Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 27, Issue 1, pp 189–196 | Cite as

Pullout fixation for medial meniscus posterior root tears: clinical results were not age-dependent, but osteoarthritis progressed

  • Kyu Sung Chung
  • Jeong Ku Ha
  • Ho Jong Ra
  • Han Sung Lee
  • Dhong Won Lee
  • Jung Ho Park
  • Du Han Kim
  • Jin Goo KimEmail author



This study investigated the outcomes of pullout fixation for medial meniscus posterior root tears (MMPRTs) in patients ≤ 60 years old versus patients > 60 years old. It was hypothesized that older patients would demonstrate results comparable with those of younger patients.


Patients with pullout fixation who were followed-up for more than 5 years were included. Patients were categorized into two groups based on age (group A, ≤ 60 years; group B, > 60 years). The Lysholm score, Kellgren–Lawrence (K–L, 0/1/2/3/4) grade, and medial joint space width were evaluated retrospectively. Preoperative results were compared with the final results in each group, which were compared between groups.


Twenty-five patients in group A (mean age, 54.7 ± 3.8 years) and 22 patients in group B (mean age, 65.6 ± 4.4 years) were recruited. The mean follow-up duration was 70.9 months. The Lysholm score (group A, 53.0 ± 9.1 to 86.0 ± 12.1, P < 0.001; group B, 51.1 ± 7.1 to 82.9 ± 9.7, P < 0.001) improved significantly. However, the joint space width (group A, 4.7 ± 1.1 to 3.9 ± 1.1 mm, P < 0.001; group B, 4.7 ± 0.9 to 3.8 ± 0.9 mm, P < 0.001) and K–L grade (group A, 3/17/5/0/0 to 0/7/11/7/0, P < 0.001; group B, 2/14/6/0/0 to 0/3/14/5/0, P < 0.001) worsened significantly. No significant differences between groups were observed in final outcomes, including Lysholm score (n.s.), K–L grade (n.s.), and joint space narrowing (n.s.). No case with operation failure that require total knee arthroplasty was not observed.


MMPRT fixation did not prevent the progression of arthrosis completely. However, clinical outcomes were not age-dependent. Thus, age may not be a critical factor to consider when applying fixation.

Level of evidence

Retrospective case–control study; Level of evidence, IV.


Medial meniscus Posterior root tear Pullout fixation Age 



All authors have no financial interests, activities, relationships, and affiliations to disclose.

Compliance with ethical standards

Conflict of interest

All authors have no potential conflict of interest.

Ethical approval

Ethical approval was obtained from the institutional review board of our hospital district (IRB no. 2013-06-027-002).


  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 90:1922–1931CrossRefPubMedGoogle Scholar
  2. 2.
    Bhatia S, LaPrade CM, Ellman MB, LaPrade RF (2014) Meniscal root tears: significance, diagnosis, and treatment. Am J Sports Med 42:3016–3030CrossRefPubMedGoogle Scholar
  3. 3.
    Bin SI, Kim JM, Shin SJ (2004) Radial tears of the posterior horn of the medial meniscus. Arthroscopy 20:373–378CrossRefPubMedGoogle Scholar
  4. 4.
    Cho JH, Song JG (2014) Second-look arthroscopic assessment and clinical results of modified pull-out suture for posterior root tear of the medial meniscus. Knee Surg Relat Res 26:106–113CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Choi ES, Park SJ (2015) Clinical Evaluation of the Root Tear of the Posterior Horn of the Medial Meniscus in Total Knee Arthroplasty for Osteoarthritis. Knee Surg Relat Res 27:90–94CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Chung KS, Ha JK, Ra HJ, Kim JG (2016) A meta-analysis of clinical and radiographic outcomes of posterior horn medial meniscus root repairs. Knee Surg Sports Traumatol Arthrosc 24:1455–1468CrossRefPubMedGoogle Scholar
  7. 7.
    Chung KS, Ha JK, Ra HJ, Kim JG (2016) Prognostic Factors in the Midterm Results of Pullout Fixation for Posterior Root Tears of the Medial Meniscus. Arthroscopy 32:1319–1327CrossRefPubMedGoogle Scholar
  8. 8.
    Chung KS, Ha JK, Ra HJ, Kim JG (2017) Does release of the superficial medial collateral ligament result in clinically harmful effects after the fixation of medial meniscus posterior. Root Tears? Arthroscopy 33:199–208CrossRefPubMedGoogle Scholar
  9. 9.
    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 45:42–49CrossRefPubMedGoogle Scholar
  10. 10.
    Chung KS, Ha JK, Yeom CH, Ra HJ, Jang HS, Choi SH, Kim JG (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 31:1941–1950CrossRefPubMedGoogle Scholar
  11. 11.
    Feucht MJ, Kuhle J, Bode G, Mehl J, Schmal H, Sudkamp NP, Niemeyer P (2015) Arthroscopic transtibial pullout repair for posterior medial meniscus root tears: a systematic review of clinical, radiographic, and second-look arthroscopic results. Arthroscopy 31:1808–1816CrossRefPubMedGoogle Scholar
  12. 12.
    Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16:494–502CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Kim SB, Ha JK, Lee SW, Kim DW, Shim JC, Kim JG, Lee MY (2011) Medial meniscus root tear refixation: comparison of clinical, radiologic, and arthroscopic findings with medial meniscectomy. Arthroscopy 27:346–354CrossRefPubMedGoogle Scholar
  14. 14.
    Krych AJ, Johnson NR, Mohan R, Dahm DL, Levy BA, Stuart MJ (2018) Partial meniscectomy provides no benefit for symptomatic degenerative medial meniscus posterior root tears. Knee Surg Sports Traumatol Arthrosc 26:1117–1122PubMedGoogle Scholar
  15. 15.
    Krych AJ, Reardon PJ, 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
  16. 16.
    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 43:363–369CrossRefPubMedGoogle Scholar
  17. 17.
    LaPrade RF, Matheny LM, Moulton SG, James EW, Dean CS (2017) Posterior meniscal root repairs: outcomes of an anatomic transtibial pull-out technique. Am J Sports Med 45:884–891CrossRefPubMedGoogle Scholar
  18. 18.
    Lee DW, Ha JK, Kim JG (2014) Medial meniscus posterior root tear: a comprehensive review. Knee Surg Relat Res 26:125–134CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Lee DW, Kim MK, Jang HS, Ha JK, Kim JG (2014) Clinical and radiologic evaluation of arthroscopic medial meniscus root tear refixation: comparison of the modified Mason–Allen stitch and simple stitches. Arthroscopy 30:1439–1446CrossRefPubMedGoogle Scholar
  20. 20.
    Lee YG, Shim JC, Choi YS, Kim JG, Lee GJ, Kim HK (2008) Magnetic resonance imaging findings of surgically proven medial meniscus root tear: tear configuration and associated knee abnormalities. J Comput Assist Tomogr 32:452–457CrossRefPubMedGoogle Scholar
  21. 21.
    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
  22. 22.
    Seo HS, Lee SC, Jung KA (2011) Second-look arthroscopic findings after repairs of posterior root tears of the medial meniscus. Am J Sports Med 39:99–107CrossRefPubMedGoogle Scholar
  23. 23.
    Shelbourne KD, Dickens JF (2006) Digital radiographic evaluation of medial joint space narrowing after partial meniscectomy of bucket-handle medial meniscus tears in anterior cruciate ligament-intact knees. Am J Sports Med 34:1648–1655CrossRefPubMedGoogle Scholar
  24. 24.
    Walter SD, Eliasziw M, Donner A (1998) Sample size and optimal designs for reliability studies. Stat Med 17:101–110CrossRefPubMedGoogle Scholar

Copyright information

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

Authors and Affiliations

  • Kyu Sung Chung
    • 1
  • Jeong Ku Ha
    • 1
  • Ho Jong Ra
    • 2
  • Han Sung Lee
    • 3
  • Dhong Won Lee
    • 4
  • Jung Ho Park
    • 4
  • Du Han Kim
    • 4
  • Jin Goo Kim
    • 4
    Email author
  1. 1.Department of Orthopedic Surgery and Sports Medical Center and Sports Medical Research Institute, Seoul Paik Hospital, College of MedicineInje UniversitySeoulSouth Korea
  2. 2.Department of Orthopedic Surgery, Gangneung Asan Hospital, College of MedicineUlsan UniversityGangneungSouth Korea
  3. 3.Department of Orthopedic SurgeryHanil General HospitalSeoulSouth Korea
  4. 4.Department of Orthopedic Surgery and Sports Medical CenterKonKuk University Medical CenterSeoulSouth Korea

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