perform 2 procedures simultaneously without technical difficulty. The main surgical techniques are as follows. (1) Release the superficial medial collateral ligament before arthroscopic medial meniscus pull-out repair, which secures sufficient working space and visualization. Therefore, the operation time could also be reduced by performing the arthroscopic procedure with the anterior portal. (2) Protect the pull-out sutures with an ENDOBUTTON reamer, which prevents pull-out sutures from breaking during the high tibial osteotomy procedure.
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Affiliation(s)
- Jin Woo Jin
- Department of Orthopedic Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Jin Goo Kim
- Department of Orthopedic Surgery, Myong Ji Hospital, Hanyang University School of Medicine, Seoul, Korea
| | - Joon Ho Wang
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jungyeun Tae
- Konyang University School of Medicine, Daejeon, Korea
| | - Jun Ho Kim
- Department of Orthopedic Surgery, Kyunghee University Hospital at Gangdong, Kyunghee University School of Medicine, Seoul, Korea
| | - Byung Hoon Lee
- Department of Orthopedic Surgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Jun Yong Park
- Department of Orthopedic Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Do Kyung Lee
- Department of Orthopedic Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
- Konyang University Myunggok Medical Research Institute, Daejon, Korea
- Address correspondence to Do Kyung Lee, M.D., Ph.D., Department of Orthopedic Surgery, Changwon Samsung Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.
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Nejima S, Kumagai K, Yamada S, Sotozawa M, Kumagai D, Yamane H, Inaba Y. Risk of interference between the tibial tunnel and locking screws in medial meniscus posterior root repair and open wedge high tibial osteotomy. J Exp Orthop 2022; 9:25. [PMID: 35292866 PMCID: PMC8924329 DOI: 10.1186/s40634-022-00464-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 03/04/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To evaluate whether the frequency of interference between locking screws for the plate fixation and tibial tunnels differs depending on the tibial tunnel positions in a surgical simulation of the transtibial pull-out repair of medial meniscus posterior root tears (MMPRTs) in patients undergoing biplanar open wedge high tibial osteotomy (OWHTO). METHODS Sixty-five patients (75 knees) who underwent OWHTO with TomoFix small plate (Depuy Synthes, PA, USA) for medial knee osteoarthritis with varus malalignment were enrolled in this study. Surgical simulation of transtibial pull-out repair of MMPRTs was performed using postoperative computed tomography images. The tibial tunnel was created in the anatomical attachment area of the medial meniscus posterior root. Another aperture of the tibial tunnel was created on the anteromedial (AM) tibial cortex, the posteromedial (PM) tibial cortex, and the anterolateral (AL) tibial cortex in the proximal tibial fragment. The frequency of interference between the tibial tunnel and A-D locking screws was compared in the 3 tibial tunnel positions. In each tibial tunnel position, the locking plate position with and without interference between the tibial tunnel and at least one locking screw was compared. RESULTS For screw A, the frequency of interference with the tibial tunnel in the AL position was higher than that in the AM (P = 0.048) and PM positions (P < 0.001). For screws B and C, the frequency of interference with the tibial tunnel in the AM position was higher than that in the PM (P < 0.001, P = 0.007) and AL positions (P < 0.001, P = 0.001), respectively. For screw D, there was no difference in the frequency of interference with the tibial tunnel among the three positions. The frequency of interference between the tibial tunnel and at least one screw in the AM position was 100%, which was higher than that in the PM (P < 0.001) and AL positions (P < 0.001). In the PM position, the locking plate was placed more posteriorly in the group where the locking screw interfered with the tibial tunnel. In the AL position, the locking plate was placed more parallel to the medial/lateral axis of the tibial plateau in the interference group. CONCLUSION Making the tibial tunnel in the AM position should be avoided because interference with locking screws was inevitable. When the tibial tunnel is created in the PM position, interference between the tibial tunnel and screw C should be paid attention. Anterior placement of the locking plate could be useful to prevent interference between locking screws and the tibial tunnel in the PM position. In addition, when the tibial tunnel is created in the AL position, interference between the tibial tunnel and especially screw A among screws A-C should be paid attention. Placing the locking plate in an anteromedial direction could be useful to prevent interference between locking screws and the tibial tunnel in the AL position. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Shuntaro Nejima
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Ken Kumagai
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
| | - Shunsuke Yamada
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Masaichi Sotozawa
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Dan Kumagai
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Hironori Yamane
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Yutaka Inaba
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
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Zhang X, Furumatsu T, Okazaki Y, Okazaki Y, Hiranaka T, Xue H, Kintaka K, Yamauchi T, Ozaki T. Medial meniscus posterior root repair reduces the extruded meniscus volume during knee flexion with favorable clinical outcome. Knee Surg Sports Traumatol Arthrosc 2021; 29:4205-4212. [PMID: 33704516 DOI: 10.1007/s00167-021-06505-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 02/12/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The volume of medial meniscus (MM) extrusion at 10° and 90° knee flexions using three-dimensional (3D) magnetic resonance imaging (MRI) and assessed relevant clinical outcomes at 1-year follow-up were evaluated. METHODS Twenty-four patients who underwent MM posterior root repair were retrospectively reviewed. At 10° and 90° knee flexions, the meniscal extrusion distance and volume were measured using 3D meniscus models constructed by SYNAPSE VINCENT®. The correlation between Knee Injury and Osteoarthritis Outcome Score, Lysholm, International Knee Documentation Committee scores, Tegner activity, and pain visual analog scales and changes in MM extrusion were assessed. RESULTS No significant differences in the MM medial extrusion were observed between 10° and 90° knee flexions postoperatively. MM posterior extrusion (MMPE) decreased significantly at 10° and 90° knee flexions postoperatively. At 90° knee flexion, the meniscus volume at the intra-tibial surface increased at 3 and 12 months postoperatively. The MM extrusion volume increased slightly at 10° knee flexion; however, the volume decreased significantly at 90° knee flexion postoperatively. The change in MMPE significantly correlated with clinical scores. All 12-month clinical scores were significantly improved compared to preoperative scores. CONCLUSIONS The progression of meniscus posterior extrusion and reduction of its volume at 90° knee flexion can be suppressed by MM posterior root repair. Postoperative clinical scores correlated with reductions of the posterior extrusion. Regarding clinical relevance, the dynamic stability of the meniscus can be maintained by MM posterior root repair, which is an effective therapeutic method for improving its clinical status. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Ximing Zhang
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Takayuki Furumatsu
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan.
| | - Yoshiki Okazaki
- Department of Orthopaedic Surgery, Chikamori Hospital, 1-1-16 Okawasuji, Kochi, 780-8522, Japan
| | - Yuki Okazaki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Takaaki Hiranaka
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Haowei Xue
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Keisuke Kintaka
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Takatsugu Yamauchi
- Division of Radiology, Medical Technology Department, Okayama University Hospital, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
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Kyun-Ho S, Hyun-Jae R, Ki-Mo J, Seung-Beom H. Effect of concurrent repair of medial meniscal posterior root tears during high tibial osteotomy for medial osteoarthritis during short-term follow-up: a systematic review and meta-analysis. BMC Musculoskelet Disord 2021; 22:623. [PMID: 34266424 PMCID: PMC8283898 DOI: 10.1186/s12891-021-04499-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 06/17/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Medial meniscal posterior root tears (MMPRTs) are frequently associated with medial compartment osteoarthritis, leading to loss of meniscal hoop tension. This study aimed to evaluate the efficacy of concurrent MMPRT repair during high tibial osteotomy (HTO) compared to HTO alone in patients with medial osteoarthritis and MMPRTs. METHODS The MEDLINE/PubMed, EMBASE, and Cochrane Library databases were searched for studies reporting on concurrent MMPRT repair during HTO. Pre- and postoperative data were pooled to investigate the treatment effects of concurrent MMPRT repair during HTO, and compare postoperative clinical, radiological, and arthroscopic outcomes including cartilage status and healing event rates according to the arthroscopic classification of MMPRT healing (complete, partial [lax or scar tissue], or failed healing) between HTO patients with and without concurrent MMPRT repair. The random-effect model was used to pool the standardized mean differences, odds ratios (ORs), 95% confidence intervals (CIs), and event rates. RESULTS Seven patient subgroups in six articles divided according to meniscal repair techniques were included in the final analysis. Concurrent MMPRT repair during HTO significantly improved the Lysholm score, while no intergroup differences were observed in the postoperative Lysholm and WOMAC scores, as well as radiological and arthroscopic outcomes. Those who underwent concurrent MMPRT repair showed a higher rate of complete meniscal healing (OR: 4.792, 95% CI, 1.95-11.79), with a pooled rate of complete meniscal healing of 0.327 (95% CI, 0.19-0.46). CONCLUSION Concurrent MMPRT repair during HTO for medial osteoarthritis with MMPRTs has little benefits on the clinical, radiological, and arthroscopic outcomes during short-term follow-up. Further accumulation of evidence is needed for long-term effects.
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Affiliation(s)
- Shin Kyun-Ho
- Department of Orthopedic Surgery, Anam Hospital, Korea University College of Medicine, 73 Inchon-ro, Sungbuk-gu, Seoul, 02841, South Korea
| | - Ryoo Hyun-Jae
- Department of Orthopedic Surgery, Anam Hospital, Korea University College of Medicine, 73 Inchon-ro, Sungbuk-gu, Seoul, 02841, South Korea
| | - Jang Ki-Mo
- Department of Orthopedic Surgery, Anam Hospital, Korea University College of Medicine, 73 Inchon-ro, Sungbuk-gu, Seoul, 02841, South Korea
| | - Han Seung-Beom
- Department of Orthopedic Surgery, Anam Hospital, Korea University College of Medicine, 73 Inchon-ro, Sungbuk-gu, Seoul, 02841, South Korea.
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