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Accurate placement of a tibial tunnel significantly improves meniscal healing and clinical outcomes at 1 year after medial meniscus posterior root repair

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

A medial meniscus posterior root tear results in the loss of meniscal circumferential hoop stress and causes a pathological posteromedial extrusion of the medial meniscus. Although creating a tibial tunnel in the anatomic place improves postoperative medial meniscus posterior extrusion, no studies have evaluated the relationship between tibial tunnel position and clinical outcomes. This study aimed to evaluate how tibial tunnel positioning of medial meniscus posterior root pullout repair affects meniscal healing status and clinical outcomes.

Methods

Sixty-two patients with 64 medial meniscus posterior root tears (mean age 62.8 ± 7.9 years) who had undergone pullout repairs and second-look arthroscopies were included. All 62 patients were Lachman test negative. Three-dimensional computed tomography images of the tibial surface were evaluated using a rectangular measurement grid to assess the tibial tunnel centre and medial meniscus posterior root attachment centre. Spearman’s rank correlation analysis was undertaken to determine displacement distance from the medial meniscus posterior root attachment centre to the tibial tunnel centre and a meniscal healing score, as well as clinical outcomes at 1 year post-repair.

Results

Tibial tunnel centres were located more anteriorly and medially than the medial meniscus posterior root attachment centre (mean distance 5.0 ± 2.2 mm). The mean meniscal healing score was 6.7 ± 1.8 of 10 possible points. The 1-year postoperative clinical scores showed significant improvement compared with preoperative scores for all the items. There was a significant negative correlation in the absolute distance between the medial meniscus posterior root attachment centre and the tibial tunnel centre with the meniscal healing score (ρ =  − 0.39, p = 0.002). Furthermore, there were significant positive correlations between the distance between the medial meniscus posterior root attachment centre and the tibial tunnel centre in the mediolateral direction and patient-based clinical outcomes (ρ = 0.25–0.43, p < 0.05).

Conclusion

Accurate placement of a tibial tunnel, especially in the mediolateral direction, significantly improved meniscal healing and clinical outcomes at 1 year following medial meniscus posterior root repair. Surgeons should create a medial meniscus posterior root tibial tunnel at the anatomic attachment with particular attention to the mediolateral position.

Level of evidence

Level IV.

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Abbreviations

Ac:

Attachment centre

ACL:

Anterior cruciate ligament

AP:

Anteroposterior

BMI:

Body mass index

CT:

Computed tomography

F-MMA:

FasT-Fix modified Mason–Allen suture

FTA:

Femorotibial angle

ICC:

Intra-class correlation coefficient

IKDC:

International Knee Documentation Committee

K–L:

Kellgren–Lawrence

KOOS:

Knee Injury and Osteoarthritis Outcome Score

ML:

Mediolateral

MM:

Medial meniscus

MMPRT:

Medial meniscus posterior root tear

MRI:

Magnetic resonance imaging

MTE:

Medial tibial eminence

OA:

Osteoarthritis

OATS:

Osteochondral autograft transplantation surgery

QOL:

Knee-related quality of life

SD:

Standard deviation

SIFK:

Subchondral insufficiency fracture of the knee

SONK:

Spontaneous osteonecrosis of the knee

Tc:

Tibial tunnel centre

TSS:

Two simple stitches

VAS:

Visual analogue scale

3D:

Three-dimensional

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Acknowledgements

We would like to thank our colleagues for their clinical supports. We would also like to thank Editage (www.editage.jp) for English language editing.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan

    Yusuke Kamatsuki, Takayuki Furumatsu, Takaaki Hiranaka, Yuki Okazaki, Yuya Kodama, Keisuke Kintaka & Toshifumi Ozaki

  2. Department of Orthopaedic Surgery, Kochi Health Sciences Center, 2125-1 Ike, Kochi, 781-8555, Japan

    Yusuke Kamatsuki

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  1. Yusuke Kamatsuki
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  2. Takayuki Furumatsu
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  6. Keisuke Kintaka
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Contributions

YKa, TF, and TO designed the study and prepared the manuscript. TF performed the surgeries. YKa reviewed the medical records. YO and KK performed the radiographic evaluations. YKo and TH conducted the measurement of 3D CT images. All the authors have read and approved the final version of the manuscript submitted.

Corresponding author

Correspondence to Takayuki Furumatsu.

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The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the institutional review board of Okayama University Graduate School (ID number: 1857).

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All patients provided informed consent prior to participation.

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Kamatsuki, Y., Furumatsu, T., Hiranaka, T. et al. Accurate placement of a tibial tunnel significantly improves meniscal healing and clinical outcomes at 1 year after medial meniscus posterior root repair. Knee Surg Sports Traumatol Arthrosc 29, 3715–3723 (2021). https://doi.org/10.1007/s00167-020-06376-9

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