Non-anatomic repair of medial meniscus posterior root tears to the posterior capsule provided favourable outcomes in middle-aged and older patients

Abstract

Purpose

To describe a non-anatomic arthroscopic all-inside repair technique for middle-aged and older patients with medial meniscus posterior root tears (MMPRTs) and to evaluate the short- to mid-term clinical and radiologic results. The hypothesis was that this procedure would yield good clinical outcome results and structural healing in middle- and older-aged patients.

Methods

This was a retrospective study evaluating patients who had undergone MMPRT repair by suturing the meniscal root directly to the capsule, rather than by the transtibial technique, between 2013 and 2016. This all-inside repair technique was performed for patients with type II MMPRTs who were over 40 years old. Exclusion criteria included tibial osteotomy due to malalignment, concomitant multiple-ligament injuries and follow-up time less than 2 years. The Lysholm score, Tegner activity score and International Knee Documentation Committee (IKDC) score were evaluated preoperatively and at the final follow-up. Medial meniscal extrusion, the International Cartilage Repair Society (ICRS) grades of the medial compartment, and the healing status of the medial meniscus root were assessed on magnetic resonance imaging preoperatively and at the final follow-up.

Results

Twenty-nine patients (mean age 61.7 ± 7.9) were included; the mean follow-up duration was 46.2 ± 7.9 months. The mean Lysholm score significantly improved from 33.7 ± 20.9 preoperatively to 81.7 ± 19.9 at the final follow-up (p < 0.001), the median Tegner activity score improved from 1.0 (range 1–4) to 3.0 (range 2–4, p < 0.001), and the mean IKDC score improved from 20.1 ± 16.4 to 69.6 ± 16.2 (p < 0.001). On MRI, 9 (31%) cases had complete healing; 17 (59%) had partial healing; and 3 (10%) had failed healing (ICCs ≥ 0.92). Mean meniscal extrusion significantly increased from 2.3 ± 1.7 mm preoperatively to 3.5 ± 1.5 mm postoperatively (p < 0.001, ICCs ≥ 0.92).

Conclusion

Non-anatomic arthroscopic all-inside repair of MMPRTs to the posterior capsule yielded good to excellent clinical results and a high rate of healing in the medial meniscus root on MRI in middle-aged and older patients at short- to mid-term follow-up, despite increased meniscal extrusion. This method is an alternative to the transtibial pullout repair technique for treating MMPRTs in middle- and older-aged patients.

Level of evidence

Level IV.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Abbreviations

MMPRT:

Medial meniscus posterior root tear

MRI:

Magnetic resonance imaging

BMVP:

Bone marrow-venting procedure

ROM:

Range of motion

IKDC:

International Knee Documentation Committee

ICRS:

International Cartilage Repair Society

3D-PDFS:

Three-dimensional isotropic fat-suppressed proton density-weighted sequence

MCID:

Minimal clinically important difference

ICCs:

Intraclass correlation coefficients

References

  1. 1.

    Achtnich A, Petersen W, Willinger L, Sauter A, Rasper M, Wörtler K et al (2018) Medial meniscus extrusion increases with age and BMI and is depending on different loading conditions. Knee Surg Sports Traumatol Arthrosc 26:2282–2288

    Article  Google Scholar 

  2. 2.

    Ahn JH, Jeong HJ, Lee YS, Park JH, Lee JW, Park JH et al (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 135:1265–1276

    Article  Google Scholar 

  3. 3.

    Bernard CD, Kennedy NI, Tagliero AJ, Camp CL, Saris DBF, Levy BA et al (2020) Medial meniscus posterior root tear treatment: a matched cohort comparison of nonoperative management, partial meniscectomy, and repair. Am J Sports Med 48:128–132

    Article  Google Scholar 

  4. 4.

    Bhatia S, Laprade CM, Ellman MB, Laprade RF (2014) Meniscal root tears: significance, diagnosis, and treatment. Am J Sports Med 42:3016–3030

    Article  Google Scholar 

  5. 5.

    Briggs KK, Kocher MS, Rodkey WG, Steadman JR (2006) Reliability, validity, and responsiveness of the Lysholm knee score and Tegner activity scale for patients with meniscal injury of the knee. J Bone Jt Surg Am 88:698–705

    Google Scholar 

  6. 6.

    Brittberg M, Winalski CS (2003) Evaluation of cartilage injuries and repair. J Bone Jt Surg Am 85:58–69

    Article  Google Scholar 

  7. 7.

    Chung KS, Ha JK, Yeom CH, Ra HJ, Jang HS, Choi SH et al (2015) Comparison of clinical and radiologic results between partial meniscectomy and refixation of medial meniscus posterior root tears: a minimum 5-year follow-up. Arthroscopy 31:1941–1950

    Article  Google Scholar 

  8. 8.

    Chung KS, Noh JM, Ha JK, Ra HJ, Park SB, Kim HK et al (2018) Survivorship analysis and clinical outcomes of transtibial pullout repair for medial meniscus posterior root tears: a 5- to 10-year follow-up study. Arthroscopy 34:530–535

    Article  Google Scholar 

  9. 9.

    Dragoo JL, Konopka JA, Guzman RA, Segovia N, Kandil A, Pappas GP (2020) Outcomes of arthroscopic all-inside repair versus observation in older patients with meniscus root tears. Am J Sports Med 48:1127–1133

    Article  Google Scholar 

  10. 10.

    Faucett SC, Geisler BP, Chahla J, Krych AJ, Kurzweil PR, Garner AM et al (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 47:762–769

    Article  Google Scholar 

  11. 11.

    Feucht MJ, Izadpanah K, Lacheta L, Südkamp NP, Imhoff AB, Forkel P (2019) Arthroscopic transtibial pullout repair for posterior meniscus root tears. Oper Orthop Traumatol 31:248–260

    CAS  Article  Google Scholar 

  12. 12.

    Feucht MJ, Kühle J, Bode G, Mehl J, Schmal H, Südkamp NP et al (2015) Arthroscopic transtibial pullout repair for posterior medial meniscus root tears: a systematic review of clinical, radiographic, and second-look arthroscopic results. Arthroscopy 31:1808–1816

    Article  Google Scholar 

  13. 13.

    Irrgang JJ, Anderson AF, Boland AL, Harner CD, Neyret P, Richmond JC et al (2006) Responsiveness of the International Knee Documentation Committee Subjective Knee Form. Am J Sports Med 34:1567–1573

    Article  Google Scholar 

  14. 14.

    Jae-Hwa K, Ju-Hwan C, Dong-Hoon L, Yoon-Seok L, Jung-Ryul K, Keun-Jung R (2011) Arthroscopic suture anchor repair versus pullout suture repair in posterior root tear of the medial meniscus: a prospective comparison study. Arthroscopy 27:1644–1653

    Article  Google Scholar 

  15. 15.

    Jeon SW, Jung M, Choi CH, Kim SG, Kim SH (2021) Factors related to meniscal extrusion and cartilage lesions in medial meniscus root tears. J Knee Surg 34:178–186

    Article  Google Scholar 

  16. 16.

    Johannsen AM, Civitarese DM, Padalecki JR, Goldsmith MT, Wijdicks CA, Laprade RF (2012) Qualitative and quantitative anatomic analysis of the posterior root attachments of the medial and lateral menisci. Am J Sports Med 40:2342

    Article  Google Scholar 

  17. 17.

    Kaminski R, Kulinski K, Kozar-Kaminska K, Wasko MK, Langner M, Pomianowski S (2019) Repair augmentation of unstable, complete vertical meniscal tears with bone marrow venting procedure: a prospective, randomized, double-blind, parallel-group, placebo-controlled study. Arthroscopy 35:1500–1508 (e1501)

    Article  Google Scholar 

  18. 18.

    Kaplan DJ, Alaia EF, Dold AP, Meislin RJ, Strauss EJ, Jazrawi LM et al (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 26:2826–2834

    Article  Google Scholar 

  19. 19.

    Krych AJ, Hevesi M, Leland DP, Stuart MJ (2020) Meniscal root injuries. J Am Acad Orthop Surg 28:491–499

    Article  Google Scholar 

  20. 20.

    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 26:1117–1122

    PubMed  Google Scholar 

  21. 21.

    Laprade CM, Laprade MD, Travis Lee T, Wijdicks CA, Laprade RF (2015) Biomechanical evaluation of the transtibial pull-out technique for posterior medial meniscal root repairs using 1 and 2 transtibial bone tunnels. Am J Sports Med 43:899–904

    Article  Google Scholar 

  22. 22.

    Laprade RF, Matheny LM, Moulton SG, James EW, Dean CS (2016) Posterior meniscal root repairs: outcomes of an anatomic transtibial pull-out technique. Am J Sports Med 45:884–891

    Article  Google Scholar 

  23. 23.

    Lee DW, Min KK, Jang HS, Ha JK, Jin GK (2014) Clinical and radiologic evaluation of arthroscopic medial meniscus root tear refixation: comparison of the modified Mason–Allen stitch and simple stitches. Arthroscopy 30:1439–1446

    Article  Google Scholar 

  24. 24.

    Moon HS, Choi CH, Jung M, Lee DY, Hong SP, Kim SH (2020) Early surgical repair of medial meniscus posterior root tear minimizes the progression of meniscal extrusion: 2-year follow-up of clinical and radiographic parameters after arthroscopic transtibial pull-out repair. Am J Sports Med 48:2692–2702

    Article  Google Scholar 

  25. 25.

    Okazaki Y, Furumatsu T (2019) Meniscal repair concurrent with anterior cruciate ligament reconstruction restores posterior shift of the medial meniscus in the knee-flexed position. Knee Surg Sports Traumatol Arthrosc 27:361–368

    Article  Google Scholar 

  26. 26.

    Pache S, Aman ZS, Kennedy M, Nakama GY, Moatshe G, Ziegler C et al (2018) Meniscal root tears: current concepts review. Arch Bone Jt Surg 6:250–259

    PubMed  PubMed Central  Google Scholar 

  27. 27.

    Ro KH, Kim JH, Heo JW, Lee DH (2020) Clinical and radiological outcomes of meniscal repair versus partial meniscectomy for medial meniscus root tears: a systematic review and meta-analysis. Orthop J Sports Med 8:2325967120962078

    Article  Google Scholar 

  28. 28.

    Saltzman BM, Habet NA, Rao AJ, Trofa DP, Corpus KT, Yeatts NC et al (2020) Biomechanical evaluation of an all-inside posterior medial meniscal root repair technique via suture fixation to the posterior cruciate ligament. Arthroscopy 36:2488-2497.e2486

    Article  Google Scholar 

  29. 29.

    Scholes C, Houghton ER, Lee M, Lustig S (2015) Meniscal translation during knee flexion: what do we really know? Knee Surg Sports Traumatol Arthrosc 23:32–40

    Article  Google Scholar 

Download references

Acknowledgements

Thanks for the great help of the radiology department of the Xinhua Hospital. In addition, Zhu Siyuan wants to express his special appreciation to Xiao Renqing for her endless love, care and encouragement.

Funding

This work was not supported by any foundation.

Author information

Affiliations

Authors

Contributions

SZ made substantial contributions to the conception and design of the study, acquisition and analysis of the radiological and clinical data of the patients and drafting, editing and revising the manuscript. XL made substantial contributions to the editing and revising of the manuscript as well as acquisition and interpretation of the re-analysed data. JW made substantial contributions to the design of the study, drafting, editing and revising the manuscript. LB made substantial contributions to the design of the study, acquisition and analysis of the radiological data and drafting, editing and revising the manuscript. PW made substantial contributions to acquisition and interpretation of the clinical outcomes data and drafting, editing and revising the manuscript. HG made substantial contributions to the conception and design of the study editing and revising the manuscript. CW made substantial contributions to the conception and design of the study editing and revising the manuscript. JW made substantial contributions to the conception and design of the study, acquisition and interpretation of the radiological and clinical data and drafting, editing and revising the manuscript.

Corresponding author

Correspondence to Jianhua Wang.

Ethics declarations

Conflict of interest

All the authors have no potential conflict of interest.

Ethical approval

This study was approved by the Ethics Committee of Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine (Shanghai, China, No.XHEC-D-2020–108).

Informed consent

All the patients enrolled in this study have signed the broad consent, which permits the researchers to engage in research use of patients’ identifiable data during the hospitalisation period and future follow-up without the requirement to obtain additional consents for the future storage, maintenance, or research usage, so long as the future activities are within the scope of the broad consent. The study protocol as well as the application form were fully reviewed, and we have certified that this study does not raise any issues of patient risk or cause any harm to patients. We have also certified that the study was strictly in accordance with the Declaration of Helsinki and International Ethical Guidelines for Health-related Research Involving Humans.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Zhu, S., Li, X., Wu, JL. et al. Non-anatomic repair of medial meniscus posterior root tears to the posterior capsule provided favourable outcomes in middle-aged and older patients. Knee Surg Sports Traumatol Arthrosc (2021). https://doi.org/10.1007/s00167-021-06532-9

Download citation

Keywords

  • Medial meniscus posterior root tear
  • Non-anatomic arthroscopic repair
  • Meniscus root repair
  • Meniscus root healing