Skip to main content
SpringerLink
Log in

The clinical and radiographic outcomes of type 2 medial meniscus posterior root tears following transtibial pullout repair

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data availability

The datasets are available from the corresponding author upon reasonable request.

Abbreviations

MM:

Medial meniscus

MRI:

Magnetic resonance imaging

MMPRT:

Medial meniscus posterior root tear

MME:

Medial meniscus extrusion

TKA:

Total knee arthroplasty

TSS:

Two simple stitches

TR:

Repetition time

TE:

Echo time

IKDC:

International Knee Documentation Committee

VAS:

Visual analog scale

ΔMME:

Delta medial meniscus extrusion

n.s:

Not significant

References

  1. Allaire R, Muriuki M, Gilbertson L, Harner CD (2008) Biomechanical consequences of a tear of the posterior root of the medial meniscus. Similar to total meniscectomy. J Bone Joint Surg Am 90:1922–1931

    Article  PubMed  Google Scholar 

  2. Bin S-I, Kim J-M, Shin S-J (2004) Radial tears of the posterior horn of the medial meniscus. Arthroscopy 20:373–378

    Article  PubMed  Google Scholar 

  3. Chung KS, Ha JK, Ra HJ, Nam GW, Kim JG (2017) Pullout fixation of posterior medial meniscus root tears: correlation between meniscus extrusion and midterm clinical results. Am J Sports Med 45:42–49

    Article  PubMed  Google Scholar 

  4. Dzidzishvili L, López-Torres II, Sáez D, Arguello JM, Calvo E (2021) A comparison of the transtibial pullout technique and all-inside meniscal repair in medial meniscus posterior root tear: prognostic factors and midterm clinical outcomes. J Orthop 26:130–134

    Article  PubMed  PubMed Central  Google Scholar 

  5. Fujisawa T, Choe H, Kusaba Y, Kawabata Y, Otoshi A, Miyatake K et al (2022) Medial meniscus extrusion and stage are related to the size of spontaneous osteonecrosis of the knee in patients who underwent high tibial osteotomy. Knee 36:72–79

    Article  PubMed  Google Scholar 

  6. Furumatsu T, Hiranaka T, Kintaka K, Okazaki Y, Higashihara N, Tamura M et al (2021) A characteristic MRI finding to diagnose a partial tear of the medial meniscus posterior root: an ocarina sign. Knee Surg Relat Res 33:38. https://doi.org/10.1186/s43019-021-00120-4

    Article  PubMed  PubMed Central  Google Scholar 

  7. Furumatsu T, Miyazawa S, Fujii M, Tanaka T, Kodama Y, Ozaki T (2019) Arthroscopic scoring system of meniscal healing following medial meniscus posterior root repair. Int Orthop 43:1239–1245

    Article  PubMed  Google Scholar 

  8. Furumatsu T, Okazaki Y, Kodama Y, Okazaki Y, Kamatsuki Y, Masuda S et al (2019) The accuracy of a newly developed guide system in medial meniscus posterior root repair: a comparison between two aiming guides. Knee Surg Relat Res 31:7. https://doi.org/10.1186/s43019-019-0007-1

    Article  PubMed  PubMed Central  Google Scholar 

  9. Guermazi A, Hayashi D, Jarraya M, Roemer FW, Zhang Y, Niu J et al (2013) Medial posterior meniscal root tears are associated with development or worsening of medial tibiofemoral cartilage damage: the multicenter osteoarthritis study. Radiology 268:814–821

    Article  PubMed  PubMed Central  Google Scholar 

  10. Hiranaka T, Furumatsu T, Kamatsuki Y, Miyazawa S, Okazaki Y, Masuda S et al (2020) The distance between the tibial tunnel aperture and meniscal root attachment is correlated with meniscal healing status following transtibial pullout repair for medial meniscus posterior root tear. Knee 27:899–905

    Article  PubMed  Google Scholar 

  11. Hiranaka T, Furumatsu T, Okazaki Y, Kintaka K, Yamawaki T, Ozaki T (2021) A newly-developed guide can create tibial tunnel at an optimal position during medial meniscus posterior root repairs. J Orthop Sci 27:815–820

    Article  PubMed  Google Scholar 

  12. Hiranaka T, Furumatsu T, Okazaki Y, Yamawaki T, Okazaki Y, Kodama Y et al (2021) Steep medial tibial slope and prolonged delay to surgery are associated with bilateral medial meniscus posterior root tear. Knee Surg Sports Traumatol Arthrosc 29:1052–1057

    Article  PubMed  Google Scholar 

  13. Jiang J, Xing D, Ni L, Chen J (2022) Non-anatomical arthroscopic all-inside repair of medial meniscus posterior root tear to posterior cruciate ligament for patients with normal lower limb alignment. Orthop Surg 14:397–404

    Article  PubMed  PubMed Central  Google Scholar 

  14. Kamatsuki Y, Furumatsu T, Hiranaka T, Okazaki Y, Okazaki Y, Kodama Y et al (2021) Placement of an anatomic tibial tunnel significantly improves the medial meniscus posterior extrusion at 90 of knee flexion following medial meniscus posterior root pullout repair. Knee Surg Sports Traumatol Arthrosc 29:1025–1034

    Article  PubMed  Google Scholar 

  15. Kamatsuki Y, Furumatsu T, Miyazawa S, Kodama Y, Hino T, Okazaki Y et al (2019) The early arthroscopic pullout repair of medial meniscus posterior root tear is more effective for reducing medial meniscus extrusion. Acta Med Okayama 73:503–510

    PubMed  Google Scholar 

  16. Kanda Y (2013) Investigation of the freely available easy-to-use software “EZR” for medical statistics. Bone Marrow Transplant 48:452–458

    Article  CAS  PubMed  Google Scholar 

  17. Kaplan DJ, Bloom D, Alaia EF, Walter WR, Meislin RJ, Strauss EJ et al (2022) ICRS scores worsen between 2-year short term and 5-year mid-term follow-up after transtibial medial meniscus root repair despite maintained functional outcomes. Knee Surg Sports Traumatol Arthrosc 30:2235–2243

    Article  PubMed  Google Scholar 

  18. Kim C-W, Lee C-R, Gwak H-C, Kim J-H, Park D-H, Kwon Y-U et al (2019) Clinical and radiologic outcomes of patients with lax healing after medial meniscal root repair: comparison with subtotal meniscectomy. Arthroscopy 35:3079–3086

    Article  PubMed  Google Scholar 

  19. Krych AJ, Reardon PJ, Johnson NR, Mohan R, Peter L, Levy BA et al (2017) Non-operative management of medial meniscus posterior horn root tears is associated with worsening arthritis and poor clinical outcome at 5-year follow-up. Knee Surg Sports Traumatol Arthrosc 25:383–389

    Article  PubMed  Google Scholar 

  20. Krych AJ, Song BM, Nauert RF 3rd, Cook CS, Levy BA, Camp CL et al (2022) Prospective consecutive clinical outcomes after transtibial root repair for posterior meniscal root tears: a multicenter study. Orthop J Sports Med doi 10:23259671221079790

    Google Scholar 

  21. LaPrade CM, James EW, Cram TR, Feagin JA, Engebretsen L, LaPrade RF (2015) Meniscal root tears: a classification system based on tear morphology. Am J Sports Med 43:363–369

    Article  PubMed  Google Scholar 

  22. Lee S-S, Ahn JH, Kim JH, Kyung BS, Wang JH (2018) Evaluation of healing after medial meniscal root repair using second-look arthroscopy, clinical, and radiological criteria. Am J Sports Med 46:2661–2668

    Article  PubMed  Google Scholar 

  23. Moon H-S, Choi C-H, Jung M, Lee D-Y, Hong S-P, Kim S-H (2020) Early surgical repair of medial meniscus posterior root tear minimizes the progression of meniscal extrusion: 2-year follow-up of clinical and radiographic parameters after arthroscopic transtibial pull-out repair. Am J Sports Med 48:2692–2702

    Article  PubMed  Google Scholar 

  24. Okazaki Y, Furumatsu T, Kodama Y, Kamatsuki Y, Masuda S, Ozaki T (2019) Description of a surgical technique of medial meniscus root repair: a fixation technique with two simple stiches under an expected initial tension. Eur J Orthop Surg Traumatol 29:705–709

    Article  PubMed  Google Scholar 

  25. Okazaki Y, Furumatsu T, Miyazawa S, Masuda S, Okazaki Y, Hiranaka T et al (2019) A novel suture technique to reduce the meniscus extrusion in the pullout repair for medial meniscus posterior root tears. Eur J Orthop Surg Traumatol 29:1805–1809

    Article  PubMed  Google Scholar 

  26. Ozkoc G, Circi E, Gonc U, Irgit K, Pourbagher A, Tandogan RN (2008) Radial tears in the root of the posterior horn of the medial meniscus. Knee Surg Sports Traumatol Arthrosc 16:849–854

    Article  PubMed  Google Scholar 

  27. Sundararajan SR, Ramakanth R, Sethuraman AS, Kannan M, Rajasekaran S (2022) Correlation of factors affecting correction of meniscal extrusion and outcome after medial meniscus root repair. Arch Orthop Trauma Surg 142:823–834

    Article  PubMed  Google Scholar 

  28. Ulku TK, Kaya A, Kocaoglu B (2020) Suture configuration techniques have no effect on mid-term clinical outcomes of arthroscopic meniscus root repairs. Knee 27:676–682

    Article  PubMed  Google Scholar 

  29. Zhang X, Furumatsu T, Okazaki Y, Hiranaka T, Kintaka K, Xue H et al (2021) Semi-quantitative arthroscopic scoring system is related to clinical outcomes in patients after medial meniscus posterior root repair. J Orthop Sci 27:1263–1270

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We would like to thank Eiji Sasaki for his assistance in the statistical analysis.

Funding

No funding was received for the support of this study.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan

    Takaaki Hiranaka, Takayuki Furumatsu, Yusuke Yokoyama, Keisuke Kintaka, Naohiro Higashihara, Masanori Tamura, Koki Kawada, Haowei Xue, Masanori Hamada & Toshifumi Ozaki

  2. Department of Orthopaedic Surgery, Ako Central Hospital, 52‑6 Sohmon‑cho, Ako, Hyogo, 678‑0241, Japan

    Takaaki Hiranaka

Authors
  1. Takaaki Hiranaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Takayuki Furumatsu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yusuke Yokoyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Keisuke Kintaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Naohiro Higashihara
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Masanori Tamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Koki Kawada
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Haowei Xue
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Masanori Hamada
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Toshifumi Ozaki
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Takayuki Furumatsu designed the study. Takaaki Hiranaka and Keisuke Kintaka contributed to the analysis and interpretation of data. All authors contributed to data collection and interpretation and critically reviewed the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Takayuki Furumatsu.

Ethics declarations

Conflict of interest

The authors declare no conflict of interest.

Ethical approval

This study was approved by the Institutional Review Board of Okayama University (approval no. 1857).

Informed consent

Written informed consent was obtained from all study participants.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hiranaka, T., Furumatsu, T., Yokoyama, Y. et al. The clinical and radiographic outcomes of type 2 medial meniscus posterior root tears following transtibial pullout repair. Knee Surg Sports Traumatol Arthrosc 31, 2323–2330 (2023). https://doi.org/10.1007/s00167-022-07293-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-022-07293-9

Keywords

Search

Navigation