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Concomitant posterior anchoring further reduces posterior meniscal extrusion during pullout repair of medial meniscus posterior root tears: a retrospective study

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Abstract

Purpose

Transtibial pullout repair improves the clinical outcomes of medial meniscus (MM) posterior root tears (PRTs); however, reducing MM extrusion remains challenging. Thus, the purpose of this study was to examine the role of additional posterior anchoring (PA) during pullout repair in reducing the severity of MM extrusion compared to pullout repair alone.

Methods

Patients who underwent pullout repair with two-cinch stitches (TCS) only or TCS combined with PA (TCS-PA)—deployment of an additional suture anchor in the posteromedial corner of MM—were included retrospectively. MM medial and posterior extrusion (MMME and MMPE), MM extrusion and remaining volume (MMEV and MMRV), and corresponding ratios were evaluated pre-operatively and three months post-operatively using a three-dimensional meniscal model at 10° and 90° of knee flexion and compared within and between groups.

Results

A total of 15 and 16 patients treated with TCS and TCS-PA, respectively, were enrolled. At 90° knee flexion, both techniques significantly reduced MMPE (TCS: 4.2 ± 0.7 mm to 3.5 ± 0.6 mm, p < 0.05; TCS-PA: 3.7 ± 0.8 mm to 2.8 ± 0.7 mm, p < 0.05) at three months post-operatively. TCS-PA reduced MMPE more significantly than TCS alone (p < 0.05). Only TCS-PA significantly improved the MMEV and MMRV ratios (39.6 ± 8.9% to 28.1 ± 6.0%, p < 0.05 and 60.4 ± 8.9% to 71.9 ± 6.0%, p < 0.05, respectively). Significance was not found in all other comparisons.

Conclusions

Both techniques improved MMPE at knee flexion at the three month follow-up, with TCS-PA providing significantly superior results. Our findings support the evidence that the application of PA may be an effective surgical option for alleviating persistent MMPE.

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Acknowledgements

We would like to thank Editage (www.editage.jp) for English language editing. Haowei Xue would like to thank China Scholarship Council for the scholarship support (No. 201909210014).

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama University, 2-5-1 Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan

    Haowei Xue, Takayuki Furumatsu, Takaaki Hiranaka, Keisuke Kintaka, Naohiro Higashihara, Masanori Tamura, Ximing Zhang & Toshifumi Ozaki

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  1. Haowei Xue
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  2. Takayuki Furumatsu
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Contributions

Takayuki Furumatsu designed the study. Haowei Xue, Takaaki Hiranaka, and Takayuki Furumatsu prepared the manuscript. Haowei Xue, Takaaki Hiranaka, and Keisuke Kintaka contributed to the data collection. Toshifumi Ozaki, Haowei Xue, Ximing Zhang, Naohiro Higashihara, and Masanori Tamura contributed to the analysis of data. All authors have critically reviewed the manuscript, approved the final version of the manuscript, and agreed to be accountable for all aspects of the work.

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Correspondence to Takayuki Furumatsu.

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Approval from the appropriate Institutional Review Boards was obtained (ID number: 1857), and the study was conducted retrospectively in line with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Xue, H., Furumatsu, T., Hiranaka, T. et al. Concomitant posterior anchoring further reduces posterior meniscal extrusion during pullout repair of medial meniscus posterior root tears: a retrospective study. International Orthopaedics (SICOT) 47, 2391–2400 (2023). https://doi.org/10.1007/s00264-022-05660-2

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