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Prognostic Factors and Midterm Clinical Outcome of Transtibial Pullout and Partial Meniscectomy for Medial Meniscus Posterior Root Tears in Middle-Aged Patients

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Abstract

Purpose

The purpose of this study was to compare clinical and radiological outcomes of transtibial pullout technique and partial meniscectomy, and to establish prognostic factors in middle-aged patients with mild knee osteoarthritis.

Methods

A comparative case–control analysis was conducted. 65 patients between 40 and 60 years of age were included into two groups: 30 patients who underwent transtibial pullout technique (group 1) and 35 patients who underwent partial meniscectomy (group 2). Mean follow-up was set at 27.2 months. Primary clinical outcomes included Knee injury and Osteoarthritis Outcome Score and Lysholm Knee Questionnare. Preoperative MRI and intraoperative arthroscopic findings were recorded. The correlation between these findings and patient-reported subjective outcome were assessed.

Results

The transtibial pullout group exhibited significantly greater improvement in clinical outcomes. A univariate model revealed that the presence of preoperative meniscal extrusion, body mass index (> 30), osteochondral defect, and female gender were predictors of poor clinical outcome. Multivariate regression analysis showed meniscal extrusion and osteochondral defect as significant prognostic factors for both study groups.

Conclusion

Medial meniscus root repair leads to significantly improved clinical outcomes compared to partial meniscectomy in middle-aged patients with mild knee osteoarthritis. Presence of meniscal extrusion, osteochondral defect, BMI > 30, and female gender were deemed as predictors of poor postoperative patient-reported outcome.

Level of Evidence

III therapeutic case–control study.

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References

  1. Allaire, R., Muriuki, M., Gilbertson, L., & Harner, C. D. (2008). Biomechanical consequences of a tear of the posterior root of the medial meniscus: Similar to total meniscectomy. Journal of Bone and Joint Surgery. American Volume, 90(9), 1922–1931.

    Article  Google Scholar 

  2. LaPrade, C. M., James, E. W., Cram, T. R., Feagin, J. A., Engebretsen, L., & LaPrade, R. F. (2015). Meniscal root tears: A classification system based on tear morphology. American Journal of Sports Medicine, 43(2), 363–369.

    Article  Google Scholar 

  3. Outerbridge, R. E. (1961). The etiology of chondromalacia patellae. Journal of Bone and Joint Surgery. British Volume, 43, 752–757.

    Article  Google Scholar 

  4. Roos, E. M., Roos, H. P., Lohmander, L. S., Ekdahl, C., & Beynnon, B. D. (1998). Knee Injury and Osteoarthritis Outcome Score (KOOS)–development of a self-administered outcome measure. Journal of Orthopaedic and Sports Physical Therapy, 28(2), 88–96.

    Article  CAS  Google Scholar 

  5. Tegner, Y., & Lysholm, J. (1985). Rating systems in the evaluation of knee ligament injuries. Clinical Orthopaedics and Related Research, 198, 43–49.

    Article  Google Scholar 

  6. Ebert, J. R., Smith, A., Wood, D. J., & Ackland, T. R. (2013). A comparison of the responsiveness of 4 commonly used patient-reported outcome instruments at 5 years after matrix-induced autologous chondrocyte implantation. The American Journal of Sports Medicin, 41(12), 2791–2799.

    Article  Google Scholar 

  7. Ogura, T., Ackermann, J., Mestriner, A. B., Merkely, G., & Gomoll, A. H. (2021). The minimal clinically important difference and substantial clinical benefit in the patient-reported outcome measures of patients undergoing Osteochondral Allograft transplantation in the Knee. Cartilage, 12(1), 42–50.

    Article  CAS  Google Scholar 

  8. Kellgren, J. H., & Lawrence, J. S. (1957). Radiological assessment of osteoarthrosis. Annals of the Rheumatic Diseases, 16(4), 494–502.

    Article  CAS  Google Scholar 

  9. Costa, D. R., Morrison, W. B., & Carrino, J. A. (2004). Medial meniscus extrusión on knee MRI: Is extent associated with severity of degeneration or type of tear? American Journal of Roentgenology, 183, 17–23.

    Article  Google Scholar 

  10. Lerer, D. B., Umans, H. R., Hu, M. X., & Jones, M. H. (2004). The role of meniscus root pathology and radial meniscal tear in medial meniscal extrusion. Skeletal Radiology, 33, 569–574.

    Article  CAS  Google Scholar 

  11. Chung, K. S., Ha, J. K., Yeom, C. H., Ra, H. J., Jang, H. S., Choi, S. H., & Kim, J. G. (2015). Comparison of clinical and radiologic results between partial meniscectomy and refixation of medial meniscus posterior root tears: A minimum 5-year follow-up. Arthroscopy, 31(10), 1941–1950.

    Article  Google Scholar 

  12. Bernard, C. D., Kennedy, N. I., Tagliero, A. J., Camp, C. L., Saris, D. B. F., Levy, B. A., Stuart, M. J., & Krych, A. J. (2020). Medial meniscus posterior root tear treatment: A matched cohort comparison of nonoperative management, partial meniscectomy, and repair. The American Journal of Sports Medicin, 48(1), 128–132.

    Article  Google Scholar 

  13. Chung, K. S., Ha, J. K., Ra, H. J., Nam, G. W., & Kim, J. G. (2017). Pullout fixation of posterior medial meniscus root tears: Correlation between meniscus extrusion and midterm clinical results. The American Journal of Sports Medicin, 45(1), 42–49.

    Article  Google Scholar 

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Acknowledgements

We thank Dr. Ignacio Mahillo Fernández, BS, for his contributions to the statistical analysis.

Funding

This research was funded by The Spanish Society of The Knee (SEROD-Sociedad Española de la Rodilla).

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Authors and Affiliations

  1. Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Díaz, Av. De los Reyes Católicos, 2, 28040, Madrid, Spain

    Lika Dzidzishvili, Irene Isabel López-Torres, José Manuel Arguello & Emilio Calvo

  2. Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Rey Juan Carlos, C. Gladiolo, s/n, Móstoles, 28933, Madrid, Spain

    David Sáez

Authors
  1. Lika Dzidzishvili
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  2. Irene Isabel López-Torres
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  3. José Manuel Arguello
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  4. David Sáez
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  5. Emilio Calvo
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Contributions

Conceptualization: LD; Methodology: LD, IILT, EC; Formal analysis and investigation: LD, IILT; Writing—original draft preparation: LD, IILT; Writing—review and editing: LD, IILT, JMA, DS, EC.

Corresponding author

Correspondence to Lika Dzidzishvili.

Ethics declarations

Ethical approval was waived by the local Ethics Committee. All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008. Informed consent was obtained from all patients for being included in the study.

Conflict of Interest

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ethical Standards

Approval to perform this study was granted by the local ethics committee. All patients provided informed consent to participate in the study.

Consent to Participate

Informed consent was obtained from all individual participants included in the study.

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Dzidzishvili, L., López-Torres, I.I., Arguello, J.M. et al. Prognostic Factors and Midterm Clinical Outcome of Transtibial Pullout and Partial Meniscectomy for Medial Meniscus Posterior Root Tears in Middle-Aged Patients. JOIO 56, 1457–1463 (2022). https://doi.org/10.1007/s43465-022-00650-3

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  • DOI: https://doi.org/10.1007/s43465-022-00650-3

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