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Meng XY, Li ZQ, Ding HF, Wang DY, Dai LH, Jiang D. A Novel Ultrasound Method of Evaluating Dynamic Extrusion of Lateral Meniscus in Healthy Population: Different Patterns of Dynamic Extrusion Revealed Between Lateral and Medial Meniscus. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024. [PMID: 38975721 DOI: 10.1002/jum.16507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 05/21/2024] [Accepted: 05/27/2024] [Indexed: 07/09/2024]
Abstract
OBJECTIVES To establish a reliable ultrasound (US) method of evaluating dynamic extrusion of lateral meniscus in healthy population, and to investigate the pattern of dynamic meniscus extrusion (ME) in lateral meniscus under loading conditions. METHODS The lateral ME was examined via US method in unloaded, double-leg standing, and single-leg standing positions. Two different US measurement methods were compared to the magnetic resonance imaging (MRI) results to determine the optimal measurement methods. The US results obtained by different researchers were tested for interobserver consistency and the results obtained by the same researcher on two separate days were tested for intraobserver consistency. The patterns of dynamic extrusion were compared between medial and lateral sides. RESULTS A total of healthy 44 volunteers were included in the study, with 86 knees assessed by US, and 25 knees evaluated by MRI. The US evaluation of dynamic lateral ME demonstrated excellent interobserver and intraobserver reliability. The US measurements using method A were consistent with the MRI results with no significant difference (P = .861, intraclass correlation coefficient [ICC] = 0.868), while method B underestimated the lateral ME compared to MRI (P = .001, ICC = 0.649). Lateral ME decreased slightly from unloaded (1.0 ± 0.8 mm) to single-leg standing position (0.8 ± 0.8 mm), whereas medial ME increased significantly in both double-leg and single-leg standing positions (2.4 ± 0.7 mm, 2.6 ± 0.7 mm). CONCLUSION A novel US evaluation method of lateral ME was established with reliable and accurate results compared to the MRI. Lateral ME in healthy populations decreased slightly as the loadings increased, which was different from the pattern of dynamic extrusion in medial meniscus.
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Affiliation(s)
- Xiang-Yu Meng
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
- Institute of Sports Medicine, Peking University, Beijing, China
| | - Zhi-Qiang Li
- Department of Ultrasound Medicine, Peking University Third Hospital, Beijing, China
| | - Hong-Fu Ding
- Department of Ultrasound Medicine, People's Hospital of Ningxia Autonomous Region, Yinchuan, China
| | - Ding-Yu Wang
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
- Institute of Sports Medicine, Peking University, Beijing, China
| | - Ling-Hui Dai
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
| | - Dong Jiang
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
- Institute of Sports Medicine, Peking University, Beijing, China
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Johnson SE, Kruse RC, Boettcher BJ. The Role of Ultrasound in the Diagnosis and Treatment of Meniscal Injuries. Curr Rev Musculoskelet Med 2024; 17:171-184. [PMID: 38639869 DOI: 10.1007/s12178-024-09894-y] [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] [Accepted: 03/27/2024] [Indexed: 04/20/2024]
Abstract
PURPOSE OF REVIEW This review evaluates the current understanding of the role of ultrasound in the diagnosis and treatment of meniscal disorders. RECENT FINDINGS Ultrasound (US) demonstrates similar sensitivity and specificity when compared to magnetic resonance imaging in the evaluation of meniscal injuries when compared to arthroscopy. Meniscal extrusion (ME) under US can be a reliable metric to evaluate for meniscal root tears in knees with and without osteoarthritis (OA). Sonographic ME is associated with development of OA in knees without OA. US following allograft meniscal transplant may be useful in predicting graft failure. US findings can be used to screen for discoid menisci and may demonstrate snapping of a type 3 discoid lateral meniscus. Shear wave elastography for meniscal injuries is in its infancy; however, increased meniscal stiffness may be seen with meniscal degeneration. Perimeniscal corticosteroid injections may provide short term relief from meniscal symptoms, and intrameniscal platelet-rich plasma injections appear to be safe and effective up to three years. Ultrasound-assisted meniscal surgery may increase the safety of all inside repairs near the lateral root and may assist in assessing meniscal reduction following root repair. Diagnostic US can demonstrate with high accuracy a variety of meniscal pathologies and can be considered a screening tool. Newer technologies such as shear wave elastography may allow us to evaluate characteristics of meniscal tissue that is not possible on conventional imaging. US-guided (USG) treatment of meniscal injuries is possible and may be preferable to surgery for the initial treatment of degenerative meniscal lesions. USG or US-assisted meniscal surgery is in its infancy.
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Affiliation(s)
- Shelby E Johnson
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
- Department of Orthopedic Surgery, Division of Sports Medicine, Mayo Clinic, Minneapolis, MN, USA
| | - Ryan C Kruse
- Department of Orthopedics and Rehabilitation, University of Iowa Sports Medicine, Iowa City, IA, USA
| | - Brennan J Boettcher
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA.
- Department of Orthopedic Surgery, Division of Sports Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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Shimozaki K, Nakase J, Kanayama T, Yanatori Y, Oshima T, Asai K, Shima Y, Tsuchiya H. Ultrasonographic diagnosis of medial meniscus posterior root tear in early knee osteoarthritis: a comparative study. Arch Orthop Trauma Surg 2024; 144:281-287. [PMID: 37750911 DOI: 10.1007/s00402-023-05068-6] [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: 01/30/2023] [Accepted: 09/03/2023] [Indexed: 09/27/2023]
Abstract
INTRODUCTION This study aimed to detect medial meniscal posterior root tear (MMPRT) diagnostic methods with high sensitivity and specificity using dynamic ultrasonographic evaluation in patients with early knee osteoarthritis (OA) and demonstrate the usefulness of dynamic ultrasonographic medial meniscal extrusion (MME) evaluation in MMPRT diagnosis using a cutoff value. MATERIALS AND METHODS Between 2018 and 2020, a total of 120 patients were diagnosed with early knee OA using clinical and radiographic findings. Dynamic ultrasonographic evaluations and magnetic resonance imaging were performed in all patients, and 47 patients who had and 73 patients who did not have MMPRT were classified into the MMPRT and non-MMPRT groups, respectively. Age, sex, femorotibial angle, MME of knee extension and flexion, and MME at weight-bearing were compared between the two groups. Additionally, the sensitivity and specificity of significant ultrasonographic findings were calculated using a receiver operating characteristic (ROC) curve. RESULTS The MMEs under knee extension-flexion and weight-loading in the MMPRT group were significantly larger than those in the non-MMPRT group. ROC curve analysis for each ultrasonographic evaluation condition to diagnose MMPRT indicated that the sensitivity was 72-88% and the specificity was 66-85% when the cutoff values of MME under knee flexion at 0°, 90°, and weight-loading were set at 2.55 mm, 2.00 mm, and 3.55 mm, respectively. The highest sensitivity (88%) and specificity (85%) were exhibited upon > 2 mm MME at a knee flexion of 90° and were the most useful indicators for MME diagnosis. CONCLUSIONS Ultrasonographic MME evaluations for MMPRT diagnosis showed relatively high sensitivity and specificity in patients with early knee OA. Dynamic ultrasonographic MME evaluation may lead to appropriate additional examinations, early diagnosis, and intervention for MMPRT in patients with early knee OA.
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Affiliation(s)
- Kengo Shimozaki
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-Machi, Kanazawa-Shi, Ishikawa-Ken, 920-8641, Japan
| | - Junsuke Nakase
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-Machi, Kanazawa-Shi, Ishikawa-Ken, 920-8641, Japan.
| | - Tomoyuki Kanayama
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-Machi, Kanazawa-Shi, Ishikawa-Ken, 920-8641, Japan
| | - Yusuke Yanatori
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-Machi, Kanazawa-Shi, Ishikawa-Ken, 920-8641, Japan
| | - Takeshi Oshima
- Department of Orthopedic Surgery, Asanogawa General Hospital, Kanazawa, Japan
| | - Kazuki Asai
- Department of Orthopedic Surgery, KKR Hokuriku Hospital, Kanazawa, Japan
| | - Yosuke Shima
- Department of Orthopedic Surgery, KKR Hokuriku Hospital, Kanazawa, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-Machi, Kanazawa-Shi, Ishikawa-Ken, 920-8641, Japan
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Liao X, Li H, Nie S, Lan M. Risk factors of incomplete healing following medial meniscus posterior root tear repair with gracilis tendon. Sci Rep 2023; 13:22978. [PMID: 38151519 PMCID: PMC10752884 DOI: 10.1038/s41598-023-50358-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] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 12/19/2023] [Indexed: 12/29/2023] Open
Abstract
To evaluate the clinical efficacy and meniscus healing rates of the arthroscopically assisted tendon graft fixation of the medial meniscus posterior root tears (MMPRTs), and to identify some independent risk factors correlated with meniscal root healing status. We conducted a retrospective study with 129 patients who received arthroscopically assisted tendon graft fixation of the MMPRTs between January 2018 and September 2021. Functional recovery of the knee was evaluated and meniscal root healing status was assessed. The associations between different clinical factors and meniscal root healing status were analyzed. 98 (76.0%) patients had complete meniscal root healing with a minimum 2-year follow-up, and the Lysholm score, international knee documentation committee score, and visual analogue scale score were significantly improved at final follow-up (P < 0.001; respectively). Binary logistic regression models analysis and the receiver operating characteristic curve was performed to detect independent risk factors for incomplete healing, and these results indicated that age (OR = 1.095, P = 0.039), body mass index (BMI) (OR = 1.259, P = 0.018), preoperative meniscus extrusion (OR = 5.181, P < 0.001) and varus degree (OR = 7.764, P < 0.001) were the independent risk factors correlated with incomplete healing in patients with repaired MMPRTs. In conclusion, the arthroscopically assisted tendon graft fixation of the MMPRTs can provide good clinical and radiological outcome. Additionally, we identified age > 37.5 years, BMI > 24.5 kg/m2, preoperative meniscus extrusion > 2.7 mm and varus degree > 3.3° as independent risk factors correlated with incomplete meniscus root healing status.
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Affiliation(s)
- 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, 330006, Jiangxi Province, 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, 330006, Jiangxi Province, People's Republic of China
| | - 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
| | - 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, 330006, Jiangxi Province, People's Republic of China.
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Nevalainen MT, Uusimaa AP, Saarakkala S. The ultrasound assessment of osteoarthritis: the current status. Skeletal Radiol 2023; 52:2271-2282. [PMID: 37060461 PMCID: PMC10509065 DOI: 10.1007/s00256-023-04342-3] [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: 10/11/2022] [Revised: 03/17/2023] [Accepted: 04/10/2023] [Indexed: 04/16/2023]
Abstract
Traditionally, osteoarthritis (OA) is diagnosed with the clinical examination supplemented by the conventional radiography (CR). In the research literature, the role of ultrasound (US) imaging in the diagnostics of OA has risen steadily during the last two decades. US imaging is cheap and globally widely available often already in primary healthcare. Here, we reviewed the most essential US literature focusing on OA diagnostics and progression prediction using the various search engines. Starting from the year 2000, our search provided 1 445 journal articles. After reviewing the abstracts, 89 articles were finally included. Most of the reviewed articles focused on the imaging of knee and hand OA, whereas only a minority dealt with the imaging of hip, ankle, midfoot, acromioclavicular, and temporomandibular joints. Overall, during the last 20 years, the use of US imaging for OA assessment has increased in the scientific literature. In knee and hand joints, US imaging has been reported to be a promising tool to evaluate OA changes. Furthermore, the reproducibility of US as well as its association to MRI findings are excellent. Importantly, US seems to even outperform CR in certain aspects, such as detection of osteophytes, joint inflammation, meniscus protrusion, and localized cartilage damage (especially at the medial femoral condyle and sulcus area). Based on the reviewed literature, US can be truly considered as a complementary tool to CR in the clinical setup for OA diagnostics. New technical developments may even enhance the diagnostic value of the US in the future.
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Affiliation(s)
- Mika T Nevalainen
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, POB 5000, FI-90014, Oulu, Finland.
- Department of Diagnostic Radiology, Oulu University Hospital, P.O. Box 50, 90029, Oulu, Finland.
| | - Antti-Pekka Uusimaa
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, POB 5000, FI-90014, Oulu, Finland
| | - Simo Saarakkala
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, POB 5000, FI-90014, Oulu, Finland
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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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Demehri S, Kasaeian A, Roemer FW, Guermazi A. Osteoarthritis year in review 2022: imaging. Osteoarthritis Cartilage 2023; 31:1003-1011. [PMID: 36924919 DOI: 10.1016/j.joca.2023.03.005] [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: 10/31/2022] [Revised: 02/17/2023] [Accepted: 03/08/2023] [Indexed: 03/18/2023]
Abstract
PURPOSE This narrative review summarizes original research focusing on imaging in osteoarthritis (OA) published between April 1st 2021 and March 31st 2022. We only considered English publications that were in vivo human studies. METHODS The PubMed, Medline, Embase, Scopus, and ISI Web of Science databases were searched for "Osteoarthritis/OA" studies based on the search terms: "Radiography", "Ultrasound/US", "Computed Tomography/CT", "DXA", "Magnetic Resonance Imaging/MRI", "Artificial Intelligence/AI", and "Deep Learning". This review highlights the anatomical focus of research on the structures within the tibiofemoral, patellofemoral, hip, and hand joints. There is also a noted focus on artificial intelligence applications in OA imaging. RESULTS Over the last decade, the increasing trend of using open-access large databases has reached a plateau (from 17 to 37). Compositional MRI has had the most prominent use in OA imaging and its biomarkers have been used in the detection of preclinical OA and prediction of OA outcomes. Most noteworthy, there has been an accelerated rate of publications on the implications of artificial intelligence, used in developing prediction models and performing trabecular texture analysis, in OA imaging (from 17 to 154). CONCLUSIONS While imaging has maintained its key role in OA research, publication trends have shown an emphasis on the integration of AI. During the past year, MRI has maintained the highest prevalence in usage while US and CT remain as readily available modalities. Finally, there has been a notable uptake in the development and validation of AI techniques used to perform texture analysis and predict OA progression.
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Affiliation(s)
- S Demehri
- Musculoskeletal Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - A Kasaeian
- Musculoskeletal Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - F W Roemer
- Department of Radiology, Boston University School of Medicine, Boston, MA, USA; Department of Radiology, Universitätsklinikum Erlangen & Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
| | - A Guermazi
- Department of Radiology, Boston University School of Medicine, Boston, MA, USA.
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Moon HS, Choi CH, Jung M, Chung K, Jung SH, Kim YH, Kim SH. Medial Meniscus Posterior Root Tear: How Far Have We Come and What Remains? MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1181. [PMID: 37511993 PMCID: PMC10386469 DOI: 10.3390/medicina59071181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/16/2023] [Accepted: 06/19/2023] [Indexed: 07/30/2023]
Abstract
Medial meniscus posterior root tears (MMRTs), defined as tears or avulsions that occur within 1 cm of the tibial attachment of the medial meniscus posterior root, lead to biomechanically detrimental knee conditions by creating a functionally meniscal-deficient status. Given their biomechanical significance, MMRTs have recently been gaining increasing interest. Accordingly, numerous studies have been conducted on the anatomy, biomechanics, clinical features, diagnosis, and treatment of MMRTs, and extensive knowledge has been accumulated. Although a consensus has not yet been reached on several issues, such as surgical indications, surgical techniques, and rehabilitation protocols, this article aimed to comprehensively review the current knowledge on MMRTs and to introduce the author's treatment strategies.
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Affiliation(s)
- Hyun-Soo Moon
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
- Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea
| | - Chong-Hyuk Choi
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Min Jung
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Kwangho Chung
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
- Department of Orthopedic Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin 16995, Republic of Korea
| | - Se-Han Jung
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
- Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea
| | - Yun-Hyeok Kim
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Sung-Hwan Kim
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
- Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea
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