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Current Reviews in Musculoskeletal Medicine: Current Controversies for Treatment of Meniscus Root Tears

  • Meniscus (A Kyrch, Section Editor)
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Abstract

Purpose of Review

The role of the meniscus in preserving the biomechanical function of the knee joint has been clearly defined. The hypothesis that meniscus root integrity is a prerequisite for meniscus function is supported by the development of progressive knee osteoarthritis (OA) following meniscus root tears (MRTs) treated either non-operatively or with meniscectomy. Consequently, there has been a resurgence of interest in the diagnosis and treatment of MRTs. This review examines the contemporary literature surrounding the natural history, clinical presentation, evaluation, preferred surgical repair technique and outcomes.

Recent Findings

Surgeons must have a high index of suspicion in order to diagnose a MRT because of the nonspecific clinical presentation and difficult visualization on imaging. Compared with medial MRTs that commonly occur in middle age/older patients, lateral meniscus root injuries tend to occur in younger males with lower BMIs, less cartilage degeneration, and with concomitant ligament injury. Subchondral insufficiency fractures of the knee have been found to be associated with both MRTs and following arthroscopic procedures. Meniscus root repair has demonstrated good outcomes, and acute injuries with intact cartilage should be repaired. Cartilage degeneration, BMI, and malalignment are important considerations when choosing surgical candidates. Meniscus centralization has emerged as a viable adjunct strategy aimed at correcting meniscus extrusion.

Summary

Meniscus root repair results in a decreased rate of OA and arthroplasty and is economically advantageous when compared with nonoperative treatment and partial meniscectomy. The transtibial pull-through technique with the addition of centralization for the medial meniscus is associated with encouraging early results.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Dustin R. Lee, Anna K. Reinholz, Sara E. Till, Yining Lu, Christopher L. Camp, Michael J. Stuart & Aaron J. Krych

  2. Department of Orthopaedics, Joe R. and Teresa Lozano Long School of Medicine, UT Health San Antonio, San Antonio, TX, USA

    Thomas M. DeBerardino

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  1. Dustin R. Lee
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Correspondence to Aaron J. Krych.

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Conflict of Interest

Dr. Lee, Dr. Lu, Anna Reinholz, and Sara Till declare they have no conflict of interest.

Dr. Camp reports personal fees from Arthrex, Inc, other from Zimmer Biomet Holdings, Inc, other from Gemini Medical LLC

Dr. DeBerardino reports paid consultant for Aesculap/B.Braun, board or committee member for the American Orthopaedic Society for Sports Medicine, paid consultant, IP royalties, research support, and other services from Arthrex, Inc, board or committee member for Arthroscopy Association of North America, editorial or governing board of Current Orthopaedic Practice, paid consultant for EMOVI, board or committee member for the International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine, paid consultant for the Joint Restoration Foundation, paid consultant for the Musculoskeletal Transplant Foundation

Dr. Stuart reports royalties, consulting fee, and compensation for services other than consulting from Arthrex, Inc; editorial or governing board of AJSM, and research support from Stryker

Dr. Krych reports research support from Aesculap/B.Braun, editorial or governing board of the American Journal of Sports Medicine, consulting fees from Arthrex (through 2020), IP royalties (2019-2020), speaking fees (through 2019), and research support from Arthrex, research support from the Arthritis Foundation, research support and personal from Ceterix, personal from Gemini Mountain Medical, LLC, personal from Smith & Nephew, research support from Histogenics, board or committee member for the International Cartilage Repair Society, board or committee member for the International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine, paid consultant for JRF Ortho, board or committee member of the Minnesota Orthopedic Society, board or committee member for the Musculoskeletal Transplantation Foundation, paid consultant for Vericel and honoraria (2017), consulting fee and royalties for Responsive Arthroscopy LLC, Joint Restoration Foundation honoraria, Responsive Arthroscopy (2019), serves on the medical board of trustees for the Musculoskeletal Transplant Foundation (through 2018) ; grant from DJO (2020) and Exatech (2017)

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Lee, D.R., Reinholz, A.K., Till, S.E. et al. Current Reviews in Musculoskeletal Medicine: Current Controversies for Treatment of Meniscus Root Tears. Curr Rev Musculoskelet Med 15, 231–243 (2022). https://doi.org/10.1007/s12178-022-09759-2

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