Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 19, Issue 2, pp 222–229 | Cite as

Predictors of degenerative medial meniscus extrusion: radial component and knee osteoarthritis

  • Dae-Hee Lee
  • Bum-Sik Lee
  • Jong-Min Kim
  • Kyung-Sook Yang
  • Eun-Jong Cha
  • Ji-Hun Park
  • Seong-Il BinEmail author



The purpose of this study was to determine the effect of a radial tear on degenerative medial meniscus posterior horn tear extrusion and to identify predictors of medial meniscus extrusion.


We reviewed the records of 102 knees with medial meniscus posterior horn tears and degeneration that underwent a partial meniscectomy. Tears were classified as root (n = 17) and non-root (n = 85) tears, or as radial (n = 46) and non-radial (n = 56) tears. Groups were compared in terms of absolute and relative meniscal extrusion, and the proportion of knees with major (>3 mm) extrusion. Multiple regression analysis was used to identify predictors of extrusion.


The radial group had greater mean absolute (4 ± 1 vs. 3 ± 1 mm, P = 0.001) and relative (31 ± 11 vs. 23 ± 12%, P = 0.031) extrusion than the non-radial group. The radial group also had a greater proportion of major extrusions than the non-radial group (74% vs. 26%; P = 0.016). In contrast, the root tear and non-root tear groups were similar in terms of mean absolute (3 ± 1 vs. 3 ± 1 mm, P = n.s.) and relative (30 ± 7 vs. 26 ± 13%; P = n.s.) extrusion and in terms of proportion with major extrusions (59 vs. 55%; P = n.s.). Extrusion was found to be associated with a similar strength with both the presence of a radial component and the preoperative Kellgren-Lawrence grade.


Meniscal extrusion was greater and more severe in knees with a radial tear component than in knees without a radial component. The incidence and degree of major extrusion was similar in knees with root tears and non-root tears. A radial component and knee osteoarthritis severity were similarly predictive of absolute and relative extrusion. Meniscal extrusion in osteoarthritic knees was associated not only with degenerative meniscal tear but also with osteoarthritis severity. Therefore, arthroscopic meniscal procedures, especially meniscal repair, should be cautiously considered in patients with meniscal extrusion.


Extrusion Root tear Medial meniscus Posterior horn Osteoarthritis 



This work was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (2010-000-1733).


  1. 1.
    Adams JG, McAlindon T, Dimasi M, Carey J, Eustace S (1999) Contribution of meniscal extrusion and cartilage loss to joint space narrowing in osteoarthritis. Clin Radiol 54:502–506CrossRefPubMedGoogle Scholar
  2. 2.
    Allaire R, Muriuki M, Gilbertson L, Harner C (2008) Biomechanical consequences of a tear of the posterior root of the medial meniscus. Similar to total meniscectomy. J Bone Joint Surg Am 90:1922–1931CrossRefPubMedGoogle Scholar
  3. 3.
    Bin SI, Kim JC, Kim JM, Park SS, Han YK (2002) Correlation between type of discoid lateral menisci and tear pattern. Knee Surg Sports Traumatol Arthrosc 10:218–222CrossRefPubMedGoogle Scholar
  4. 4.
    Bin SI, Kim JM, Shin SJ (2004) Radial tears of the posterior horn of the medial meniscus. Arthroscopy 20:373–378CrossRefPubMedGoogle Scholar
  5. 5.
    Chan W, Huang GS, Hsu SM, Chang YC, Ho WP (2008) Radiographic joint space narrowing in osteoarthritis of the knee: relationship to meniscal tears and duration of pain. Skeletal Radiol 37:917–922CrossRefPubMedGoogle Scholar
  6. 6.
    Choi NH, Son KM, Victoroff B (2008) Arthroscopic all-inside repair for a tear of posterior root of the medial meniscus: a technical note. Knee Surg Sports Traumatol Arthrosc 16:891–893CrossRefPubMedGoogle Scholar
  7. 7.
    Costa CR, Morrison WB, Carrino JA (2004) Medial meniscus extrusion on knee MRI: is extent associated with severity of degeneration or type of tear? AJR Am J Roentgenol 183:17–23PubMedGoogle Scholar
  8. 8.
    Gale DR, Chaisson CE, Totterman SM, Schwartz RK, Gale ME, Felson D (1999) Meniscal subluxation: association with osteoarthritis and joint space narrowing. Osteoar Cartil 7:526–532CrossRefGoogle Scholar
  9. 9.
    Habata T, Uematsu K, Kasanami R, Hattori K, Takakura Y, Tohma Y, Fujisawa Y (2006) Long-term clinical and radiographic follow-up of total resection for discoid lateral meniscus. Arthroscopy 22:1339–1343CrossRefPubMedGoogle Scholar
  10. 10.
    Hunter DJ, Zhang YQ, Tu X, Lavalley M, Niu JB, Amin S, Guermazi A, Genant H, Gale D, Felson DT (2006) Change in joint space width: hyaline articular cartilage loss or alteration in meniscus? Arthritis Rheum 54:2488–2495CrossRefPubMedGoogle Scholar
  11. 11.
    Kim YJ, Kim JG, Chang SH, Shim JC, Kim SB, Lee MY (2009) Posterior root tear of the medial meniscus in multiple knee ligament injuries. Knee ( in press). doi:  10.1016/j.knee.2009.10.001
  12. 12.
    Koenig J, Ranawat A, Umans H, Difelice G (2009) Meniscal root tears: diagnosis and treatment. Arthroscopy 25:1025–1032CrossRefPubMedGoogle Scholar
  13. 13.
    Lee DH, Kim TH, Kim JM, Bin SI (2009) Results of subtotal/total or partial meniscectomy for discoid lateral meniscus in children. Arthroscopy 25:496–503CrossRefPubMedGoogle Scholar
  14. 14.
    Lee JH, Lim YJ, Kim KB, Kim KH, Song JH (2009) Arthroscopic pullout suture repair of posterior root tear of the medial meniscus: radiographic and clinical results with a 2-year follow-up. Arthroscopy 25:951–958CrossRefPubMedGoogle Scholar
  15. 15.
    Lee S, Jee WH, Kim JM (2008) Radial tear of the medial meniscal root: reliability and accuracy of MRI for diagnosis. Am J Roentgenol 191:81–85CrossRefGoogle Scholar
  16. 16.
    Lerer DB, Umans HR, Hu MX, Jones MH (2004) The role of meniscal root pathology and radial meniscal tear in medial meniscal extrusion. Skeletal Radiol 33:569–574CrossRefPubMedGoogle Scholar
  17. 17.
    Lim HC, Bae JH, Wang JH, Seok CW, Kim MK (2010) Non-operative treatment of degenerative posterior root tear of the medial meniscus. Knee Surg Sports Traumatol Arthrosc 18:535–539CrossRefPubMedGoogle Scholar
  18. 18.
    Magee T (2008) MR findings of meniscal extrusion correlated with arthroscopy. J Magn Reson Imaging 28:466–470CrossRefPubMedGoogle Scholar
  19. 19.
    Matava MJ, Kim YM (2010) Tibial avulsion fracture of the posterior root of the medial meniscus in a skeletally-immature child—A case report. Knee (in press). doi:  10.1016/j.knee.2010.01.007
  20. 20.
    Mikulicz J (1878) Ueber individuelle Formdifferenzen am Femur und an der Tibia des Menschen. Mit Berücksichtigung der Statik des Kniegelenks. Arch Anat Entwick:351-404Google Scholar
  21. 21.
    Nicholas S, Golant A, Schachter A, Lee S (2009) A new surgical technique for arthroscopic repair of the meniscus root tear. Knee Surg Sports Traumatol Arthrosc 17:1433–1436CrossRefPubMedGoogle Scholar
  22. 22.
    Puig L, Monllau JC, Corrales M, Pelfort X, Melendo E, Caceres E (2006) Factors affecting meniscal extrusion: correlation with MRI, clinical, and arthroscopic findings. Knee Surg Sports Traumatol Arthrosc 14:394–398CrossRefPubMedGoogle Scholar
  23. 23.
    Raynauld JP, Martel-Pelletier J, Berthiaume MJ, Beaudoin G, Choquette D, Haraoui B, Tannenbaum H, Meyer J, Beary J, Cline G, Pelletier JP (2006) Long term evaluation of disease progression through the quantitative magnetic resonance imaging of symptomatic knee osteoarthritis patients: correlation with clinical symptoms and radiographic changes. Arthritis Res Ther 8:R21–R33CrossRefPubMedGoogle Scholar
  24. 24.
    Rennie WJ, Finlay DB (2006) Meniscal extrusion in young athletes: associated knee joint abnormalities. AJR Am J Roentgenol 186:791–794CrossRefPubMedGoogle Scholar
  25. 25.
    Seo JH, Li G, Shetty GM, Kim JH, Bae JH, Jo ML, Kim JS, Lee SJ, Nha KW (2009) Effect of repair of radial tears at the root of the posterior horn of the medial meniscus with the pullout suture technique: a biomechanical study using porcine knees. Arthroscopy 25:1281–1287CrossRefPubMedGoogle Scholar
  26. 26.
    Sharma L, Eckstein F, Song J, Guermazi A, Prasad P, Kapoor D, Cahue S, Marshall M, Hudelmaier M, Dunlop D (2008) Relationship of meniscal damage, meniscal extrusion, malalignment, and joint laxity to subsequent cartilage loss in osteoarthritic knees. Arthritis Rheum 58:1716–1726CrossRefPubMedGoogle Scholar
  27. 27.
    Sugita T, Kawamata T, Ohnuma M, Yoshizumi Y, Sato K (2001) Radial displacement of the medial meniscus in varus osteoarthritis of the knee. Clin Orthop Relat Res 387:171–177CrossRefPubMedGoogle Scholar
  28. 28.
    Vedi V, Williams A, Tennant SJ, Spouse E, Hunt DM, Gedroyc WM (1999) Meniscal movement. An in vivo study using dynamic MRI. J Bone Joint Surg Br 81:37–41CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Dae-Hee Lee
    • 1
  • Bum-Sik Lee
    • 4
  • Jong-Min Kim
    • 4
  • Kyung-Sook Yang
    • 2
  • Eun-Jong Cha
    • 3
  • Ji-Hun Park
    • 1
  • Seong-Il Bin
    • 4
    Email author
  1. 1.Department of Orthopaedic SurgeryKorea University, College of Medicine, Anam HospitalSeoulKorea
  2. 2.Department of BiostatisticsKorea University, College of MedicineSeoulKorea
  3. 3.Department of Biomedical Engineering, School of MedicineChungbuk National UniversityCheongjuKorea
  4. 4.Department of Orthopedic SurgeryUniversity of Ulsan, College of MedicineSeoulKorea

Personalised recommendations