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Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 26, Issue 12, pp 3731–3737 | Cite as

Meniscal root tears occur frequently in multi-ligament knee injury and can be predicted by associated MRI injury patterns

  • Jonathan D. KosyEmail author
  • Luigi Matteliano
  • Anshul Rastogi
  • Dawn Pearce
  • Daniel B. Whelan
Knee
  • 158 Downloads

Abstract

Purpose

The frequency of meniscal root tears in association with multi-ligament knee injury has not been established but adds to the complexity of surgical reconstruction and may have long-term consequences. Therefore, identifying root tears, on preoperative imaging, is important. The aim of this study was to identify the frequency of meniscal root tears, on preoperative magnetic resonance imaging, following multi-ligament injury and distinguish associated injury patterns that may aid detection.

Methods

Cases were identified from a prospectively collected institutional database. The magnetic resonance imaging of 188 multi-ligament injuries [median age 31 years (range 16–64)] was retrospectively reviewed by three musculoskeletal radiologists with the presence of meniscal injuries recorded alongside the ligament injury pattern and intra-articular fractures. Assessment of injury pattern was solely made on this imaging.

Results

38 meniscal root injuries were identified in 37 knees (overall frequency = 20.2%; medial = 10.6%; lateral = 9.6%). The frequency of meniscal root tears was not increased in higher grade injuries (21.5% vs. 17.0%, n.s.). Valgus injury patterns were associated with lateral root tears (p < 0.05) and varus patterns were associated with medial root tears (p < 0.05). Further, fractures in the same compartment were associated with both medial and lateral root tears (p < 0.05).

Conclusions

Meniscal root tears occur more frequently in multi-ligament knee injury than previously reported with isolated anterior cruciate rupture. Root tears can be predicted by ligament injury patterns and fractures sustained (suggestive of a compressive force). In multi-ligament cases, the preoperative magnetic resonance imaging can be used to detect these tears and associated patterns of injury.

Level of evidence

IV.

Keywords

Multi-ligament injury Knee dislocation Meniscal root tear Magnetic resonance imaging Radiologic 

Notes

Funding

No external funding was used.

Compliance with ethical standards

Conflict of interest

We declare that we have no conflicts of interest in the authorship or publication of this contribution.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of study formal consent is not required.

References

  1. 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 90:1922–1931CrossRefGoogle Scholar
  2. 2.
    Bin SI, Jeong TW, Kim SJ, Lee DH (2016) A new arthroscopic classification of degenerative medial meniscus root tear that correlates with meniscus extrusion on magnetic resonance imaging. Knee 23:246–250CrossRefGoogle Scholar
  3. 3.
    Bonasia DE, Pellegrino P, D’Amelio A, Cottino U, Rossi R (2015) Meniscal root tear repair: why, when and how? Orthop Rev (Pavia) 7:5792Google Scholar
  4. 4.
    Chahla J, Moulton SG, LaPrade CM, Dean CS, LaPrade RF (2016) Posterior meniscal root repair: the transtibial double tunnel pullout technique. Arthrosc Tech 5:e291–e296CrossRefGoogle Scholar
  5. 5.
    Feucht MJ, Bigdon S, Bode G, Salzmann GM, Dovi-Akue D, Sudkamp NP, Niemeyer P (2015) Associated tears of the lateral meniscus in anterior cruciate ligament injuries: risk factors for different tear patterns. J Orthop Surg Res 10:34CrossRefGoogle Scholar
  6. 6.
    Forkel P, von Deimling C, Lacheta L, Imhoff FB, Foehr P, Willinger L, Dyrna F, Petersen W, Imhoff AB, Burgkart R (2018) Repair of the lateral posterior meniscal root improves stability in the ACL-deficient knee. Knee Surg Sports Traumatol Arthrosc.  https://doi.org/10.1007/s00167-018-4949-8 CrossRefPubMedGoogle Scholar
  7. 7.
    Frank JM, Moatshe G, Brady AW, Dornan GJ, Coggins A, Muckenhirn KJ, Slette EL, Mikula JD, LaPrade RF (2017) Lateral meniscus posterior root and meniscofemoral ligaments as stabilizing structures in the ACL-deficient knee: a biomechanical study. Orthop J Sports Med 5:2325967117695756CrossRefGoogle Scholar
  8. 8.
    Guermazi A, Hayashi D, Jarraya M, Roemer FW, Zhang Y, Niu J, Crema MD, Englund M, Lynch JA, Nevitt MC, Torner JC, Lewis CE, Felson CT (2013) Medial posterior meniscal root tears are associated with development or worsening of medial tibiofemoral cartilage damage: the multicenter osteoarthritis study. Radiology 268:814–821CrossRefGoogle Scholar
  9. 9.
    Halinen J, Koivikko M, Lindahl J, Hirvensalo E (2009) The efficacy of magnetic resonance imaging in acute multi-ligament injuries. Int Orthop 33:1733–1738CrossRefGoogle Scholar
  10. 10.
    Hussain ZB, Chahla J, Mandelbaum BR, Gomoll AH, LaPrade RF (2018) The role of meniscal tears in spontaneous osteonecrosis of the knee. Am J Sports Med.  https://doi.org/10.1177/0363546517743734 CrossRefGoogle Scholar
  11. 11.
    Hwang BY, Kim SJ, Lee SW, Lee HE, Lee CK, Hunter DJ, Jung KA (2012) Risk factors for medial meniscus posterior root tear. Am J Sports Med 40:1606–1610CrossRefGoogle Scholar
  12. 12.
    Jiang W, Yao J, He Y, Sun W, Huang Y, Kong D (2015) The timing of surgical treatment of knee dislocations: a systematic review. Knee Sports Surg Traumatol Arthrosc 23:3108–3113CrossRefGoogle Scholar
  13. 13.
    Kaplan DJ, Alaia EF, Dold AP, Meislin RJ, Strauss EJ, Jazrawi LM, Alaia MJ (2017) Increased extrusion and ICRS grades at 2-years follow-up following transtibial medial meniscal root repair evaluated by MRI. Knee Surg Sports Traumatol Arthrosc.  https://doi.org/10.1007/s00167-017-4755-8 CrossRefPubMedGoogle Scholar
  14. 14.
    Kim YJ, Kim JG, Chang SH, Shim JC, Kim SB, Lee MY (2010) Posterior root tears of the medial meniscus in multiple knee ligament injuries. Knee 17:324–328CrossRefGoogle Scholar
  15. 15.
    King AH, Krych AJ, Prince MR, Sousa PL, Stuart MJ, Levy BA (2015) Are meniscal tears and articular cartilage injury predictive of inferior patient outcome after surgical reconstruction for the dislocated knee? Knee Surg Sports Traumatol Arthrosc 23:3008–3011CrossRefGoogle Scholar
  16. 16.
    Klimkiewicz JJ, Petrie RS, Harner CD (2000) Surgical treatment of combined injury to anterior cruciate ligament, posterior cruciate ligament, and medial structures. Clin Sports Med 19:479–492CrossRefGoogle Scholar
  17. 17.
    Koenig JH, Ranawat AS, Umans HR, Difelice GS (2009) Meniscal root tears: diagnosis and treatment. Arthroscopy 25:1025–1032CrossRefGoogle Scholar
  18. 18.
    Krych AJ, Reardon P, Johnson NR, Mohan R, Peter L, Levy BA, Stuart MJ (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 25:383–389CrossRefGoogle Scholar
  19. 19.
    Krych AJ, Sousa PL, King AH, Engasser WM, Stuart MJ, Levy BA (2015) Meniscal tears and articular cartilage damage in the dislocated knee. Knee Surg Sports Traumatol Arthrosc 23:3019–3025CrossRefGoogle Scholar
  20. 20.
    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 43:363–369CrossRefGoogle Scholar
  21. 21.
    LaPrade CM, Jansson KS, Dornan G, Smith SD, Wijdicks CA, LaPrade RF (2014) Altered tibiofemoral contact mechanics due to lateral meniscus posterior horn root avulsions and radial tears can be restored with in situ pull-out suture repairs. J Bone Joint Surg Am 96:471–479CrossRefGoogle Scholar
  22. 22.
    Levy BA, Dajani KA, Whelan DB, Stannard JP, Fanelli GC, Stuart MJ, Boyd JL, MacDonald PA, Marx RG (2009) Decision making in the multiligament injured knee: an evidence based systematic review. Arthroscopy 25:430–438CrossRefGoogle Scholar
  23. 23.
    Lonner JH, Dupuy DE, Siliski JM (2000) Comparison of magnetic resonance imaging with operative findings in acute traumatic dislocations of the adult knee. J Orthop Trauma 14:183–186CrossRefGoogle Scholar
  24. 24.
    Matheny LM, Ockuly AC, Steadman JR, LaPrade RF (2015) Posterior meniscus root tears: associated pathologies to assist as diagnostic tools. Knee Surg Sports Traumatol Arthrosc 23:3127–3131CrossRefGoogle Scholar
  25. 25.
    Marzo JM, Gurske-DePerio J (2009) Effects of medial meniscus posterior horn avulsion and repair on tibiofemoral contact area and peak contact pressure with clinical implications. Am J Sports Med 37:124–129CrossRefGoogle Scholar
  26. 26.
    Moatshe G, Chahla J, Slette E, Engebretsen L, LaPrade RF (2016) Posterior meniscal root injuries. Acta Orthop 87:452–458CrossRefGoogle Scholar
  27. 27.
    Ozkoc G, Circi E, Gonc U, Irgit K, Pourbagher A, Tandogan RN (2008) Radial tears of the root of the posterior horn of the medial meniscus. Knee Surg Sports Traumatol Arthrosc 16:849–854CrossRefGoogle Scholar
  28. 28.
    Padalecki JR, Jansson KS, Smith SD, Dornan GJ, Pierce CM, Wijdicks CA, LaPrade RF (2014) Biomechanical consequences of a complete radial tear adjacent to the medial meniscus posterior root attachment site: in situ pull-out repair restores derangement of joint mechanics. Am J Sports Med 42:699–707CrossRefGoogle Scholar
  29. 29.
    Petersen W, Forkel P, Feucht MJ, Zantop T, Imhoff AB, Brucker PU (2014) Posterior root tear of the medial and lateral meniscus. Arch Orthop Trauma Surg 134:237–255CrossRefGoogle Scholar
  30. 30.
    Ra HJ, Ha JK, Jang HS, Kim JG (2015) Traumatic posterior root tear of the medial meniscus in patients with severe medial instability of the knee. Knee Surg Sports Traumatol Arthrosc 23:3121–3126CrossRefGoogle Scholar
  31. 31.
    Schenck R (2003) Classification of knee dislocation. Oper Tech Sports Med 11:193–198CrossRefGoogle Scholar
  32. 32.
    Yamagami R, Taketomi S, Inui H, Tahra K, Tanaka S (2017) The role of the medial meniscus posterior root tear and the proximal tibial morphology in the development of spontaneous osteonecrosis and osteoarthritis of the knee. Knee 24:390–395CrossRefGoogle Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2018

Authors and Affiliations

  • Jonathan D. Kosy
    • 1
    Email author
  • Luigi Matteliano
    • 1
  • Anshul Rastogi
    • 2
  • Dawn Pearce
    • 1
  • Daniel B. Whelan
    • 1
  1. 1.St Michael’s HospitalTorontoCanada
  2. 2.New Victoria HospitalKingston Upon ThamesUK

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