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Preoperative varus alignment and postoperative meniscus extrusion are the main long-term predictive factors of clinical failure of meniscal root repair

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

No studies have been conducted to determine long-term predictors of clinical failure after surgical root repair. This study identified long-term prognostic factors of clinical failure after pull-out repair of medial meniscus posterior root tears (MMPRTs) at a minimum of 10 year follow-up.

Methods

A total of 37 patients who underwent MMPRT pull-out repair and had been observed for more than 10 years were recruited for this study. The mean follow-up period was 125.9 ± 21.2 months. Clinical failure of the procedures was defined as conversion to total knee arthroplasty (TKA). Participants were categorized into two groups: non-failure and failure groups. Various factors, including demographic features and radiologic findings, were analyzed and compared between the two groups. Meniscus extrusion was assessed at coronal magnetic resonance imaging preoperatively and 1 year postoperatively. Independent risk factors were determined by univariate analysis and logistic regression analysis. To determine the cut-off value for risk factors, the receiver-operating characteristic curve analysis was performed.

Results

In total, eight patients (22%) were converted to TKA during the follow-up period. With univariate analysis, statistically significant differences between two groups were observed in mechanical varus alignment (P = 0.018), rate of the number of patient with more meniscal extrusion values after surgery (P = 0.024), and the difference between the preoperative and 1-year postoperative value of meniscus extrusion (mm) (P = 0.010). In a logistic analysis, OR of mechanical varus alignment and differences in meniscus extrusion value before and 1 year after surgery was 1.5 (P = 0.048) and 3.7 (P = 0.034). The cut-off values of mechanical varus alignment and differences in meniscus extrusion values were 5 degrees and 0.7 mm.

Conclusion

Clinically, preoperative varus alignment and increased meniscal extrusion after surgery were found to be predictive for a clinical failure after meniscal root repair in a long-term perspective. Thus, these negative prognostic factors should be taken into consideration for performing root repair in MMPRTs.

Level of evidence

Level III.

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Acknowledgements

All authors have no potential conflict of interest, including financial interests, activities, relationships, and affiliations, to disclose.

Funding

All authors declare that this study had no funding resource.

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Authors and Affiliations

  1. Department of Orthopedic Surgery and Sports Medical Center and Sports Medical Research Institute, Seoul Paik Hospital, College of Medicine, Inje University, Seoul, Korea

    Kyu Sung Chung & Jeong Ku Ha

  2. Department of Orthopedic Surgery, Gangneung Asan Hospital, College of Medicine, Ulsan University, Gangneung, Korea

    Ho Jong Ra

  3. Department of Orthopedic Surgery and Sports Center, Myong-Ji Hospital, 55, Hwasu-ro 14 beon-gil, Deogyang-gu, Goyang-si, Seoul, 10475, Gyeonggi-do, Korea

    Jin Goo Kim

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  1. Kyu Sung Chung
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Contributions

KSC and JGK designed the study. JKH and HJR analyzed the data and performed the calculations. KSC, JKH, and HJR performed formal analysis. KSC wrote the manuscript with input from the all authors. All authors provided critical feedback and helped shape the manuscript.

Corresponding author

Correspondence to Jin Goo Kim.

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Conflict of interest

No potential conflict of interest relevant to this article was reported.

Ethical approval

The study protocol was reviewed and approved by the Institutional Review Board (IRB) of our institute (IRB no. PAIK-2020-02-012).

Informed consent

The Institutional Review Board (IRB) waived the requirements of informed consent as all data were anonymous. Therefore, this study was performed without prior informed consent.

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Chung, K.S., Ha, J.K., Ra, H.J. et al. Preoperative varus alignment and postoperative meniscus extrusion are the main long-term predictive factors of clinical failure of meniscal root repair. Knee Surg Sports Traumatol Arthrosc 29, 4122–4130 (2021). https://doi.org/10.1007/s00167-020-06405-7

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  • DOI: https://doi.org/10.1007/s00167-020-06405-7

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