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Subchondral insufficiency fracture is a predictive factor of osteoarthritis progression and conversion to arthroplasty in non-surgically treated medial meniscus root tear

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To investigate the radiographic and clinical outcomes of non-surgical treatment for medial meniscus posterior root tear (MMPRT), and prognostic factors for osteoarthritis (OA) progression and clinical failure.

Methods

A prospectively collected database was retrospectively reviewed for patients who were diagnosed with acute medial meniscus posterior root tear (MMPRT) between 2013 and 2021 and treated non-surgically for more than 2 years. Patient demographic characteristics and clinical outcomes including pain numeric rating scale (NRS), International Knee Documentation Committee (IKDC) subjective score, Lysholm score, and Tegner activity scale were evaluated. For radiographic evaluation, knee radiographs were obtained to assess the angle of knee alignment and Kellgren–Lawrence (K–L) grade during the first and annually follow-up visits. Baseline magnetic resonance (MR) images were reviewed for the presence of medial meniscus extrusion, bone marrow edema, subchondral insufficiency fracture of medial femoral condyle, and cartilage lesion. The OA progression group was defined as patients who experienced a worsening of one or more grades in the K–L classification system. Prognostic factors were evaluated for OA progression and conversion to total knee arthroplasty (TKA).

Results

Ninety-four patients (90 female and 4 male) with a mean age of 67.0 ± 7.3 years (range, 53–83 years) were followed for a mean of 46.1 ± 22.1 months (range, 24.1–170.5). During the follow-up period, no significant differences in clinical scores were observed, and there were also no significant differences between the groups with and without OA progression. Overall, 12 patients (13%) underwent TKA at a mean of 20.7 ± 16.5 months (range, 8–69 months) and 34 patients (36%) demonstrated OA progression at a mean time of 24 ± 15 months (range, 12–62). The subchondral insufficiency fracture was a prognostic factor for OA progression (p = 0.045 for knee radiograph and p = 0.019 for MR) and conversion to TKA (RR, 4.08 [95% CI 1.23–13.57]; p = 0.022).

Conclusions

Non-surgical treatment for acute medial meniscus posterior root tear did not result in any significant change in clinical outcomes from the initial to the final follow-up. The rate of conversion to arthroplasty was 13%, and the rate of osteoarthritis progression was 36%. Furthermore, subchondral insufficiency fracture was found to be a concomitant prognostic factor correlated with OA progression and conversion to arthroplasty. This information can provide insights for physicians when discussing treatment options with patients, particularly regarding the use of non-surgical treatment and may contribute as a source for future studies of medial meniscus posterior root tear.

Level of evidence

IV.

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Data availability statement

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Funding

No funding was received for this study.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-Ro Jongno-Gu, Seoul, 03080, Republic of Korea

    Byung Sun Choi, Jeehyeok Chung, Junpyo Kwak & Hyuk-Soo Han

  2. Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea

    Hyuk-Soo Han

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  1. Byung Sun Choi
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Contributions

We have included four authors, who contributed significantly to this study. Each of the authors has read and concurs with the content in the final manuscript. BSC contributed to methodology, data curation, formal analysis, investigation, visualization, writing—original draft, and writing—review and editing. JHC contributed to data curation, formal analysis, investigation, and writing—review and editing. JPK contributed to data curation, formal analysis, investigation, writing—review and editing. HSH contributed to conceptualization, methodology, project administration, resources, supervision, validation, and writing—review and editing.

Corresponding author

Correspondence to Hyuk-Soo Han.

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All authors have no competing interests to declare.

Ethical approval

This study was approved by Seoul National University College of Medicine/Seoul National University Hospital Institutional Review Board. All investigations were conducted in conformity with ethical principles of research.

Informed consent

This study is a retrospective study; then, we were exempted informed consent by the institutional review board.

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Choi, B.S., Chung, J., Kwak, J. et al. Subchondral insufficiency fracture is a predictive factor of osteoarthritis progression and conversion to arthroplasty in non-surgically treated medial meniscus root tear. Knee Surg Sports Traumatol Arthrosc 31, 4492–4500 (2023). https://doi.org/10.1007/s00167-023-07444-6

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