Degenerative medial meniscus posterior root tear and non-root tear do not show differences in joint survival and clinical outcome after partial meniscectomy

  • Oh-Jin Kwon
  • Seong-Il BinEmail author
  • Jong-Min Kim
  • Bum-Sik Lee
  • Sang-Min Lee
  • Jun-Gu Park
  • Gi-Woon Yoon



No comparative studies of outcomes between degenerative medial meniscus posterior root tear (MM PRT) and non-root tear (NRT) have been conducted. This study aimed to compare joint survival and clinical outcome between MM PRT and MM NRT after partial meniscectomy with proper control of confounding factors.


One hundred and ten patients each in MM PRT and MM NRT groups who underwent arthroscopic partial meniscectomy were retrospectively evaluated through propensity score matching. Joint survival was assessed on the basis of surgical and radiographic failures. Clinical outcomes were assessed using the Lysholm score.


The confounding variables were well balanced between the groups, with standardized mean differences of < 0.2 after propensity score matching. Failures occurred in 30 (27.3%) and 35 patients (31.8%) in the MM PRT group and MM NRT group, respectively. The estimated mean survival times were 12.5 years (95% confidence interval [CI] 11.5–13.5) and 11.7 years (10.7–12.7), respectively. There were no significant differences in the overall survival rate and Lysholm score between the two groups (n.s.).


In middle-aged patients with degenerative MM PRT, joint survival and clinical outcome showed comparable results with those with MM NRT after partial meniscectomy. Arthroscopic partial meniscectomy is one of the effective treatments for MM PRT with consideration of various patient factors.

Level of evidence



Degenerative medial meniscus root tear Arthroscopic partial meniscectomy Joint survivorship Clinical outcome 



No funding was required.

Compliance with ethical standards

Conflict of interest

All authors declared that they have no conflicts of interest.

Ethical approval

Ethical approval for the study was given by the Ethics Committee of Asan Medical Center.


  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(8):502–506CrossRefPubMedGoogle Scholar
  2. 2.
    Ahn JH, Jeong HJ, Lee YS, Park JH, Lee JW, Park JH, Ko TS (2015) Comparison between conservative treatment and arthroscopic pull-out repair of the medial meniscus root tear and analysis of prognostic factors for the determination of repair indication. Arch Orthop Trauma Surg 135(9):1265–1276CrossRefPubMedGoogle Scholar
  3. 3.
    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 Jt Surg Am 90(9):1922–1931Google Scholar
  4. 4.
    Anderson AF, Irrgang JJ, Dunn W, Beaufils P, Cohen M, Cole BJ, Coolican M, Ferretti M, Glenn RE Jr, Johnson R, Neyret P, Ochi M, Panarella L, Siebold R, Spindler KP, Ait Si Selmi T, Verdonk P, Verdonk R, Yasuda K, Kowalchuk DA (2011) Interobserver reliability of the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) classification of meniscal tears. Am J Sports Med 39(5):926–932CrossRefPubMedGoogle Scholar
  5. 5.
    Austin PC (2008) A critical appraisal of propensity-score matching in the medical literature between 1996 and 2003. Stat Med 27(12):2037–2049CrossRefPubMedGoogle Scholar
  6. 6.
    Austin PC (2009) Using the standardized difference to compare the prevalence of a binary variable between two groups in observational research. Commun Stat Simul Comput 38(6):1228–1234CrossRefGoogle Scholar
  7. 7.
    Austin PC (2011) An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivar Behav Res 46(3):399–424CrossRefGoogle Scholar
  8. 8.
    Beaufils P, Becker R, Kopf S, Englund M, Verdonk R, Ollivier M, Seil R (2017) Surgical management of degenerative meniscus lesions: The 2016 ESSKA meniscus consensus. Joints 5(2):59–69CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Beaufils P, Becker R, Kopf S, Englund M, Verdonk R, Ollivier M, Seil R (2017) Surgical management of degenerative meniscus lesions: the 2016 ESSKA meniscus consensus. Knee Surg Sports Traumatol Arthrosc 25(2):335–346CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Bedson J, Croft PR (2008) The discordance between clinical and radiographic knee osteoarthritis: a systematic search and summary of the literature. BMC Musculoskelet Disord 9:116CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Bin SI, Kim JM, Shin SJ (2004) Radial tears of the posterior horn of the medial meniscus. Arthroscopy 20(4):373–378CrossRefPubMedGoogle Scholar
  12. 12.
    Brouwer GM, van Tol AW, Bergink AP, Belo JN, Bernsen RM, Reijman M, Pols HA, Bierma-Zeinstra SM (2007) Association between valgus and varus alignment and the development and progression of radiographic osteoarthritis of the knee. Arthritis Rheum 56(4):1204–1211CrossRefPubMedGoogle Scholar
  13. 13.
    Burks RT, Metcalf MH, Metcalf RW (1997) Fifteen-year follow-up of arthroscopic partial meniscectomy. Arthroscopy 13(6):673–679CrossRefPubMedGoogle Scholar
  14. 14.
    Cerejo R, Dunlop DD, Cahue S, Channin D, Song J, Sharma L (2002) The influence of alignment on risk of knee osteoarthritis progression according to baseline stage of disease. Arthritis Rheum 46(10):2632–2636CrossRefPubMedGoogle Scholar
  15. 15.
    Chatain F, Adeleine P, Chambat P, Neyret P (2003) A comparative study of medial versus lateral arthroscopic partial meniscectomy on stable knees: 10-year minimum follow-up. Arthroscopy 19(8):842–849CrossRefPubMedGoogle Scholar
  16. 16.
    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(7):1319–1327CrossRefPubMedGoogle Scholar
  17. 17.
    Elattrache N, Lattermann C, Hannon M, Cole B (2014) New England journal of medicine article evaluating the usefulness of meniscectomy is flawed. Arthroscopy 30(5):542–543CrossRefPubMedGoogle Scholar
  18. 18.
    Englund M, Guermazi A, Lohmander SL (2009) The role of the meniscus in knee osteoarthritis: a cause or consequence? Radiol Clin North Am 47(4):703–712CrossRefPubMedGoogle Scholar
  19. 19.
    Fabricant PD, Jokl P (2007) Surgical outcomes after arthroscopic partial meniscectomy. J Am Acad Orthop Surg 15(11):647–653CrossRefPubMedGoogle Scholar
  20. 20.
    Fairbank TJ (1948) Knee joint changes after meniscectomy. J Bone Jt Surg Br 30b(4):664–670Google Scholar
  21. 21.
    Faucett SC, Geisler BP, Chahla J, Krych AJ, Kurzweil PR, Garner AM, Liu S, LaPrade RF, Pietzsch JB (2019) Meniscus root repair vs meniscectomy or nonoperative management to prevent knee osteoarthritis after medial meniscus root tears: clinical and economic effectiveness. Am J Sports Med 47(3):762–769CrossRefPubMedGoogle Scholar
  22. 22.
    Felson DT (1990) The epidemiology of knee osteoarthritis: results from the Framingham Osteoarthritis Study. Semin Arthritis Rheum 20(3 Suppl 1):42–50CrossRefPubMedGoogle Scholar
  23. 23.
    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(9):1808–1816CrossRefPubMedGoogle Scholar
  24. 24.
    Habata T, Uematsu K, Hattori K, Takakura Y, Fujisawa Y (2004) Clinical features of the posterior horn tear in the medial meniscus. Arch Orthop Trauma Surg 124(9):642–645CrossRefPubMedGoogle Scholar
  25. 25.
    Han SB, Shetty GM, Lee DH, Chae DJ, Seo SS, Wang KH, Yoo SH, Nha KW (2010) Unfavorable results of partial meniscectomy for complete posterior medial meniscus root tear with early osteoarthritis: a 5- to 8-year follow-up study. Arthroscopy 26(10):1326–1332CrossRefPubMedGoogle Scholar
  26. 26.
    Heidari B (2011) Knee osteoarthritis prevalence, risk factors, pathogenesis and features: Part I. Casp J Intern Med 2(2):205–212Google Scholar
  27. 27.
    Herrlin S, Hallander M, Wange P, Weidenhielm L, Werner S (2007) Arthroscopic or conservative treatment of degenerative medial meniscal tears: a prospective randomised trial. Knee Surg Sports Traumatol Arthrosc 15(4):393–401CrossRefPubMedGoogle Scholar
  28. 28.
    Hulet CH, Locker BG, Schiltz D, Texier A, Tallier E, Vielpeau CH (2001) Arthroscopic medial meniscectomy on stable knees. J Bone Jt Surg Br 83(1):29–32CrossRefGoogle Scholar
  29. 29.
    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(7):1606–1610CrossRefPubMedGoogle Scholar
  30. 30.
    Jiang EX, Abouljoud MM, Everhart JS, DiBartola AC, Kaeding CC, Magnussen RA, Flanigan DC (2019) Clinical factors associated with successful meniscal root repairs: as systematic review. Knee 26(2):285–291CrossRefPubMedGoogle Scholar
  31. 31.
    Jones AO, Houang MT, Low RS, Wood DG (2006) Medial meniscus posterior root attachment injury and degeneration: MRI findings. Aust Radiol 50(4):306–313CrossRefGoogle Scholar
  32. 32.
    Kan A, Oshida M, Oshida S, Imada M, Nakagawa T, Okinaga S (2010) Anatomical significance of a posterior horn of medial meniscus: the relationship between its radial tear and cartilage degradation of joint surface. Sports Med Arthrosc Rehabil Ther Technol 2:1PubMedPubMedCentralGoogle Scholar
  33. 33.
    Kaplan DJ, Alaia EF, Dold AP, Meislin RJ, Strauss EJ, Jazrawi LM, Alaia MJ (2018) Increased extrusion and ICRS grades at 2-year follow-up following transtibial medial meniscal root repair evaluated by MRI. Knee Surg Sports Traumatol Arthrosc 26(9):2826–2834CrossRefPubMedGoogle Scholar
  34. 34.
    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(3):346–354CrossRefPubMedGoogle Scholar
  35. 35.
    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(2):383–389CrossRefPubMedGoogle Scholar
  36. 36.
    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(4):1117–1122PubMedGoogle Scholar
  37. 37.
    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(2):363–369CrossRefPubMedGoogle Scholar
  38. 38.
    Lee BS, Bin SI, Kim JM, Park MH, Lee SM, Bae KH (2019) Partial meniscectomy for degenerative medial meniscal root tears shows favorable outcomes in well-aligned, nonarthritic knees. Am J Sports Med 47:606–611Google Scholar
  39. 39.
    Lee DH, Kim TH, Kim JM, Bin SI (2009) Results of subtotal/total or partial meniscectomy for discoid lateral meniscus in children. Arthroscopy 25(5):496–503CrossRefPubMedGoogle Scholar
  40. 40.
    Lee DW, Moon SG, Kim NR, Chang MS, Kim JG (2018) Medial knee osteoarthritis precedes medial meniscal posterior root tear with an event of painful popping. Orthop Traumatol Surg Res 104(7):1009–1015CrossRefPubMedGoogle Scholar
  41. 41.
    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(9):951–958CrossRefPubMedGoogle Scholar
  42. 42.
    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(10):569–574CrossRefPubMedGoogle Scholar
  43. 43.
    Magnusson K, Kumm J, Turkiewicz A, Englund M (2018) A naturally aging knee, or development of early knee osteoarthritis? Osteoarthr Cartil 26(11):1447–1452CrossRefPubMedGoogle Scholar
  44. 44.
    Papalia R, Del Buono A, Osti L, Denaro V, Maffulli N (2011) Meniscectomy as a risk factor for knee osteoarthritis: a systematic review. Br Med Bull 99:89–106CrossRefPubMedGoogle Scholar
  45. 45.
    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(10):3121–3126CrossRefPubMedGoogle Scholar
  46. 46.
    Rangger C, Klestil T, Gloetzer W, Kemmler G, Benedetto KP (1995) Osteoarthritis after arthroscopic partial meniscectomy. Am J Sports Med 23(2):240–244CrossRefPubMedGoogle Scholar
  47. 47.
    Scuderi GR, Bourne RB, Noble PC, Benjamin JB, Lonner JH, Scott WN (2012) The new Knee Society Knee Scoring System. Clin Orthop Relat Res 470(1):3–19CrossRefPubMedGoogle Scholar
  48. 48.
    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(1):99–107CrossRefPubMedGoogle Scholar
  49. 49.
    Zampogna B, Vasta S, Amendola A, Uribe-Echevarria Marbach B, Gao Y, Papalia R, Denaro V (2015) Assessing Lower limb alignment: comparison of standard knee X-ray vs long leg view. Iowa Orthop J 35:49–54PubMedPubMedCentralGoogle Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019

Authors and Affiliations

  1. 1.Department of Orthopedic Surgery, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulSouth Korea
  2. 2.Department of Orthopedic Surgery, Research Institute for Convergence of Biomedical Science and TechnologyPusan National University Yangsan Hospital, Pusan National University School of MedicineYangsanRepublic of Korea

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