Skip to main content

Advertisement

SpringerLink
Log in

Insufficient restoration of meniscal extrusion by transtibial pullout repair for medial meniscus posterior root tears

  • KNEE
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The long-term changes in the dynamics of the medial meniscus after transtibial pullout repair for medial meniscus posterior root tears (MMPRTs) are not completely understood. Thus, the aim of this study was to investigate the effects of transtibial pullout repair on MMPRTs and whether the effects would be sustained.

Methods

Nineteen knees with MMPRTs that were treated by trans-tibial pullout repair were enrolled in this study. Medial meniscus extrusion (MME) was measured by ultrasonography during knee extension (no weight-bearing with the knee at 0° extension: NW0°) and 90° flexion (no weight-bearing with the knee at 90° flexion: NW90°) with the patient in the supine position and with full weight-bearing (FW0°) preoperatively and at 3 and 12 months postoperatively. The clinical outcomes were assessed using the Knee Injury and Osteoarthritis Outcome Score, Lysholm score, and International Knee Documentation Committee score.

Results

The difference in MME with NW0° was not statistically significant between the preoperative (3.4 ± 1.0 mm) and 12-month postoperative (3.7 ± 0.6 mm) time points. The MME with NW90° at 3 (2.1 ± 0.7 mm) and 12 months (2.9 ± 0.6 mm) postoperatively were significantly lower than the preoperative values (3.4 ± 0.8 mm) (P < 0.05). However, the value significantly increased from 3 to 12 months postoperatively (P < 0.05). The MME with FW0° at 12 months postoperatively (4.3 ± 0.6 mm) was significantly larger than that at pre-operatively (3.6 ± 0.9 mm) (P < 0.05). All the patients’ clinical conditions were significantly improved at 12 months postoperatively when compared to their preoperative clinical conditions.

Conclusion

Surgery did not reduce the extrusion in the no weight-bearing and weight-bearing positions at knee extension, and these values increased in the postoperative period. In addition, while the surgery reduced the extrusion in the knee flexion position, the restoration achieved by the surgery was not sustained in the long term.

Level of evidence: Level IV.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

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

Similar content being viewed by others

Data Availability

Not applicable.

Abbreviations

FW0°:

Full weight-bearing

ICC:

Intraclass correlation coefficient

IKDC:

International Knee Documentation Committee

K/L:

Kellgren and Lawrence grade

KOOS:

Knee Injury and Osteoarthritis Outcome Score

MCL:

Medial collateral ligament

MME:

Medial meniscus extrusion

MMPRT:

Medial meniscus posterior root tear

MRI:

Magnetic resonance imaging

NW0°:

No weight-bearing with the knee at 0° extension

NW90°:

No weight-bearing at knee 90° flexion

References

  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  PubMed  Google Scholar 

  2. Allaire R, Muriuki M, Gilbertson 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 90:1922–1931

    Article  PubMed  Google Scholar 

  3. Cho JC, Tollefson L, Reckelhoff K (2021) Sonographic evaluation of the degree of medial meniscal extrusion during Thessaly test in healthy knees. Chiropr Man Therap 29:31. https://doi.org/10.1186/s12998-021-00390-5

    Article  PubMed  PubMed Central  Google Scholar 

  4. Choi BS, Chung J, Kwak J, Han HS (2023) 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. https://doi.org/10.1007/s00167-023-07444-6

    Article  PubMed  Google Scholar 

  5. Chung KS, Ha JK, Ra HJ, Kim JG (2016) A meta-analysis of clinical and radiographic outcomes of posterior horn medial meniscus root repairs. Knee Surg Sports Traumatol Arthrosc 24:1455–1468

    Article  PubMed  Google Scholar 

  6. Chung KS, Ha JK, Ra HJ, Lee HS, Lee DW, Park JH et al (2019) Pullout fixation for medial meniscus posterior root tears: clinical results were not age-dependent, but osteoarthritis progressed. Knee Surg Sports Traumatol Arthrosc 27:189–196

    Article  PubMed  Google Scholar 

  7. 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  PubMed  Google Scholar 

  8. 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  PubMed  Google Scholar 

  9. Fong FJY, Ong BWL, Lee YHD (2023) Medial meniscal extrusion in patients with medial meniscus root tears: a systematic review and meta-analysis. Orthop J Sports Med 11:23259671231151696

    PubMed  PubMed Central  Google Scholar 

  10. Furumatsu T, Kodama Y, Fujii M, Tanaka T, Hino T, Kamatsuki Y et al (2017) A new aiming guide can create the tibial tunnel at favorable position in transtibial pullout repair for the medial meniscus posterior root tear. Orthop Traumatol Surg Res 103:367–371

    Article  CAS  PubMed  Google Scholar 

  11. Furumatsu T, Kodama Y, Kamatsuki Y, Hino T, Okazaki Y, Ozaki T (2017) Meniscal extrusion progresses shortly after the medial meniscus posterior root tear. Knee Surg Relat Res 29:295–301

    Article  PubMed  PubMed Central  Google Scholar 

  12. Furumatsu T, Miyazawa S, Fujii M, Tanaka T, Kodama Y, Ozaki T (2019) Arthroscopic scoring system of meniscal healing following medial meniscus posterior root repair. Int Orthop 43:1239–1245

    Article  PubMed  Google Scholar 

  13. Hiranaka T, Furumatsu T, Yokoyama Y, Kintaka K, Higashihara N, Tamura M et al (2023) The clinical and radiographic outcomes of type 2 medial meniscus posterior root tears following transtibial pullout repair. Knee Surg Sports Traumatol Arthrosc 31:2323–2330

    Article  PubMed  Google Scholar 

  14. Kamatsuki Y, Furumatsu T, Hiranaka T, Okazaki Y, Kintaka K, Kodama Y et al (2023) Epidemiological features of acute medial meniscus posterior root tears. Int Orthop. https://doi.org/10.1007/s00264-023-05848-0

    Article  PubMed  Google Scholar 

  15. 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  PubMed  Google Scholar 

  16. Kaplan DJ, Bloom D, Alaia EF, Walter WR, Meislin RJ, Strauss EJ et al (2022) ICRS scores worsen between 2-year short term and 5-year mid-term follow-up after transtibial medial meniscus root repair despite maintained functional outcomes. Knee Surg Sports Traumatol Arthrosc 30:2235–2243

    Article  PubMed  Google Scholar 

  17. Karpinski K, Diermeier T, Willinger L, Imhoff AB, Achtnich A, Petersen W (2019) No dynamic extrusion of the medial meniscus in ultrasound examination in patients with confirmed root tear lesion. Knee Surg Sports Traumatol Arthrosc 27:3311–3317

    Article  PubMed  Google Scholar 

  18. Kawata M, Sasabuchi Y, Taketomi S, Inui H, Matsui H, Fushimi K et al (2018) Annual trends in arthroscopic meniscus surgery: Analysis of a national database in Japan. PLoS ONE 13:e0194854

    Article  PubMed  PubMed Central  Google Scholar 

  19. Kim SB, Ha JK, Lee SW, Kim DW, Shim JC, Kim JG et al (2011) Medial meniscus root tear refixation: comparison of clinical, radiologic, and arthroscopic findings with medial meniscectomy. Arthroscopy 27:346–354

    Article  PubMed  Google Scholar 

  20. Kodama Y, Furumatsu T, Masuda S, Okazaki Y, Kamatsuki Y, Hiranaka T et al (2019) Transtibial fixation for medial meniscus posterior root tear reduces posterior extrusion and physiological translation of the medial meniscus in middle-aged and elderly patients. Knee Surg Sports Traumatol Arthrosc 28:3416–3425

    Article  PubMed  Google Scholar 

  21. Krivicich LM, Kunze KN, Parvaresh KC, Jan K, DeVinney A, Vadhera A et al (2021) Comparison of long-term radiographic outcomes and rate and time for conversion to total knee arthroplasty between repair and meniscectomy for medial meniscus posterior root tears: a systematic review and meta-analysis. Am J Sports Med 50(7):2023–2031

    Article  PubMed  Google Scholar 

  22. Krych AJ, Reardon PJ, Johnson NR, Mohan R, Peter L, Levy BA et al (2017) Non-operative management of medial meniscus posterior horn root tears is associated with worsening arthritis and poor clinical outcome at 5-year follow-up. Knee Surg Sports Traumatol Arthrosc 25:383–389

    Article  PubMed  Google Scholar 

  23. LaPrade CM, James EW, Cram TR, Feagin JA, Engebretsen L, LaPrade RF (2015) Meniscal root tears: a classification system based on tear morphology. Am J Sports Med 43:363–369

    Article  PubMed  Google Scholar 

  24. Lee JK, Jung M, Yang JH, Song SY, Shin YS, Cha M et al (2020) Repair versus nonrepair of medial meniscus posterior root tear: A systematic review of patients’ selection criteria, including clinical and radiographic outcomes. Medicine (Baltimore) 99:e19499

    Article  PubMed  Google Scholar 

  25. Makiev KG, Vasios IS, Georgoulas P, Tilkeridis K, Drosos G, Ververidis A (2022) Clinical significance and management of meniscal extrusion in different knee pathologies: a comprehensive review of the literature and treatment algorithm. Knee Surg Relat Res 34:35. https://doi.org/10.1186/s43019-022-00163-1

    Article  PubMed  PubMed Central  Google Scholar 

  26. Moon HK, Koh YG, Kim YC, Park YS, Jo SB, Kwon SK (2012) Prognostic factors of arthroscopic pull-out repair for a posterior root tear of the medial meniscus. Am J Sports Med 40:1138–1143

    Article  PubMed  Google Scholar 

  27. Nakamura N, Takeuchi R, Sawaguchi T, Ishikawa H, Saito T, Goldhahn S (2011) Cross-cultural adaptation and validation of the Japanese Knee Injury and Osteoarthritis Outcome Score (KOOS). J Orthop Sci 16:516–523

    Article  PubMed  Google Scholar 

  28. Okazaki Y, Furumatsu T, Yamauchi T, Kamatsuki Y, Hiranaka T, Kajiki Y et al (2020) Medial meniscus posterior root repair restores the intra-articular volume of the medial meniscus by decreasing posteromedial extrusion at knee flexion. Knee Surg Sports Traumatol Arthrosc 28:3435–3442

    Article  PubMed  Google Scholar 

  29. 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 16:849–854

    Article  PubMed  Google Scholar 

  30. Padalecki JR, Jansson KS, Smith SD, Dornan GJ, Pierce CM, Wijdicks CA et al (2014) Biomechanical consequences of a complete radial tear adjacent to the medial meniscus posterior root attachment site: in situ pull-out repair restores derangement of joint mechanics. Am J Sports Med 42:699–707

    Article  PubMed  Google Scholar 

  31. Petersen W, Forkel P, Feucht MJ, Zantop T, Imhoff AB, Brucker PU (2014) Posterior root tear of the medial and lateral meniscus. Arch Orthop Trauma Surg 134:237–255

    Article  PubMed  Google Scholar 

  32. Shimozaki K, Nakase J, Oshima T, Asai K, Toyooka K, Ohno N et al (2020) Investigation of extrusion of the medial meniscus under full weight-loading conditions using upright weight-loading magnetic resonance imaging and ultrasonography. J Orthop Sci 25:652–657

    Article  PubMed  Google Scholar 

  33. Yanagisawa S, Kimura M, Hagiwara K, Ogoshi A (2020) Association between postoperative meniscal extrusion and clinical outcomes of the pullout fixation technique for medial meniscus posterior root tear. Asia Pac J Sports Med Arthrosc Rehabil Technol 21:27–31

    PubMed  PubMed Central  Google Scholar 

  34. Zhan H, Liu Z, Wang Y, Chen Y, Teng F, Yang A et al (2023) Radiographic OA, bone marrow lesions, higher body mass index and medial meniscal root tears are significantly associated with medial meniscus extrusion with OA or medial meniscal tears: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-023-07418-8

    Article  PubMed  Google Scholar 

  35. Zhang X, Furumatsu T, Okazaki Y, Hiranaka T, Xue H, Kintaka K et al (2021) Medial meniscus posterior root repair reduces the extruded meniscus volume during knee flexion with favorable clinical outcome. Knee Surg Sports Traumatol Arthrosc 29:4205–4212

    Article  PubMed  Google Scholar 

  36. Zhu S, Li X, Wu JL, Bao L, Wang P, Gu H et al (2021) 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 29:4261–4269

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to thank Japan Medical Communication and American Journal Experts for performing the English language editing of this article.

Funding

This study did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showa, Maebashi, Gunma, 371-8511, Japan

    Ryota Takase, Takashi Ohsawa, Shogo Hashimoto, Shingo Kurihara & Hirotaka Chikuda

  2. Zenshukai Hospital Gunma Sports Medicine Research Center, Gunma, Japan

    Shinya Yanagisawa, Keiichi Hagiwara & Masashi Kimura

Authors
  1. Ryota Takase
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Takashi Ohsawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shogo Hashimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shingo Kurihara
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shinya Yanagisawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Keiichi Hagiwara
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Masashi Kimura
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Hirotaka Chikuda
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

RT and TO designed the study. RT carried out data analysis and wrote the paper. SH, SY, and KH helped to design this study. SK helped to evaluate items. MK and HC checked the study and helped to modify the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Ryota Takase.

Ethics declarations

Conflict of interest

We declare no conflicts of interest in association with the authorship or publication of this contribution.

Ethical approval

The present study was ethically approved by the institutional review board of the hospital where the study was performed (approval number was 19060501).

Informed consent

Informed consent was obtained from all patients included in the study.

Additional information

Publisher's Note

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

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Takase, R., Ohsawa, T., Hashimoto, S. et al. Insufficient restoration of meniscal extrusion by transtibial pullout repair for medial meniscus posterior root tears. Knee Surg Sports Traumatol Arthrosc 31, 4895–4902 (2023). https://doi.org/10.1007/s00167-023-07528-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-023-07528-3

Keywords

Search

Navigation