Does meniscectomy have any advantage over conservative treatment in middle-aged patients with degenerative medial meniscus posterior root tear?

Long-term clinical and radiological outcomes after arthroscopic partial meniscectomy on stable knees are better for traumatic tears when compared to degenerative lesions: A systematic review

PURPOSE

An arthroscopic partial meniscectomy (APM) for degenerative meniscus lesions and traumatic meniscus tears are two distinct entities and their long-term outcomes are rarely reported. The aim of this review was to compare the long-term (clinical and radiological) results of APM performed on stable knees for traumatic tears (TT) or degenerative lesions (DL).

METHODS

Pubmed, Scopus and Embase databases were searched to identify relevant studies published between 2010 and 2023 using the keywords 'meniscectomy' OR 'meniscectomies' OR 'meniscal resection'. English-language, Levels I-IV evidence studies reporting either radiographic or clinical outcome measures with a minimum of 6 years' follow-up after APM were included. Studies including discoid meniscus, open meniscectomy, unstable knee and combination with other procedures were excluded. To rate the quality of evidence, the methodological index for non-randomized studies was used.

RESULTS

Thirty-two studies were included, with follow-up periods ranging from 6 to 22 years. Eleven studies dealt with TT with a mean age of 31.5 ± 6.6 years and a mean follow-up of 11.6 ± 6.9 years. At the last follow-up, radiographic osteoarthritis (OA) ranged from 36% to 76%, with an average rate of 48 ± 19%; functional scores ranged from 71 to 97, with a mean of 90 ± 4 for the Lysholm score, 86 ± 10 for the International Knee Documentation Committee (IKDC) and 94 ± 16 for the knee injury and osteoarthritis outcome (KOOS). Twenty-one studies dealt with DL with a mean age of 49.9 ± 7.2 years and a mean follow-up of 14.9 ± 6.3 years. At the last follow-up, radiographic OA ranged from 23% to 97%, with an average rate of 77 ± 28%; functional scores ranged from 40 to 87, with a mean of 79 ± 10 for the Lysholm score and 71 ± 16 for the IKDC.

CONCLUSION

Ten-year clinical outcomes of APM are better for TTs when compared to DLs. Rates of OA are difficult to compare but lower for TTs.

LEVEL OF EVIDENCE

Level IV.

Correlation between articular cartilage status on outcomes and survivorship following meniscal allograft transplantation: A systematic review

PURPOSE

To conduct a systematic review evaluating potential correlations between preoperative articular cartilage integrity on outcomes and survivorship in patients undergoing meniscal allograft transplantation (MAT).

METHODS

A literature search was performed by querying SCOPUS, PubMed, Medline, and the Cochrane Central Register for Controlled Trials from database inception through May 2023 according to the 2020 PRISMA statement. Inclusion criteria were limited to studies reporting on outcomes and survivorship following MAT based on preoperative cartilage status.

RESULTS

Sixteen studies, consisting of 1723 patients (n = 1758 total menisci), were identified in six level III and 10 level IV evidence studies. There was high heterogeneity in cartilage grading scales, reporting of concomitant cartilage procedures, and indications for MAT based on osteoarthritis. Patients with lower limb malalignment were either excluded or corrected with an osteotomy. MAT failure rate was reported in nine studies, with four studies reporting a greater rate of failure in knees with higher degrees of cartilage damage. Eight studies reported on clinical outcomes based on cartilage grade, with two studies reporting significant differences in clinical outcomes based on cartilage grade. Of the five studies reporting management of full-thickness chondral defects with cartilage surgery, three studies reported no significant difference in survivorship based on preoperative cartilage grade, while one study reported lower survivorship and one study reported unclear results. No studies found significant differences in survivorship and outcomes between medial and lateral MAT.

CONCLUSIONS

Conflicting results and high variability in reporting of concomitant cartilage repair and indications for MAT exist in studies evaluating the efficacy of MAT based on articular cartilage status. The degree of preoperative chondral damage did not have a strong relationship with clinical outcomes following MAT. Higher degrees of cartilage damage were associated with higher MAT failure rates, with possible improvement in survivorship when treated with an appropriate cartilage procedure.

LEVEL OF EVIDENCE

Level IV.

Subchondral insufficiency fracture is a predictive factor of osteoarthritis progression and conversion to arthroplasty in non-surgically treated medial meniscus root tear

PURPOSE

To investigate the radiographic and clinical outcomes of non-surgical treatment for medial meniscus posterior root tear (MMPRT), and prognostic factors for osteoarthritis (OA) progression and clinical failure.

METHODS

A prospectively collected database was retrospectively reviewed for patients who were diagnosed with acute medial meniscus posterior root tear (MMPRT) between 2013 and 2021 and treated non-surgically for more than 2 years. Patient demographic characteristics and clinical outcomes including pain numeric rating scale (NRS), International Knee Documentation Committee (IKDC) subjective score, Lysholm score, and Tegner activity scale were evaluated. For radiographic evaluation, knee radiographs were obtained to assess the angle of knee alignment and Kellgren-Lawrence (K-L) grade during the first and annually follow-up visits. Baseline magnetic resonance (MR) images were reviewed for the presence of medial meniscus extrusion, bone marrow edema, subchondral insufficiency fracture of medial femoral condyle, and cartilage lesion. The OA progression group was defined as patients who experienced a worsening of one or more grades in the K-L classification system. Prognostic factors were evaluated for OA progression and conversion to total knee arthroplasty (TKA).

RESULTS

Ninety-four patients (90 female and 4 male) with a mean age of 67.0 ± 7.3 years (range, 53-83 years) were followed for a mean of 46.1 ± 22.1 months (range, 24.1-170.5). During the follow-up period, no significant differences in clinical scores were observed, and there were also no significant differences between the groups with and without OA progression. Overall, 12 patients (13%) underwent TKA at a mean of 20.7 ± 16.5 months (range, 8-69 months) and 34 patients (36%) demonstrated OA progression at a mean time of 24 ± 15 months (range, 12-62). The subchondral insufficiency fracture was a prognostic factor for OA progression (p = 0.045 for knee radiograph and p = 0.019 for MR) and conversion to TKA (RR, 4.08 [95% CI 1.23-13.57]; p = 0.022).

CONCLUSIONS

Non-surgical treatment for acute medial meniscus posterior root tear did not result in any significant change in clinical outcomes from the initial to the final follow-up. The rate of conversion to arthroplasty was 13%, and the rate of osteoarthritis progression was 36%. Furthermore, subchondral insufficiency fracture was found to be a concomitant prognostic factor correlated with OA progression and conversion to arthroplasty. This information can provide insights for physicians when discussing treatment options with patients, particularly regarding the use of non-surgical treatment and may contribute as a source for future studies of medial meniscus posterior root tear.

LEVEL OF EVIDENCE

IV.

Medial Meniscus Posterior Root Tear: How Far Have We Come and What Remains?

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.

Feasibility of Constructing an Automatic Meniscus Injury Detection Model Based on Dual-Mode Magnetic Resonance Imaging (MRI) Radiomics of the Knee Joint

Objective

To explore the feasibility of automatically detecting the degree of meniscus injury by radiomics fusion of dual-mode magnetic resonance imaging (MRI) features of sagittal and coronal planes of the knee joint.

Methods

This retrospective study included 164 arthroscopically confirmed meniscus injuries in 152 patients admitted to the Department of Orthopaedics of our hospital from July 2018 to March 2021. A total of 1316-dimensional radiomics signatures were extracted from single-mode sagittal and coronal plane images of menisci, respectively. Then, the sagittal and coronal plane features were fused to form a dual-mode joint feature group with a total of 2632-dimensional radiomics signatures. The minimum redundancy maximum relevance (mRMR) algorithm and the least absolute shrinkage and selection operator (LASSO) regression were used to select features and generate optimal radiomics signatures. The single-mode sagittal plane feature model (Model 1), single-mode coronal plane feature model (Model 2), and the combined sagittal and coronal plane feature model (Model 3) performance were tested by receiver operating characteristic (ROC) curves and Delong test. The calibration curve test was used to verify the reliability of radiomics signatures of the three models.

Results

The average intra- and interobserver intraclass correlation coefficients (ICCs) of the most significant 8-dimensional radiomics signatures of Model 1 and Model 2 were 0.935 (range 0.832-0.998) and 0.928 (range 0.845-0.998), respectively. All the three models had good detection performance; Model 3 had the most significant performance (the areas under the curve (AUCs) of training, and validation sets were 0.947 and 0.923, respectively), which was superior to Model 1 (AUCs of training set and validation set were 0.889 and 0.876, respectively) and Model 2 (AUCs of training set and validation set were 0.831 and 0.851, respectively). The detection probability of training and validation sets in the three models was highly consistent with the actual clinical probability.

Conclusions

It is feasible to establish a model for automatic detection of meniscus damage by means of radiomics. The detection performance of the dual-mode knee MRI model is better than that of any single-mode model, showing potent feature analysis ability and outstanding detection performance.