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Lee HY, Kim JM, Lee BS, Bin SI, Kim SM, Lee SJ. Lateral Meniscal Allograft Transplantation Shows a Long-Term Chondroprotective Effect on Quantitative Magnetic Resonance Imaging T2 Mapping at 7-Year Minimum Follow-Up. Arthroscopy 2024; 40:1568-1574. [PMID: 37813204 DOI: 10.1016/j.arthro.2023.09.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 09/11/2023] [Accepted: 09/14/2023] [Indexed: 10/11/2023]
Abstract
PURPOSE To assess the long-term chondroprotective effect of lateral meniscal allograft transplantation (MAT) using quantitative magnetic resonance imaging (MRI) T2 mapping. METHODS In patients who underwent isolated lateral MAT, quantitative MRI T2 mapping was conducted preoperatively and postoperatively with at minimum follow-up of 7 years to assess the articular cartilage status. On the sagittal section image bisecting the lateral femoral condyle, the weight-bearing portions of the femoral and tibial articular cartilage were divided into 3 segments each-6 segments in total-based on the meniscal coverage area. The regions-of-interest analyses were performed on the 6 segments to measure the mean T2 value. Then the whole layer was divided into deep and superficial layers for further zonal analysis. The longitudinal change in T2 values was statistically analyzed using paired t-tests. Clinical outcome was evaluated using the Lysholm score. RESULTS A total of 31 patients were included in the study, with the MRI follow-up period of a minimum of 7 years (mean: 8.9 ± 1.3 years; range: 7.0-11.2 years). The mean T2 value of the whole layer showed significant improvement in all segments of the femoral cartilage and the posterior segment of tibial cartilage. In the zonal analysis, the mean T2 value of the tibial cartilage showed significant improvement in the superficial layer of the mid to posterior portion, while the deep layer remained stable. In contrast, the mean T2 value of the femoral cartilage showed significant improvement in the superficial and deep layers in all segments. The mean Lysholm score significantly improved from 62.6 ± 12.8 to 90.9 ± 10.5 (P < .001). CONCLUSIONS This study suggests that MAT appears to have a long-term chondroprotective effect on the articular cartilage as judged by quantitative T2 mapping. LEVEL OF EVIDENCE Level Ⅳ, case series.
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Affiliation(s)
- Hyo Yeol Lee
- Department of Orthopaedic Surgery, Eulji Medical Center Daejeon Hospital, Eulji University College of Medicine, Daejeon, Republic of Korea; Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jong-Min Kim
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Bum-Sik Lee
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seong-Il Bin
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung-Min Kim
- Department of Orthopaedic Surgery, Wiltse Memorial Hospital, Anyang, Republic of Korea
| | - Seon-Jong Lee
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Tamura M, Furumatsu T, Yokoyama Y, Higashihara N, Kawada K, Ozaki T. Superior outcomes of pullout repairs for medial meniscus posterior root tears in partial tear compared to complete radial tear. Knee Surg Relat Res 2024; 36:8. [PMID: 38331953 PMCID: PMC10854085 DOI: 10.1186/s43019-023-00206-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 12/15/2023] [Indexed: 02/10/2024] Open
Abstract
PURPOSE To reveal the outcomes of partial medial meniscus posterior root tears following transtibial pullout repair compared with the outcomes of complete radial meniscus posterior root tears. MATERIALS AND METHODS We retrospectively evaluated 15 consecutive patients (male/female, 5/10; average age, 64.4 years) who underwent transtibial pullout repair for partial medial meniscus posterior root tears and compared their results with those of 86 consecutive patients who underwent the same surgery for complete medial meniscus posterior root tears. All patients underwent second-look arthroscopy on average 1 year postoperatively, and a semi-quantitative meniscal healing score (anteroposterior width, stability, and synovial coverage, total 10 points) was evaluated. Medial meniscus extrusion was evaluated preoperatively and at second-look arthroscopy. RESULTS Postoperative clinical scores were not significantly different in the short term. However, second-look arthroscopy revealed a significant difference in repaired meniscal stability (partial tear; 3.3 points, complete tear; 2.3 points, p < 0.001) and total meniscal healing scores (partial tear; 8.3 points, complete tear; 7.1 points, p < 0.001). Medial meniscus extrusion progression was significantly different (partial tear; 0.4 mm, complete tear; 1.0 mm, p < 0.001). CONCLUSION Partial medial meniscus posterior root tears showed better meniscal healing and less medial meniscus extrusion progression following pullout repair than complete medial meniscus posterior root tears.
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Affiliation(s)
- Masanori Tamura
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Takayuki Furumatsu
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
| | - Yusuke Yokoyama
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Naohiro Higashihara
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Koki Kawada
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
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Kawada K, Furumatsu T, Tamura M, Xue H, Higashihara N, Kintaka K, Yokoyama Y, Ozaki T. Time-Dependent Increase in Medial Meniscus Extrusion Predicts the Need for Meniscal Repair in Patients with Partial Medial Meniscus Posterior Root Tears: A Case-Control Study. Indian J Orthop 2023; 57:1633-1639. [PMID: 37766949 PMCID: PMC10519898 DOI: 10.1007/s43465-023-00987-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023]
Abstract
Purpose This study aimed to compare medial meniscus extrusion (MME) in patients with partial medial meniscus posterior root tears (MMPRTs) through magnetic resonance imaging (MRI) conducted at two-time points and to determine whether patient characteristics or MME measurements differ in patients who respond to nonoperative treatment compared with those who require surgical treatment. Methods Thirty-seven patients with partial MMPRTs underwent two MRI scans during nonoperative management or before pull-out repair. Among these, 17 patients received nonoperative management, and 20 underwent pull-out repair. Partial MMPRTs were diagnosed based on the MRI findings. MME measurements were performed on both MRI scans. Statistical and receiver operating curve (ROC) analyses were performed. Results The duration between the two MRI scans was significantly shorter in the pull-out repair group than in the nonoperative management group. The increase in MME (ΔMME) on MRI scans was significantly greater in the pull-out repair group than in the nonoperative management group. Linear regression analysis revealed a weak correlation between the MRI interval and ΔMME in the nonoperative management group and a moderate correlation in the pull-out repair group. In the ROC construction, the cut-off value for ΔMME that requires surgical intervention was 0.41 mm, with a sensitivity and specificity of 85.0% and 52.9%, respectively. Conclusion Patients with partial MMPRTs requiring surgical treatment had greater MME progression in a shorter time and a time-dependent increase in MME. Therefore, a ΔMME of ≥ 0.41 mm may be useful in deciding surgical intervention based on MRI retests. Level of evidence III.
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Affiliation(s)
- Koki Kawada
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558 Japan
| | - Takayuki Furumatsu
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558 Japan
| | - Masanori Tamura
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558 Japan
| | - Haowei Xue
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558 Japan
| | - Naohiro Higashihara
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558 Japan
| | - Keisuke Kintaka
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558 Japan
| | - Yusuke Yokoyama
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558 Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558 Japan
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Kim JS, Lee MK, Choi MY, Kong DH, Ha JK, Kim JG, Chung KS. Rehabilitation after Repair of Medial Meniscus Posterior Root Tears: A Systematic Review of the Literature. Clin Orthop Surg 2023; 15:740-751. [PMID: 37811518 PMCID: PMC10551690 DOI: 10.4055/cios21231] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 07/19/2022] [Accepted: 07/25/2022] [Indexed: 10/10/2023] Open
Abstract
Background There is no consensus established on postoperative rehabilitation after medial meniscus posterior root tear (MMPRT) repair, including when and how physicians can apply range of motion (ROM) exercise, weight-bearing (WB), brace use, and return to sports (RTS). The purpose of this study was to systematically review the literature on postoperative rehabilitation characteristics of MMPRT repair regarding ROM, WB, brace use, and RTS. Methods A literature search was performed using the Medline/PubMed, Cochrane Central Register of Controlled Trials, and Embase databases. The inclusion criteria were English language, human clinical studies, and studies describing rehabilitation protocols after MMPRT repair such as ROM, WB, brace use, and RTS. Abstracts, case reports, cohort studies, controlled laboratory studies, human cadaveric or animal studies, systematic reviews, and meta-analyses were excluded. Results Thirteen studies were included. Of the 12 ROM studies, ROM was started immediately within 1 or 2 days after operation in 6 studies and after 2 to 3 weeks of knee immobilization in the rest. Of the 13 WB studies, partial weight-bearing was initiated 1 to 4 weeks after operation in 8 studies and 6 weeks in the rest. Of the 9 brace studies, patients were immobilized by a splint for 2 weeks in 3 studies, and in the rest, a brace with full extension was applied for 3 to 6 weeks after several days of splint application. Of the 7 RTS studies, RTS was allowed at 6 months in 6 studies and 5 to 7 months in 1 study. Conclusions This systematic review revealed conservative rehabilitation protocols were more widely adapted as ROM and WB were restricted at certain degrees during postoperative periods in most protocols analyzed. However, it is impossible to identify a consensus on rehabilitation protocols as the protocols analyzed in this review were distinct each other and heterogeneous. In the future, a well-designed comparative study among different rehabilitation protocols is essential to establish a consensus.
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Affiliation(s)
- Jin Seong Kim
- Department of Orthopedic Surgery and Sports Medical Center, Sports Medical Research Institute, Seoul Paik Hospital, College of Medicine, Inje University, Seoul, Korea
| | - Min Ki Lee
- Department of Orthopedic Surgery and Sports Medical Center, Sports Medical Research Institute, Seoul Paik Hospital, College of Medicine, Inje University, Seoul, Korea
| | - Moon Young Choi
- Department of Orthopedic Surgery and Sports Medical Center, Sports Medical Research Institute, Seoul Paik Hospital, College of Medicine, Inje University, Seoul, Korea
| | - Doo Hwan Kong
- Department of Orthopedic Surgery and Sports Medical Center, Sports Medical Research Institute, Seoul Paik Hospital, College of Medicine, Inje University, Seoul, Korea
| | - Jeong Ku Ha
- Department of Orthopedic Surgery and Sports Medical Center, Sports Medical Research Institute, Seoul Paik Hospital, College of Medicine, Inje University, Seoul, Korea
| | - Jin Goo Kim
- Department of Orthopaedic Surgery, Hanyang University Myongji Hospital, Goyang, Korea
| | - Kyu Sung Chung
- Department of Orthopedic Surgery and Sports Medical Center, Sports Medical Research Institute, Seoul Paik Hospital, College of Medicine, Inje University, Seoul, Korea
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Van Dyck P, Vandenrijt J, Vande Vyvere T, Snoeckx A, Heusdens CHW. Analysis of Discordant Findings between 3T Magnetic Resonance Imaging and Arthroscopic Evaluation of the Knee Meniscus. J Clin Med 2023; 12:5667. [PMID: 37685734 PMCID: PMC10489133 DOI: 10.3390/jcm12175667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/23/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
Numerous studies have assessed the performance of magnetic resonance imaging (MRI) in detecting tears of the knee menisci using arthroscopy results as the gold standard, but few have concentrated on the nature of discordant findings. The purpose of this study was to analyze the discordances between 3T MRI and arthroscopic evaluation of the knee meniscus. Medical records of 112 patients who underwent 3T MRI and subsequent arthroscopy of the knee were retrospectively analyzed to determine the accuracy of diagnoses of meniscal tear. Compared with arthroscopy, there were 22 false-negative and 14 false-positive MR interpretations of meniscal tear occurring in 32 patients. Images with errors in diagnosis were retrospectively reviewed by two musculoskeletal radiologists in consensus and all errors were categorized as either unavoidable, equivocal or as interpretation error. Of 36 MR diagnostic errors, there were 16 (44%) unavoidable, 5 (14%) interpretation errors and 15 (42%) equivocal for meniscal tear. The largest categories of errors were unavoidable false-positive MRI diagnoses (71%) and equivocal false-negative MRI diagnoses (50%). All meniscal tears missed by MRI were treated with partial meniscectomy (n = 14) or meniscal repair (n = 8). Discordant findings between 3T MRI and arthroscopic evaluation of the knee meniscus remain a concern and primarily occur due to unavoidable and equivocal errors. Clinicians involved in the diagnosis and treatment of patients with meniscal tears should understand why and how the findings seen on knee MRI and arthroscopy may sometimes differ.
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Affiliation(s)
- Pieter Van Dyck
- Department of Radiology, Antwerp University Hospital, Drie Eikenstraat 655, 2650 Edegem, Belgium; (T.V.V.); (A.S.)
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium;
| | - Jasper Vandenrijt
- Department of Orthopedics, Antwerp University Hospital, Drie Eikenstraat 655, 2650 Edegem, Belgium;
| | - Thijs Vande Vyvere
- Department of Radiology, Antwerp University Hospital, Drie Eikenstraat 655, 2650 Edegem, Belgium; (T.V.V.); (A.S.)
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium;
| | - Annemiek Snoeckx
- Department of Radiology, Antwerp University Hospital, Drie Eikenstraat 655, 2650 Edegem, Belgium; (T.V.V.); (A.S.)
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium;
| | - Christiaan H. W. Heusdens
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium;
- Department of Orthopedics, Antwerp University Hospital, Drie Eikenstraat 655, 2650 Edegem, Belgium;
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Furumatsu T, Kintaka K, Higashihara N, Tamura M, Kawada K, Xue H, Ozaki T. Meniscus extrusion is a predisposing factor for determining arthroscopic treatments in partial medial meniscus posterior root tears. Knee Surg Relat Res 2023; 35:8. [PMID: 36918982 PMCID: PMC10012578 DOI: 10.1186/s43019-023-00182-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 03/04/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Patients with partial medial meniscus posterior root tears (MMPRTs) sometimes require arthroscopic pullout repair because of their intolerable/repeated knee pains and continuous disturbance in gait during activities of daily living. However, the predisposing factors for future knee surgery in patients with partial MMPRTs remain unclear. We compared the findings of magnetic resonance imaging (MRI) between patients who underwent pullout repair and nonoperative management following partial MMPRTs. METHODS Twenty-five patients who required arthroscopic repair for partial MMPRTs and 23 patients who were managed nonoperatively were evaluated during a mean follow-up period of 27.1 months. Sex, age, height, body weight, body mass index, duration from onset to initial MRI, MRI findings, and medial meniscus (MM) extrusion were compared between the two groups. Linear regression analysis was used to assess the correlation between MM extrusion and duration from onset to MRI examination. RESULTS No significant differences were observed between the pullout repair and nonoperative management groups in terms of patient demographics and the positive ratio of MRI-based root tear signs. However, absolute MM extrusion in the pullout repair group (3.49 ± 0.82 mm) was larger than that in the nonoperative management group (2.48 ± 0.60 mm, P < 0.001). Extrusion of the MM (> 3 mm) was detected more frequently in the pullout repair group than in the nonoperative management group (P < 0.001). The odds ratio in the pullout repair and MM extrusion > 3 mm cases was 9.662. Linear regression analysis revealed a fair correlation between the duration from onset to MRI and MM extrusion only in the pullout repair group (0.462 mm/month increase in MM extrusion). CONCLUSIONS This study demonstrated that more severe MM extrusions were observed in the pullout repair group than in the nonoperative management group. Major extrusion (> 3 mm) was also observed more in the pullout repair group than in the nonoperative group. Assessing MM extrusion and its severity can help determine a valid treatment for patients with partial MMPRTs. LEVEL OF EVIDENCE IV, Retrospective comparative study.
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Affiliation(s)
- Takayuki Furumatsu
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan.
| | - Keisuke Kintaka
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Naohiro Higashihara
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Masanori Tamura
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Koki Kawada
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Haowei Xue
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
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Karpinski K, Forkel P, Häner M, Bierke S, Petersen W. Etiology of posterior meniscus root tears: medial vs. lateral. Arch Orthop Trauma Surg 2023; 143:429-437. [PMID: 35076768 DOI: 10.1007/s00402-022-04347-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 01/04/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of this study was to generate more information on the etiology and pathogenesis of medial (MM) and lateral (LM) meniscus root tears. Our hypothesis was that root tears of the MM predominantly result from degenerative damage, whereas root injuries of the LM are mainly of traumatic origin. METHODS Consecutively, 53 patients with a root tear of the medial meniscus (MMRT) and 51 patients with a root tear of the lateral meniscus (LMRT) were included in this study. The diagnosis was confirmed radiologically by MRI as well as arthroscopically. In addition to patient-specific data such as age, BMI and trauma history, the leg axis was determined and accompanying injuries (ligamentous and chondrogenic) were documented. RESULTS The mean age of the MMRT group was 57.2 (± 11.2) years, and that of the LMRT group 33.9 (± 11.4) years. The BMI was significantly higher in the MMRT group compared to the LMRT (30.5 vs. 25.1). 82.4% of patients in the LMRT group demonstrated an accompanying anterior cruciate ligament (ACL) rupture, whereas only 5.7% of the MMRT were associated with an ACL injury. A trauma was described in only 13.2% of patients of the MMRT group in contrast to 88.2% of the LMRT group. An extrusion > 3 mm of the MM in the coronal plane of MRI images could be detected in 86.8% of patients, whereas in the LMRT group, it was 15.7%. The mechanical varus angle was 5.6° in the MMRT group and 2.4° in the LMRT group. The rate and degree of concomitant cartilage damage in the affected compartment was significantly higher in the group with medial root injuries than in the group with lateral root tears. CONCLUSIONS The root injuries of the MM and LM show significant differences in terms of patient age, etiology and accompanying injuries. Root injuries to the medial meniscus are mostly of non-traumatic origin and more likely to occur in the context of medial osteoarthritis and varus deformity of the knee. Lateral root tears tend to be predominantly traumatic and are frequently associated with ACL ruptures. However, in the MMRT group, a small subgroup with a traumatic etiology and in the LMRT group a small subgroup of patients with non-traumatic etiology could be identified. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Katrin Karpinski
- Klinik für Orthopädie und Unfallchirurgie, Martin Luther Krankenhaus, Caspar-Theyss-Strasse 27-31, 14193, Berlin, Germany
| | - Philipp Forkel
- Department for Orthopaedic Sports Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Martin Häner
- Klinik für Orthopädie und Unfallchirurgie, Martin Luther Krankenhaus, Caspar-Theyss-Strasse 27-31, 14193, Berlin, Germany
| | - Sebastian Bierke
- Klinik für Orthopädie und Unfallchirurgie, Martin Luther Krankenhaus, Caspar-Theyss-Strasse 27-31, 14193, Berlin, Germany
| | - Wolf Petersen
- Klinik für Orthopädie und Unfallchirurgie, Martin Luther Krankenhaus, Caspar-Theyss-Strasse 27-31, 14193, Berlin, Germany.
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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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Hiranaka T, Furumatsu T, Okazaki Y, Kintaka K, Kamatsuki Y, Zhang X, Xue H, Hamada M, Ozaki T. Clinical evaluation of suture materials for transtibial pullout repair of medial meniscus posterior root tear. Knee Surg Relat Res 2022; 34:39. [PMID: 36209256 PMCID: PMC9548199 DOI: 10.1186/s43019-022-00167-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 09/25/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND There are no recommendations for specific suture materials in transtibial pullout repair of medial meniscus posterior root tears. This study aimed to evaluate the clinical outcomes of transtibial pullout repair of medial meniscus posterior root tears using ultrahigh-molecular-weight polyethylene sutures and suture tape. METHODS We retrospectively reviewed the data of 36 patients (27 women and 9 men, mean age 64.1 years) who had undergone transtibial pullout repair of medial meniscus posterior root tears between November 2018 and December 2019. Two groups of 18 patients each received either two different cord-like sutures or suture tape. Clinical parameters were assessed preoperatively and on second-look arthroscopy (mean postoperative period 12 months). The meniscal healing status was assessed using a previously published scoring system (ranging from 0 to 10), and the incidence rate of suture cut-out was assessed on second-look arthroscopy. RESULTS All clinical scores significantly improved in both groups, with no significant between-group differences on second-look arthroscopy. The arthroscopic meniscal healing scores significantly differed between sutures (mean 6.7 points) and suture tape (mean 7.4 points; p = 0.044). No significant between-group difference in the suture cut-out rate was observed. CONCLUSIONS This study found no significant differences in the clinical outcomes between ultrahigh-molecular-weight polyethylene sutures and suture tape. Favorable clinical outcomes were obtained using both types of suture; however, the usefulness of suture tape appears to be limited.
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Affiliation(s)
- Takaaki Hiranaka
- grid.412342.20000 0004 0631 9477Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558 Japan ,Department of Orthopaedic Surgery, Ako Central Hospital, 52-6 Soumoncho, Ako, Hyogo 678-0241 Japan
| | - Takayuki Furumatsu
- grid.412342.20000 0004 0631 9477Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558 Japan ,Department of Orthopaedic Surgery, Ako Central Hospital, 52-6 Soumoncho, Ako, Hyogo 678-0241 Japan ,grid.261356.50000 0001 1302 4472Department of Orthopaedic Surgery, Okayama University Graduate School, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558 Japan
| | - Yuki Okazaki
- grid.412342.20000 0004 0631 9477Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558 Japan
| | - Keisuke Kintaka
- grid.412342.20000 0004 0631 9477Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558 Japan
| | - Yusuke Kamatsuki
- grid.412342.20000 0004 0631 9477Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558 Japan
| | - Ximing Zhang
- grid.412342.20000 0004 0631 9477Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558 Japan
| | - Haowei Xue
- grid.412342.20000 0004 0631 9477Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558 Japan
| | - Masanori Hamada
- grid.412342.20000 0004 0631 9477Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558 Japan
| | - Toshifumi Ozaki
- grid.412342.20000 0004 0631 9477Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558 Japan
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Kim KI, Kim JH, Lee SH, Song SJ, Jo MG. Mid- to Long-Term Outcomes After Medial Open-Wedge High Tibial Osteotomy in Patients With Radiological Kissing Lesion. Orthop J Sports Med 2022; 10:23259671221101875. [PMID: 35859646 PMCID: PMC9289913 DOI: 10.1177/23259671221101875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/22/2022] [Indexed: 11/21/2022] Open
Abstract
Background: Although medial open-wedge high tibial osteotomy (MOWHTO) is the treatment of
choice for patients with mild to moderate osteoarthritis with varus
malalignment, concerns about inferior outcomes in patients with preoperative
radiological kissing lesion (RKL) remain. Purpose: To compare the mid- to long-term clinical and radiological results and
survivorship after MOWHTO in patients with versus without preoperative
RKL. Study Design: Cohort study; Level of evidence, 3. Methods: Included were 122 knees in patients who underwent MOWHTO with a medial locked
plate and had minimum 5-year follow-up data. The mean age at surgery was
55.9 years (range, 38-65 years), and the mean follow-up was 7.5 years
(range, 5-12.8 years). All patients had undergone second-look arthroscopy
around 2 years after MOWHTO. The knees were divided into an RKL group (n =
17) and no-RKL group (n = 105) based on preoperative standing radiographs.
The authors compared postoperative American Knee Society (AKS) knee and
function scores, range of motion, and improvements in AKS scores between
groups, as well as hip-knee-ankle angle, medial proximal tibial angle, and
joint-line convergence angle from preoperatively to postoperatively. Also
compared were the degree of cartilage regeneration between first- and
second-look arthroscopy and the survival rate after index surgery. Results: Preoperative AKS scores were significantly lower in the RKL group versus the
no-RKL group (AKS knee, 79.6 ± 7.5 vs 83.8 ± 3.9, P = .037;
AKS function, 68.8 ± 9.3 vs 76.0 ± 5.1, P = .006).
Likewise, postoperative AKS scores were significantly lower in the RKL group
versus the no-RKL group (AKS knee: 91.3 ± 4.2 vs 94.4 ± 1.6, respectively,
P = .008; AKS function: 90.0 ± 10.0 vs 97.6 ± 4.5,
respectively, P = .007). However, all patients had
excellent postoperative AKS knee and function scores (>80). Moreover,
there were no between-group differences in pre- to postoperative improvement
in AKS scores, postoperative radiological changes, or grade of cartilage
regeneration. The survival rates in the RKL and no-RKL groups were 100% and
97.1%, respectively (P ≥ .999). Conclusion: Although the latest clinical scores were lower in the RKL group than in the
no-RKL group, comparable results in postoperative clinical improvement,
cartilage regeneration, and survivorship were observed in patients with RKL
at mid- to long-term follow-up.
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Affiliation(s)
- Kang-Il Kim
- Department of Orthopaedic Surgery, Center for Joint Diseases, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea.,Department of Orthopaedic Surgery, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Jun-Ho Kim
- Department of Orthopaedic Surgery, Center for Joint Diseases, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Sang-Hak Lee
- Department of Orthopaedic Surgery, Center for Joint Diseases, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea.,Department of Orthopaedic Surgery, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Sang-Jun Song
- Department of Orthopaedic Surgery, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Myeong-Guk Jo
- Department of Orthopaedic Surgery, Center for Joint Diseases, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
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