Skip to main content
SpringerLink
Log in

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

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusion

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  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 54:502–506

    Article  CAS  PubMed  Google Scholar 

  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 90:1922–1931

    Article  PubMed  Google Scholar 

  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 10:218–222

    Article  PubMed  Google Scholar 

  4. Bin SI, Kim JM, Shin SJ (2004) Radial tears of the posterior horn of the medial meniscus. Arthroscopy 20:373–378

    Article  PubMed  Google Scholar 

  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 37:917–922

    Article  PubMed  Google Scholar 

  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 16:891–893

    Article  PubMed  Google Scholar 

  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 183:17–23

    PubMed  Google Scholar 

  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 7:526–532

    Article  CAS  Google Scholar 

  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 22:1339–1343

    Article  PubMed  Google Scholar 

  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 54:2488–2495

    Article  CAS  PubMed  Google Scholar 

  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. Koenig J, Ranawat A, Umans H, Difelice G (2009) Meniscal root tears: diagnosis and treatment. Arthroscopy 25:1025–1032

    Article  PubMed  Google Scholar 

  13. Lee DH, Kim TH, Kim JM, Bin SI (2009) Results of subtotal/total or partial meniscectomy for discoid lateral meniscus in children. Arthroscopy 25:496–503

    Article  PubMed  Google Scholar 

  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 25:951–958

    Article  PubMed  Google Scholar 

  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 191:81–85

    Article  Google Scholar 

  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 33:569–574

    Article  CAS  PubMed  Google Scholar 

  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 18:535–539

    Article  PubMed  Google Scholar 

  18. Magee T (2008) MR findings of meniscal extrusion correlated with arthroscopy. J Magn Reson Imaging 28:466–470

    Article  PubMed  Google Scholar 

  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. Mikulicz J (1878) Ueber individuelle Formdifferenzen am Femur und an der Tibia des Menschen. Mit Berücksichtigung der Statik des Kniegelenks. Arch Anat Entwick:351-404

  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 17:1433–1436

    Article  PubMed  Google Scholar 

  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 14:394–398

    Article  PubMed  Google Scholar 

  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–R33

    Article  PubMed  Google Scholar 

  24. Rennie WJ, Finlay DB (2006) Meniscal extrusion in young athletes: associated knee joint abnormalities. AJR Am J Roentgenol 186:791–794

    Article  PubMed  Google Scholar 

  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 25:1281–1287

    Article  PubMed  Google Scholar 

  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 58:1716–1726

    Article  PubMed  Google Scholar 

  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 387:171–177

    Article  PubMed  Google Scholar 

  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 81:37–41

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

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).

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Korea University, College of Medicine, Anam Hospital, Seoul, Korea

    Dae-Hee Lee & Ji-Hun Park

  2. Department of Biostatistics, Korea University, College of Medicine, Seoul, Korea

    Kyung-Sook Yang

  3. Department of Biomedical Engineering, School of Medicine, Chungbuk National University, Cheongju, Korea

    Eun-Jong Cha

  4. Department of Orthopedic Surgery, University of Ulsan, College of Medicine, Asan Medical Center, 388-1, Poongnap-2dong, Songpa-gu, Seoul, 138-736, Korea

    Bum-Sik Lee, Jong-Min Kim & Seong-Il Bin

Authors
  1. Dae-Hee Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bum-Sik Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jong-Min Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kyung-Sook Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Eun-Jong Cha
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ji-Hun Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Seong-Il Bin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Seong-Il Bin.

Additional information

Research was performed at Asan Medical Center.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lee, DH., Lee, BS., Kim, JM. et al. Predictors of degenerative medial meniscus extrusion: radial component and knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 19, 222–229 (2011). https://doi.org/10.1007/s00167-010-1274-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-010-1274-2

Keywords

Search

Navigation