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Boksh K, Martins A, Elbashir M, Boutefnouchet T, Aujla R. Modified Mason-Allen vs Two Simple Stitch Fixation for Medial Meniscus Posterior Root Tears: A Systematic Review and Meta-analysis. Am J Sports Med 2024; 52:1877-1887. [PMID: 38258492 DOI: 10.1177/03635465231190650] [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] [Indexed: 01/24/2024]
Abstract
BACKGROUND Various suture configurations are available for medial meniscus posterior root tear (MMPRT) repair. The modified Mason-Allen (MMA) technique has been proposed as a refixation technique for MMPRT instead of the conventional 2 simple stitches (TSS). This is in view of its superior biomechanical characteristics. PURPOSE To perform a systematic review and meta-analysis to compare MMA and TSS configuration techniques for MMPRT repair and identify any differences between the 2 techniques in terms of clinical outcomes, medial meniscal extrusion (MME), and postoperative healing. STUDY DESIGN Meta-analysis; Level of evidence, 4. METHODS The Cochrane Controlled Register of Trials, PubMed, Medline, and Embase databases were used to perform a systematic review and meta-analysis using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria with the following search terms: ("meniscus" OR "meniscal injuries") AND ("Mason-Allen" OR "simple stitch" OR "suture techniques"). Data pertaining to all patient-reported outcome measures, postoperative complications, MME, postoperative healing, cartilage degeneration, and progression of knee osteoarthritis were extracted from each study. The pooled outcome data were analyzed using random- and fixed-effects models. RESULTS After abstract and full-text screening, 6 clinical studies were included. In total, there were 291 patients; 160 underwent MMA fixation, and 131 underwent the TSS technique. The majority of studies had similar surgical techniques regarding repair technique, suture material, tibial fixation, and number and position of tibial tunnels. There were no differences between the groups in terms of patient-reported outcome measures at 14.2 months. Both techniques were also similar in the degree of postoperative MME and meniscal healing. CONCLUSION Both suture configurations were equivalent in terms of clinical outcomes, the extent of meniscal extrusion, and postoperative healing. The TSS technique may offer advantages in terms of faster learning curve and shorter operative time. However, randomized controlled trials with large sample sizes, longer follow-up and assessment of chondral degeneration, and presence of knee osteoarthritis are required to assess whether a true difference exists, as the majority of included studies were limited by their retrospective design.
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Affiliation(s)
- Khalis Boksh
- Leicester Knee Unit, Department of Trauma and Orthopaedics, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Andre Martins
- Leicester Knee Unit, Department of Trauma and Orthopaedics, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Mohamed Elbashir
- Leicester Knee Unit, Department of Trauma and Orthopaedics, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Tarek Boutefnouchet
- Department of Mechanical Engineering, University of Birmingham, Birmingham, United Kingdom
| | - Randeep Aujla
- Leicester Knee Unit, Department of Trauma and Orthopaedics, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
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Jackson GR, Warrier AA, Wessels M, Khan ZA, Obioha O, McCormick JR, Kaplan DJ, Mameri ES, Knapik DM, Verma NN, Chahla J. A Systematic Review of Adverse Events and Complications After Isolated Posterior Medial Meniscus Root Repairs. Am J Sports Med 2024; 52:1109-1115. [PMID: 37129097 DOI: 10.1177/03635465231157758] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND Medial meniscus posterior root (MMPR) tears are recognized as a substantial cause of disability and morbidity. However, meniscus root repair, regardless of technique, is not without potential complications. PURPOSE To evaluate the reported incidence of complications and adverse events after isolated MMPR repair. 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) guidelines using Embase, PubMed, and Scopus databases with the following search terms combined with Boolean operators: "meniscus,""root," and "repair." Inclusion criteria consisted of level 1 to 4 human clinical studies in English or English-language translation reporting complications and adverse events after isolated posterior medial meniscus root repairs. The overall incidence of specific complications was estimated from the pooled sample of the included studies. RESULTS Eleven studies with a total pooled sample of 442 patients were identified. The mean patient age was 58.1 years, while the mean final follow-up time was 37.2 months (range, 12-84.8 months). The overall incidence of complications was 9.7% (n = 43/442), with the most commonly reported complication being progressive degenerative changes within the knee (10.4%; n = 25/240; n = 5 studies). A total of 1.25% (n = 3/240) of patients who experienced degenerative changes required conversion to total knee arthroplasty. Repair failures were reported in 3.1% (n = 10/327; n = 8 studies) of patients. CONCLUSION Repairing MMPR tears is critical in preventing accelerated progression of knee osteoarthritis in patients without significant knee osteoarthritis preoperatively. While this repair is still recommended and necessary in appropriate patients, this review found that the incidence of complications after isolated posterior medial meniscus root repair was 9.7%, primarily involving the presence of progressive degeneration, while repair failure was reported in 3% of patients.
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Affiliation(s)
- Garrett R Jackson
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Alec A Warrier
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Morgan Wessels
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Zeeshan A Khan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Obianuju Obioha
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Johnathon R McCormick
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Daniel J Kaplan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Enzo S Mameri
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
- Instituto Brasil de Tecnologia da Saúde, Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Orthopedics and Traumatology, Federal University of São Paulo (EPM-UNIFESP), São Paulo, São Paulo, Brazil
| | - Derrick M Knapik
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
- Department of Orthopaedic Surgery, Washington University and Barnes-Jewish Orthopedic Center, Chesterfield, Missouri, USA
| | - Nikhil N Verma
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Jorge Chahla
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
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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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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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Mameri ES, Kerzner B, Jackson GR, Jawanda H, Khan ZA, Kaplan DJ, Chahla J. Top Ten Pearls for a Successful Transtibial Pull-Out Repair of Medial Meniscal Posterior Root Tears With a Concomitant Centralization Stitch. Arthrosc Tech 2023; 12:e1039-e1049. [PMID: 37533905 PMCID: PMC10390883 DOI: 10.1016/j.eats.2023.02.053] [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: 12/29/2022] [Revised: 02/06/2023] [Accepted: 02/19/2023] [Indexed: 08/04/2023] Open
Abstract
Although historically overlooked, medial meniscus posterior root (MMPR) tears are now increasingly recognized as a substantial cause of biomechanical impairment and morbidity. MMPR tears, when left untreated, are strongly correlated to meniscal extrusion and ultimately lead to altered kinematics and loading functionally equivalent to a total meniscectomy. To prevent progressive joint degeneration and alleviate pain while re-establishing native joint kinematics, MMPR repair is generally recommended in appropriately selected patients. In this Technical Note, the authors describe a detailed checklist with 10 crucial points of emphasis when performing the gold-standard transtibial pull-out repair of the MMPR, with an additional centralization stitch, providing technical pearls backed up by previous literature and ample experience treating this condition.
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Affiliation(s)
- Enzo S. Mameri
- Midwest Orthopaedics at Rush, Chicago, Illinois
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
- Escola Paulista de Medicina, Federal University of São Paulo, São Paulo - SP, Brazil
- Instituto Brasil de Tecnologias da Saúde, Rio de Janeiro - RJ, Brazil
| | - Benjamin Kerzner
- Midwest Orthopaedics at Rush, Chicago, Illinois
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Garrett R. Jackson
- Midwest Orthopaedics at Rush, Chicago, Illinois
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Harry Jawanda
- Midwest Orthopaedics at Rush, Chicago, Illinois
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Zeeshan A. Khan
- Midwest Orthopaedics at Rush, Chicago, Illinois
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Daniel J. Kaplan
- Midwest Orthopaedics at Rush, Chicago, Illinois
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Jorge Chahla
- Midwest Orthopaedics at Rush, Chicago, Illinois
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
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6
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Wang H, Man Q, Gao Y, Xu L, Zhang J, Ma Y, Meng Q. The efficacy of medial meniscal posterior Root tear Repair with or without high tibial osteotomy: a systematic review. BMC Musculoskelet Disord 2023; 24:464. [PMID: 37280599 DOI: 10.1186/s12891-023-06520-9] [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: 01/19/2023] [Accepted: 05/11/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Medial meniscal posterior root tear (MMPRTs) is a common lesion of the knee joint, and repair surgery is a well-established treatment option. However, patients with obvious varus alignment are at an increased risk for MMPRT and can suffer from a greater degree of medial meniscus extrusion, which leads to the development of osteoarthritis following repair. The efficacy of high tibial osteotomy (HTO) as a means of correcting this malformation, and its potential benefits for MMPRT repair, remains unclear. PURPOSE To explore whether HTO influenced the outcome of MMPRT repair in clinical scores and radiological findings. STUDY DESIGN Systematic review. METHODS According to the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) guidelines, we searched PubMed, Embase, Web of Science, and the Cochrane Library databases for studies reporting the outcomes of MMPRT repair and extracted data about characteristics of patients, clinical functional scores and radiologic outcomes. One reviewer extracted the data and 2 reviewers assessed the risk of bias and performed a synthesis of the evidence. Articles were eligible if they reported the results of MMPRT repair with exact mechanical axis (registered in the International Prospective Register of Systematic Reviews, CRD42021292057). RESULTS Fifteen studies with 625 cases of high methodological quality were identified. Eleven studies were assigned to the MMPRT repair group (M) with 478 cases performing MMPRT repair only, and others belonged to the MMPRT repair and HTO group (M and T) performing HTO and MMPRT repair. Most of the studies had significantly improved clinical outcome scores, especially in M groups. And the radiologic outcomes showed that the osteoarthritis deteriorated in both groups with similar degree in about 2-year follow-up. CONCLUSION HTO is a useful supplement in treating MMPRT patients with severe osteoarthritis and the clinical and radiological outcomes were similar with MMPRT repair alone. Which would be better for patients' prognosis generally, performing MMPRT repair alone or a combination of HTO and MMPRT repair, was still controversial. We suggested taking K-L grade into account. Large-scale randomized control studies were called for in the future to help make better clinical decisions. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Hangle Wang
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Institute of Sports Medicine of Peking University, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
- Peking University Health Science Center, 38 Xueyuan Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Qian Man
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Institute of Sports Medicine of Peking University, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
- Peking Unversity First Hospital, 8 Xishiku Street, Xicheng District, Beijing, 100034, People's Republic of China
| | - Yitian Gao
- Peking University Health Science Center, 38 Xueyuan Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Lingyi Xu
- Peking Unversity First Hospital, 8 Xishiku Street, Xicheng District, Beijing, 100034, People's Republic of China
| | - Jingwei Zhang
- Peking University People's Hospital, No.11 Xizhimen South Street, Xicheng District, Beijing, 100044, People's Republic of China
| | - Yong Ma
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Institute of Sports Medicine of Peking University, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China.
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, People's Republic of China.
| | - Qingyang Meng
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Institute of Sports Medicine of Peking University, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China.
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, People's Republic of China.
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Khoo JR, Yau WP. Repair of meniscus root tear - Is there a difference between medial meniscus root repair and lateral meniscus root repair? A systematic review and meta-analysis. J Orthop Surg (Hong Kong) 2023; 31:10225536231175233. [PMID: 37173149 DOI: 10.1177/10225536231175233] [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] [Indexed: 05/15/2023] Open
Abstract
PURPOSE Complete meniscus root tear is associated with meniscus extrusion; this causes a loss of meniscus function and accelerated osteoarthritis of the knee. Existing small-scale retrospective case-control studies suggested that the outcomes were different between medial and lateral meniscus root repair. This meta-analysis aims to study whether such discrepancies exist via a systematic review of the available evidence in the literature. METHODS Studies evaluating the outcomes of surgical repair of posterior meniscus root tears, with reassessment MRI or second-look arthroscopy, were identified through a systematic search of PubMed, Embase, and Cochrane Library. The degree of meniscus extrusion, healing status of the repaired meniscus root, and functional outcome scores after repair were the outcomes of interest. RESULTS Among the 732 studies identified, 20 studies were included in this systematic review. 624 knees and 122 knees underwent MMPRT and LMPRT repair, respectively. The amount of meniscus extrusion following MMPRT repair was 3.8 ± 1.7 mm, which was significantly larger than the 0.9 ± 1.2 mm observed after LMPRT repair (p < 0.001). Significantly better healing outcomes were observed on reassessment MRI after LMPRT repair (p < 0.001). The postoperative Lysholm score and IKDC score was also significantly better after LMPRT than MMPRT repair (p < 0.001). CONCLUSIONS LMPRT repairs resulted in significantly less meniscus extrusion, substantially better healing outcomes on MRI, and superior Lysholm/IKDC scores, when compared to MMPRT repair. This is the first meta-analysis we are aware of that systematically reviews the differences in the clinical, radiographic, and arthroscopic results of MMPRT and LMPRT repair.
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Affiliation(s)
- Jun Ren Khoo
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
| | - W P Yau
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
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Shetty CC, Ming W, Lee YHD. Concomitant Medial and Lateral Meniscus Posterior Horn Root Repair With ACL Reconstruction Using Trans-Tibial Tunnel Technique. Arthrosc Tech 2023; 12:e477-e482. [PMID: 37138685 PMCID: PMC10149901 DOI: 10.1016/j.eats.2022.11.031] [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: 08/18/2022] [Accepted: 11/18/2022] [Indexed: 05/05/2023] Open
Abstract
Concomitant medial meniscus posterior horn root tears and lateral meniscus posterior horn root tears are rare in occurrence. There is limited literature on the simultaneous repair of medial and lateral meniscus root tears, with ACL reconstruction. We discuss management of concomitant medial meniscus posterior horn root tear (MMPHRT), lateral meniscus posterior horn root tear (LMPHRT), and anterior cruciate ligament (ACL) tear. We highlight the surgical technique in which we perform a repair of both medial and lateral meniscus posterior horn root repairs with ACL reconstruction. We explain the sequence of such a repair to avoid tunnel coalescence.
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Affiliation(s)
- Chandan C. Shetty
- Address correspondence to Chandan C. Shetty, M.B.B.S., D.Ortho, D.N.B. (Ortho), Department of Orthopaedic Surgery, National University Hospital, 5 Lower Kent Ridge Rd., Singapore 119074.
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9
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Does Accelerated Rehabilitation Provide Better Outcomes Than Restricted Rehabilitation in Postarthroscopic Repair of Meniscal Injury? J Sport Rehabil 2023; 32:335-345. [PMID: 36476967 DOI: 10.1123/jsr.2022-0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 09/25/2022] [Accepted: 10/11/2022] [Indexed: 12/12/2022]
Abstract
CONTEXT Meniscal injury is a common pathology, and the postoperative rehabilitation program is essential to patients after surgery. However, the optimal rehabilitation plan after meniscus suture is still controversial. OBJECTIVE To compare the clinical outcomes between accelerated rehabilitation and restricted programs in patients with meniscus suture (with or without anterior cruciate ligament reconstruction, ACLR). EVIDENCE ACQUISITION Four databases, including PubMed, Ovid, Embase, and the Cochrane Library, were searched up to November 2021. This study only included studies comparing the clinical outcomes between accelerated (immediate range of motion and weight-bearing) and restricted rehabilitation (immobilization and progressive weight-bearing) for meniscus suture. All selected studies were divided into 2 subgroups: isolated meniscus suture or combined with ACLR. The Lysholm score, Tegner score, and Knee Injury and Osteoarthritis Outcome Score were evaluated in simple meniscus sutures no less than 1 year. Failure rate was evaluated in both groups, and the tunnel enlargement was additionally evaluated in patients who underwent ACLR. EVIDENCE SYNTHESIS Eleven studies with 612 patients were eligible for analysis. The accelerated group included 4 studies with 330 participants, while the restricted group included 7 studies with 282 participants. For the patients after isolated meniscus suture, the accelerated group achieved higher Lysholm scores (mean difference = -4.66; 95% confidence interval, -8.6 to -0.73; P = .02; I2 = 88%) than the restricted group. For the patients after meniscus suture with ACLR, patients undergoing accelerated rehabilitation were associated with a significantly larger tibial tunnel enlargement in the anterior-posterior view (mean difference = -7.08; 95% confidence interval, -10.92 to -3.24; P = .0003; I2 = 0%) and lateral view (mean difference = -10.33; 95% confidence interval, -16.9 to -3.75; P = .002; I2 = 17%). CONCLUSION This meta-analysis evaluated the effects of postoperative rehabilitation in either accelerated or restricted programs in patients with meniscus lesions after repair. A significant higher mean self-reported function was discovered at final follow-ups in the accelerated group. However, a significant increase in tibial tunnel enlargement was also found in accelerated group.
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Hiranaka T, Furumatsu T, Yokoyama Y, Kintaka K, Higashihara N, Tamura M, Kawada K, Xue H, Hamada M, Ozaki T. The clinical and radiographic outcomes of type 2 medial meniscus posterior root tears following transtibial pullout repair. Knee Surg Sports Traumatol Arthrosc 2022; 31:2323-2330. [PMID: 36566386 DOI: 10.1007/s00167-022-07293-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 12/13/2022] [Indexed: 12/26/2022]
Abstract
PURPOSE The aim of this study was to compare the clinical outcomes of different subtypes of type 2 medial meniscus posterior root tears following transtibial pullout repair. METHODS In total, 147 patients (mean age: 66.2 ± 8.3 years) who were diagnosed with type 2 medial meniscus posterior root tears and underwent transtibial pullout repair were included. Patients were divided into 2A (n = 31), 2B (n = 90), and 2C (n = 26) groups according to tear type. Clinical outcomes were assessed pre-operatively and at second-look arthroscopy using the Knee injury and Osteoarthritis Outcome Score. The meniscal healing status was evaluated at second-look arthroscopy. Medial meniscus extrusion was calculated using magnetic resonance imaging pre-operatively and at second-look arthroscopy. RESULTS No significant differences in pre-operative or post-operative clinical scores were observed between each subtype, although clinical scores improved post-operatively for each subtype. Significant differences were noted in the anteroposterior width of the bridging tissues at second-look arthroscopy (2A, 7.1 ± 1.2; 2B, 6.2 ± 1.7; and 2C, 6.2 ± 1.7 mm; p = 0.045); type 2A tears were the widest. There was a significant difference in post-operative medial meniscus extrusion (2A, 3.2 ± 0.9; 2B, 4.0 ± 1.2; and 2C, 4.0 ± 1.4 mm; p = 0.004) and its progression (2A, 0.7 ± 0.6; 2B, 1.2 ± 0.8; and 2C, 1.2 ± 0.8 mm; p = 0.008), and type 2A tears were the shortest. CONCLUSION Although there was no significant difference in the post-operative clinical scores among different type 2 tears in the short term, type 2A tears showed better healing and medial meniscus extrusion progression prevention, thus indicating the usefulness of classifying tear type in estimating post-operative outcomes. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Takaaki Hiranaka
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan.,Department of Orthopaedic Surgery, Ako Central Hospital, 52‑6 Sohmon‑cho, Ako, Hyogo, 678‑0241, Japan
| | - Takayuki Furumatsu
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan.
| | - Yusuke Yokoyama
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Keisuke Kintaka
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Naohiro Higashihara
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Masanori Tamura
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Koki Kawada
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Haowei Xue
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Masanori Hamada
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
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Li H, Nie S, Lan M. Medial meniscus posterior root tear reconstructed with gracilis autograft improve healing rate and patient reported outcome measures. BMC Musculoskelet Disord 2022; 23:1094. [PMID: 36517773 PMCID: PMC9749208 DOI: 10.1186/s12891-022-06067-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Many surgeries have not reversed or prevented progressive symptomatic knee arthritis, and there is no consensus regarding the ideal repair or reconstruction technique for meniscal root treatment. Additionally, there is a lack of studies comparing the clinical efficacy evaluation of different repair techniques. The aim of the present study is to compare the clinical efficacy and healing rates of meniscus root in the treatment of medial meniscus posterior root tear (MMPRT) with the arthroscopically assisted meniscus root reconstruction with gracilis autograft and transtibial pull-out technique. METHODS Patients with MMPRT (type II) who received treatment of posterior meniscus root attachment point through the tibial tunnel between January 2018 and April 2019 were included in this study. Patients were divided into 2 groups (arthroscopically assisted gracilis autograft reconstruction technique: 29 cases; transtibial pull-out technique group: 35 cases) according to the different treatment methods. The mean follow-up period was 26.9 ± 2.3 months. The demographics, functional recovery of the knee, and meniscus root healing rates (assessed using knee magnetic resonance imaging (MRI) at the final follow-up) were compared between the two groups. RESULTS There was a statistically significant improvement in the Lysholm score, international knee documentation committee (IKDC) score, and visual analogue scale (VAS) score (P < 0.001 in both groups). Additionally, compared with the transtibial pull-out repair group, the arthroscopically assisted reconstruction with gracilis autograft showed significant improvement in the meniscus root healing rates, Lysholm score, and IKDC score at the end of follow-up (P < 0.05). CONCLUSIONS Compared with the transtibial pull-out technique, the arthroscopically assisted meniscus root reconstruction with gracilis autograft was advantageous for treating these patients with superior clinical outcome and higher meniscus root healing rates. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Hongbo Li
- grid.415002.20000 0004 1757 8108Department of Orthopedic Surgery, Jiangxi Provincial People’s Hospital (The First Affiliated Hospital of Nanchang Medical College), No.92 Aiguo Road, Donghu District, 330006 Nanchang, Jiangxi Province People’s Republic of China
| | - Si Nie
- grid.415002.20000 0004 1757 8108Department of Radiology, Jiangxi Provincial People’s Hospital (The First Affiliated Hospital of Nanchang Medical College), Nanchang, 330006 People’s Republic of China
| | - Min Lan
- grid.415002.20000 0004 1757 8108Department of Orthopedic Surgery, Jiangxi Provincial People’s Hospital (The First Affiliated Hospital of Nanchang Medical College), No.92 Aiguo Road, Donghu District, 330006 Nanchang, Jiangxi Province People’s Republic of China
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12
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Jin P, Liu L, Chen X, Cheng L, Zhang W, Zhong G. Applications and prospects of different functional hydrogels in meniscus repair. Front Bioeng Biotechnol 2022; 10:1082499. [PMID: 36568293 PMCID: PMC9773848 DOI: 10.3389/fbioe.2022.1082499] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 11/28/2022] [Indexed: 12/14/2022] Open
Abstract
The meniscus is a kind of fibrous cartilage structure that serves as a cushion in the knee joint to alleviate the mechanical load. It is commonly injured, but it cannot heal spontaneously. Traditional meniscectomy is not currently recommended as this treatment tends to cause osteoarthritis. Due to their good biocompatibility and versatile regulation, hydrogels are emerging biomaterials in tissue engineering. Hydrogels are excellent candidates in meniscus rehabilitation and regeneration because they are fine-tunable, easily modified, and capable of delivering exogenous drugs, cells, proteins, and cytokines. Various hydrogels have been reported to work well in meniscus-damaged animals, but few hydrogels are effective in the clinic, indicating that hydrogels possess many overlooked problems. In this review, we summarize the applications and problems of hydrogels in extrinsic substance delivery, meniscus rehabilitation, and meniscus regeneration. This study will provide theoretical guidance for new therapeutic strategies for meniscus repair.
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Affiliation(s)
- Pan Jin
- Health Science Center, Yangtze University, Jingzhou, China,Collaborative Innovation Centre of Regenerative Medicine and Medical BioResource Development and Application Co-constructed by the Province and Ministry, Guangxi Medical University, Nanning, China,*Correspondence: Pan Jin, ; Gang Zhong,
| | - Lei Liu
- Articular Surgery, The Second Nanning People’s Hospital (Third Affiliated Hospital of Guangxi Medical University), Nanning, China
| | - Xichi Chen
- Health Science Center, Yangtze University, Jingzhou, China
| | - Lin Cheng
- Health Science Center, Yangtze University, Jingzhou, China
| | - Weining Zhang
- Health Science Center, Yangtze University, Jingzhou, China
| | - Gang Zhong
- Center for Materials Synthetic Biology, CAS Key Laboratory of Quantitative Engineering Biology, Shenzhen Institute of Synthetic Biology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China,*Correspondence: Pan Jin, ; Gang Zhong,
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13
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Perry AK, Lavoie-Gagne O, Knapik DM, Maheshwer B, Hodakowski A, Gursoy S, LaPrade RF, Chahla J. Examining the Efficacy of Medial Meniscus Posterior Root Repair: A Meta-analysis and Systematic Review of Biomechanical and Clinical Outcomes. Am J Sports Med 2022:3635465221077271. [PMID: 35384728 DOI: 10.1177/03635465221077271] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Medial meniscus posterior root (MMPR) injuries accelerate the progression of osteoarthritis. While partial meniscectomy was once considered the gold standard for treatment, meniscus root repair has become increasingly utilized with reported improvements in clinical and biomechanical outcomes. PURPOSE To perform a systematic review of biomechanical outcomes and a meta-analysis of clinical and radiographic outcomes after MMPR repair. STUDY DESIGN Meta-analysis and systematic review; Level of evidence, 4. METHODS The PubMed, Embase, and Cochrane databases were queried in August 2021 for studies reporting biomechanical, clinical, and radiographic outcomes after MMPR repair. Biomechanical studies were assessed for main results and conclusions. Data including study characteristics, cohort demographics, and outcomes were extracted. Included clinical studies were analyzed with a random-effects meta-analysis of proportions for binary outcomes or continuous outcomes for mean differences between preoperative and postoperative time points. Subgroup analysis for studies reporting repair outcomes with concomitant high tibial osteotomy (HTO) was performed where appropriate. RESULTS A total of 13 biomechanical studies were identified and reported an overall improvement in mean and peak contact pressures after MMPR repair. There were 24 clinical studies, consisting of 876 patients (877 knees), identified, with 3 studies (106 knees) reporting outcomes with concomitant HTO. The mean patient age was 57.1 years (range, 23-74 years), with a mean follow-up of 27.7 months (range, 2-64 months). Overall, clinical outcomes (Lysholm, Hospital for Special Surgery, International Knee Documentation Committee, visual analog scale for pain, Tegner, and Knee injury and Osteoarthritis Outcome Score scores) were noted to improve postoperatively compared with preoperatively, with improved Lysholm scores in patients undergoing concomitant HTO versus MMPR repair alone. Meniscal extrusion was not significantly improved after MMPR repair compared with preoperative measurements. The progression in Kellgren-Lawrence grades from grade 0 to grades 1 to 3 occurred in 5.9% (21/354) of patients after repair, with no patients progressing from grades 1 to 3 to grade 4. CONCLUSION MMPR repair generally improved biomechanical outcomes and led to improved patient-reported outcomes with greater improvements noted in patients undergoing concomitant HTO. Repair did not significantly improve meniscal extrusion, while only 5.9% of patients were noted to progress to low-grade osteoarthritis. The high level of heterogeneity in the included biomechanical and clinical investigations emphasizes the need for more well-designed studies that evaluate outcomes after MMPR repair.
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Affiliation(s)
- Allison K Perry
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Ophelie Lavoie-Gagne
- Department of Orthopaedics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Derrick M Knapik
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | | | - Alexander Hodakowski
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Safa Gursoy
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | | | - Jorge Chahla
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
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Chang PS, Radtke L, Ward P, Brophy RH. Midterm Outcomes of Posterior Medial Meniscus Root Tear Repair: A Systematic Review. Am J Sports Med 2022; 50:545-553. [PMID: 33780278 DOI: 10.1177/0363546521998297] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Whereas there has been growing interest in surgical repair of posterior medial meniscus root tears (PMMRTs), our understanding of the medium- and long-term results of this procedure is still evolving. PURPOSE To report midterm clinical outcomes from PMMRT repairs. STUDY DESIGN Systematic review. METHODS A literature review for this systematic analysis was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We identified studies that reported the results of arthroscopic repair of PMMRTs. Functional and imaging outcomes were reviewed and summarized. RESULTS In total, 28 studies with a total of 994 patients (83% female) with an overall mean age of 57.1 were included in this review. Clinical outcomes (Lysholm, International Knee Documentation Committee, Hospital for Special Surgery, and Tegner scores) were improved at final follow-up in all studies. Of patients, 49% had radiographic progression of at least 1 grade in the Kellgren-Lawrence scale at a mean follow-up of 4.0 years in 11 studies. Cartilage degeneration had progressed at least 1 grade on magnetic resonance imaging scans in 23% of patients at a mean follow-up of 31.6 months in 4 studies. CONCLUSION PMMRT repairs provide a functional benefit with consistent improvements in clinical outcome scores. There is some evidence that PMMRT repair slows the progression of osteoarthritis but does not prevent it at midterm follow-up.
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Affiliation(s)
- Peter S Chang
- Department of Orthopaedic Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Logan Radtke
- Sanford School of Medicine, University of South Dakota, Sioux Falls, South Dakota, USA
| | - Patrick Ward
- Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Robert H Brophy
- Department of Orthopaedic Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
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Furumatsu T, Hiranaka T, Okazaki Y, Kintaka K, Kodama Y, Kamatsuki Y, Ozaki T. Medial meniscus posterior root repairs: A comparison among three surgical techniques in short-term clinical outcomes and arthroscopic meniscal healing scores. J Orthop Sci 2022; 27:181-189. [PMID: 33581924 DOI: 10.1016/j.jos.2020.11.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 10/09/2020] [Accepted: 11/24/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Medial meniscus (MM) posterior root repairs lead to favorable clinical outcomes in patients with MM posterior root tears (MMPRTs). However, there are few comparative studies in evaluating the superiority among several pullout repair techniques such as modified Mason-Allen suture, simple stitch, and concomitant posteromedial pullout repair. We hypothesized that an additional pullout suture at the MM posteromedial part would have clinical advantages in transtibial pullout repairs of the MMPRTs. The aim of this study was to compare the clinical usefulness among several types of pullout repair techniques in patients with MMPRTs. METHODS Eighty-three patients who underwent arthroscopic pullout repairs of the MMPRTs were investigated. Patients were divided into three groups using different pullout repair techniques: a modified Mason-Allen suture using FasT-Fix all-inside meniscal repair device (F-MMA, n = 28), two simple stitches (TSS, n = 30), and TSS concomitant with posteromedial pullout repair using all-inside meniscal repair device (TSS-PM, n = 25). Postoperative clinical outcomes and semi-quantitative arthroscopic meniscal healing scores (0-10 points) were evaluated at second-look arthroscopies. RESULTS No significant differences among the three groups were observed in patient demographics and preoperative clinical scores, except for preoperative Lysholm scores. At second-look arthroscopies, there were no significant differences among the three techniques in postoperative clinical outcomes and meniscal healing scores. CONCLUSIONS This study demonstrated that the TSS-PM pullout repair technique did not show better scores in postoperative clinical outcomes and meniscal healings compared with the F-MMA and TSS techniques. Our results suggest that the concomitant posteromedial pullout suture may have no clinical advantage in the conventional pullout repairs for the patients with MMPRTs.
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Affiliation(s)
- Takayuki Furumatsu
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan.
| | - Takaaki Hiranaka
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Yuki Okazaki
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Keisuke Kintaka
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Yuya Kodama
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Yusuke Kamatsuki
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
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Lateral meniscal posterior root tears experience acceptable healing status after transtibial repair technique. J Exp Orthop 2021; 8:114. [PMID: 34888755 PMCID: PMC8660950 DOI: 10.1186/s40634-021-00433-z] [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: 09/29/2021] [Accepted: 11/17/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To evaluate patient MRI results, demography and clinical outcome following transtibial repair of lateral and medial meniscal posterior root tears. METHODS Patients treated with transtibial repairs of posterior meniscal root tears from 2015 through 2018 performed pre- and postoperative MRI scans. Outcome measures were continuity/discontinuity of the meniscal root and change in meniscal extrusion on MRI. Other outcomes were KOOS, Lysholm score, Tegner activity scale and the Global Rate of Change (GRoC) score for function and pain at follow-up. STUDY DESIGN Retrospective case-series. RESULTS Of 41 patients, 36 attended follow-up at mean 26 (12-38) months postoperatively. At follow-up, 11 out of 18 lateral meniscus posterior root tear (LMPRT) versus 5 out of 18 medial meniscus posterior root tear (MMPRT) repairs were classified as healed. Meniscal extrusion decreased in LMPRTs from of 2.3 ± 1.5 mm to 1.4 ± 1.09 mm (p = 0.080) and increased in MMPRTs from 3.1 ± 1.6 mm to 4.8 ± 1.9 mm (p = 0.005) at FU (between-group difference, p < 0.001). LMPRT repairs were associated with ACL injury and additional meniscal injury and were younger and with lower BMI. No between-group differences were found for KOOS, Lysholm or GRoC Function scores. Tegner scale was higher and GRoC Pain score lower in the LMPRT group compared to the MMPRTs. CONCLUSION Following transtibial repair for meniscal posterior root repairs, the LMPRTs had a higher frequency of healing, whereas most MMPRTs continued to extrude, despite surgical intervention. The study confirmed that LMPRTs and MMPRTs differ in demography and associated injuries.
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Wang L, Zhang K, Liu X, Liu Z, Yi Q, Jiang J, Xia Y. The efficacy of meniscus posterior root tears repair: A systematic review and meta-analysis. J Orthop Surg (Hong Kong) 2021; 29:23094990211003350. [PMID: 33832364 DOI: 10.1177/23094990211003350] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To report of efficacy repair treatment for meniscus posterior root tears repair. METHODS We systematically searched databases including PubMed, Embase, and Cochrane Library for relevant articles. Coleman Methodology Score was used for a quality assessment of the included studies. A meta-analysis was performed to analyze for efficacy of MMPRTs repair. RESULTS Twenty-two studies, 14 level III and 8 level IV, were included in this systematic review, with a total of 926 cases. Studies comparing repair with either meniscectomy or conservative treatment found greater improvement and slower progression of Kellgrene-Lawrence grade with meniscal repair. Decreased meniscus extrusion is beneficial to the prognosis of patients undergoing MMPRTs repair. As treatment efficacy, the Lysholm score increased 28.87 (P < 0.001), IKDC score increased 31.73. The overall pooled event rates of progression of K-L grade is 0.200. Difference of Lysholm score and IKDC score between repair and meniscectomy were 8.72 and 9.67. CONCLUSIONS The clinical subjective score after MMPRT repair was significantly improved compared with the preoperative status. Considering the progression of joint K-L grade, it can prevent the progression of arthrosis to some extent, but not completely. Decreased meniscus extrusion is beneficial to the prognosis of patients undergoing MMPRTs repair. Based on these results, MMPRTs repair cloud result favorable outcomes.
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Affiliation(s)
- Lifu Wang
- Department of Orthopedics, The Second Clinical Medical College of Lanzhou University, Lanzhou, Gansu, People's Republic of China
| | - Kun Zhang
- Department of Orthopedics, The Second Clinical Medical College of Lanzhou University, Lanzhou, Gansu, People's Republic of China
| | - Xuening Liu
- Department of Orthopedics, The Second Clinical Medical College of Lanzhou University, Lanzhou, Gansu, People's Republic of China
| | - Zhongcheng Liu
- Department of Orthopedics, The Second Clinical Medical College of Lanzhou University, Lanzhou, Gansu, People's Republic of China
| | - Qiong Yi
- Department of Orthopedics, The Second Clinical Medical College of Lanzhou University, Lanzhou, Gansu, People's Republic of China
| | - Jin Jiang
- Gansu Key Laboratory of Orthopaedics, Department of Orthopedics, 74713Lanzhou University Second Hospital, Lanzhou, Gansu, People's Republic of China
| | - Yayi Xia
- Gansu Key Laboratory of Orthopaedics, Department of Orthopedics, 74713Lanzhou University Second Hospital, Lanzhou, Gansu, People's Republic of China
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