Abstract
Purpose
To evaluate the reparability of the posterior horn of the medial meniscus with root ligament tear by measuring the actual pullout failure strength of a simple vertical suture of an arthroscopic subtotal meniscectomized posterior horn of the medial meniscus.
Methods
From November 2009 to May 2010, nine posterior horns of the medial meniscus specimens were collected from arthroscopic subtotal meniscectomy performed as a treatment for root ligament rupture of the posterior horn of the medial meniscus. Simple vertical sutures were performed on the specimens, and pullout failure load was tested with a biaxial servohydraulic testing machine (Model 8874; Instron Corp., Norwood, MA, USA). The degree of degeneration, extrusion, and medial displacement of the medial meniscus were evaluated with magnetic resonance imaging (MRI). The Kellgren–Lawrence classification was used in standing plain radiography, and mechanical alignment was measured using orthoroentgenography. Tear morphology was classified into ligament proper type or meniscoligamentous junctional type according to the site of the torn root ligament of the posterior horn of the medial meniscus during arthroscopy.
Results
The mean pullout failure strength of the posterior horn of the medial meniscus was 71.6 ± 23.2 N (range, 41.4–107.7 N). The degree of degeneration of the posterior horn of the medial meniscus on MRI showed statistically significant correlation with pullout failure strength and Kellgren–Lawrence classification. Pullout failure strength showed correlation with mechanical alignment and Kellgren–Lawrence classification (P < 0.05).
Conclusions
The measurement of pullout failure strength of the posterior horn of the medial meniscus with root ligament tear showed a degree of repairability. The degree of degeneration of the posterior horn of the medial meniscus on MRI showed a significant correlation with the pullout failure strength. The pullout failure strength was also not only correlated with the degree of degeneration of the posterior horn of the medial meniscus, but also with mechanical alignment and Kellgren-Lawrence classification, which represent bony degenerative change.
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References
Ahn JH, Wang JH, Yoo JC, Noh HK, Park JH (2007) A pull out suture for transection of the posterior horn of the medial meniscus: using a posterior trans-septal portal. Knee Surg Sports Traumatol Arthrosc 15(12):1510–1513
Allaire R, Muriuki M, Gilberson 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(9):1922–1931
Arnoczky SP, Warren RF (1983) The microvasculature of the meniscus and its response to injury. An experimental study in the dog. Am J Sports Med 11(3):131–141
Aros BC, Pedroza A, Vasileff WK, Litsky AS, Flanigan DC (2010) Mechanical comparison of meniscal repair devices with mattress suture devices in vitro. Knee Surg Sports Traumatol Arthrosc 18(11):1594–1598
Beaupré A, Choukroun R, Guidouin R, Garneau R, Gérardin H, Cardou A (1986) Knee menisci. Correlation between microstructure and biomechanics. Clin Orthop Relat Res 208:72–75
Berthiaume MJ, Raynauld JP, Martel-Pelletier J et al (2005) Meniscal tear and extrusion are strongly associated with progression of symptomatic knee osteoarthritis as assessed by quantitative magnetic resonance imaging. Ann Rheum Dis 64(4):556–563
Bin SI, Kim JM, Shin SJ (2004) Radial tears of the posterior horn of the medial meniscus. Arthroscopy 20(4):373–378
Bolano LE, Grana WA (1993) Isolated arthroscopic partial meniscectomy. Functional radiographic evaluation at five years. Am J Sports Med 21(3):432–437
Bullough PG, Munuera L, Murphy J, Weinstein AM (1970) The strength of the menisci of the knee as it relates to their fine structure. J Bone Joint Surg Br 52(3):564–567
Calle EE, Thun MJ, Petrelli JM, Rodtiguez C, Heath CW Jr (1999) Body-mass index and mortality in a prospective cohort of U.S. adults. N Engl J Med 341(15):1097–1105
Choi NH, Son KM, Victoroff BN (2008) Arthroscopic all-inside repair for a tear of posterior root of the medial meniscus: a technical note. Knee Surg Sports Traumatol Arthrosc 16(9):891–893
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(1):17–23
Englund M (2004) Meniscal tear—a feature of osteoarthritis. Acta Orthop Scand Suppl 75(312):1–45
Gale DR, Chaisson CE, Totterman SM, Schwartz RK, Gale ME, Felson D (1999) Meniscal subluxation: association with osteoarthritis and joint space narrowing. Osteoarthr Cartil 7(6):526–532
Johnson RJ, Kettelkamp DB, Clark W, Leaverton P (1974) Factors effecting late results after meniscectomy. J Bone Joint Surg Am 56(4):719–729
Jones RS, Keene GC, Learmonth DJ et al (1996) Direct measurement of hoop strains in the intact and torn human medial meniscus. Clin Biomech (Bristol, Avon) 11(5):295–300
Jørgensen U, Sonne-Holm S, Lauridsen F, Rosenklint A (1987) Long-term follow-up of meniscectomy in athletes. A prospective longitudinal study. J Bone Joint Surg Br 69(1):80–83
Kim YM, Rhee KJ, Lee JK, Hwang DS, Yang JY, Kim SJ (2006) Arthroscopic pull out repair of a complete radial tear of the tibial attachment site of the medial meniscus posterior horn. Arthroscopy 22(7):795.e1-4
Sgaglione NA, Steadman JR, Shaffer B et al (2003) Current concepts in meniscus surgery: resection to replacement. Arthroscopy 19(Suppl 1):161–188
Kohn D, Siebert W (1989) Meniscus suture techniques: a comparative biomechanical cadaver study. Arthroscopy 5(4):324–327
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):951–958
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):569–574
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(4):535–539
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(1):124–129
McGinity JB, Geuss LF, Marvin RA (1977) Partial or total meniscectomy: a comparative analysis. J Bone Joint Surg Am 59(6):763–766
Nicholas SJ, Golant A, Schachter AK, Lee SJ (2009) A new surgical technique of arthroscopic repair of the meniscus root tear. Knee Surg Sports Traumatol Arhrosc 17(12):1433–1436
Ozkoc G, Circi E, Gonc U, Irgit K, Pourbagher A, Tandogan RN (2008) Radial tears in the root of the posterior horn of the medial meniscus. Knee Surg Sports Traumatol Arthrosc 16(9):849–854
Rimmer MG, Nawana NS, Keene GC, Pearcy MJ (1995) Failure strengths of different meniscal suturing techniques. Arthroscopy 11(2):146–150
Weishalupt D, Zanetti M, Hodler J, Boos N (1998) MR imaging of the lumbar spine: prevalence of intervertebral disk extrusion and sequestration, nerve root compression, end plate abnormalities, and osteoarthritis of the facet joints in asymptomatic volunteers. Radiology 209(3):661–666
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Kim, YM., Joo, YB. Pullout failure strength of the posterior horn of the medial meniscus with root ligament tear. Knee Surg Sports Traumatol Arthrosc 21, 1546–1552 (2013). https://doi.org/10.1007/s00167-012-2131-2
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DOI: https://doi.org/10.1007/s00167-012-2131-2