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Ultrasonographic diagnosis of medial meniscus posterior root tear in early knee osteoarthritis: a comparative study

  • Arthroscopy and Sports Medicine
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

This study aimed to detect medial meniscal posterior root tear (MMPRT) diagnostic methods with high sensitivity and specificity using dynamic ultrasonographic evaluation in patients with early knee osteoarthritis (OA) and demonstrate the usefulness of dynamic ultrasonographic medial meniscal extrusion (MME) evaluation in MMPRT diagnosis using a cutoff value.

Materials and methods

Between 2018 and 2020, a total of 120 patients were diagnosed with early knee OA using clinical and radiographic findings. Dynamic ultrasonographic evaluations and magnetic resonance imaging were performed in all patients, and 47 patients who had and 73 patients who did not have MMPRT were classified into the MMPRT and non-MMPRT groups, respectively. Age, sex, femorotibial angle, MME of knee extension and flexion, and MME at weight-bearing were compared between the two groups. Additionally, the sensitivity and specificity of significant ultrasonographic findings were calculated using a receiver operating characteristic (ROC) curve.

Results

The MMEs under knee extension–flexion and weight-loading in the MMPRT group were significantly larger than those in the non-MMPRT group. ROC curve analysis for each ultrasonographic evaluation condition to diagnose MMPRT indicated that the sensitivity was 72–88% and the specificity was 66–85% when the cutoff values of MME under knee flexion at 0°, 90°, and weight-loading were set at 2.55 mm, 2.00 mm, and 3.55 mm, respectively. The highest sensitivity (88%) and specificity (85%) were exhibited upon > 2 mm MME at a knee flexion of 90° and were the most useful indicators for MME diagnosis.

Conclusions

Ultrasonographic MME evaluations for MMPRT diagnosis showed relatively high sensitivity and specificity in patients with early knee OA. Dynamic ultrasonographic MME evaluation may lead to appropriate additional examinations, early diagnosis, and intervention for MMPRT in patients with early knee OA.

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References

  1. Bhatia S, LaPrade CM, Ellman MB, LaPrade RF (2014) Meniscal root tears: significance, diagnosis, and treatment. Am J Sports Med 42:3016–3030. https://doi.org/10.1177/0363546514524162

    Article  PubMed  Google Scholar 

  2. 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. https://doi.org/10.5792/ksrr.17.027

    Article  PubMed  PubMed Central  Google Scholar 

  3. 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. https://doi.org/10.1007/s00167-016-4359-8

    Article  PubMed  Google Scholar 

  4. Yamagami R, Taketomi S, Inui H, Tahara K, Tanaka S (2017) The role of medial meniscus posterior root tear and proximal tibial morphology in the development of spontaneous osteonecrosis and osteoarthritis of the knee. Knee 24:390–395. https://doi.org/10.1016/j.knee.2016.12.004

    Article  PubMed  Google Scholar 

  5. Okazaki Y, Furumatsu T, Hiranaka T, Kintaka K, Takihira S, Kamatsuki Y et al (2021) Medial meniscus posterior root repair prevents the progression of subchondral insufficiency fracture of the knee. J Orthop Sci 26:1051–1055. https://doi.org/10.1016/j.jos.2020.10.008

    Article  PubMed  Google Scholar 

  6. Ikuta F, Takahashi K, Hashimoto S, Mochizuki Y, Yuzawa Y, Inanami H et al (2020) Effect of physical therapy on early knee osteoarthritis with medial meniscal posterior tear assessed by MRI T2 mapping and 3D-to-2D registration technique: a prospective intervention study. Mod Rheumatol 30:738–747. https://doi.org/10.1080/14397595.2019.1646193

    Article  PubMed  Google Scholar 

  7. Lee YG, Shim J-C, Choi YS, Kim JG, Lee GJ, Kim HK (2008) Magnetic resonance imaging findings of surgically proven medial meniscus root tear: tear configuration and associated knee abnormalities. J Comput Assist Tomogr 32:452–457. https://doi.org/10.1097/RCT.0b013e31812f4eb0

    Article  PubMed  Google Scholar 

  8. Lee SY, Jee W-H, Kim J-M (2008) Radial tear of the medial meniscal root: reliability and accuracy of MRI for diagnosis. AJR Am J Roentgenol 91:81–85. https://doi.org/10.2214/AJR.07.2945

    Article  Google Scholar 

  9. Costa CR, Morrison WB, Carrino JA (2004) Medial meniscus extrusion on knee MRI: is extent associated with severity of degeneration or type of tear? AJR Am J Roentgenol 183:17–23. https://doi.org/10.2214/ajr.183.1.1830017

    Article  PubMed  Google Scholar 

  10. Furumatsu T, Fujii M, Kodama Y, Ozaki T (2017) A giraffe neck sign of the medial meniscus: a characteristic finding of the medial meniscus posterior root tear on magnetic resonance imaging. J Orthop Sci 22:731–736. https://doi.org/10.1016/j.jos.2017.03.013

    Article  Google Scholar 

  11. Choi S-H, Bae S, Ji SK, Chang MJ (2012) The MRI findings of meniscal root tear of the medial meniscus: emphasis on coronal, sagittal and axial images. Knee Surg Sports Traumatol Arthrosc 20:2098–2103. https://doi.org/10.1007/s00167-011-1794-4

    Article  PubMed  Google Scholar 

  12. LaPrade RF, Ho CP, James E, Crespo B, LaPrade CM, Matheny LM (2015) Diagnostic accuracy of 3.0 T magnetic resonance imaging for the detection of meniscus posterior root pathology. Knee Surg Sports Traumatol Arthrosc 23:152–157. https://doi.org/10.1007/s00167-014-3395-5

    Article  Google Scholar 

  13. Luyten FP, Bierma-Zeinstra S, Dell’Accio F, Kraus VB, Nakata K, Sekiya I et al (2018) Toward classification criteria for early osteoarthritis of the knee. Semin Arthritis Rheum 47:457–463. https://doi.org/10.1016/j.semarthrit.2017.08.006

    Article  CAS  Google Scholar 

  14. Mahmoudian A, Lohmander LS, Jafari H, Luyten FP (2021) Towards classification criteria for early-stage knee osteoarthritis: a population-based study to enrich for progressors. Semin Arthritis Rheum 51:285–291. https://doi.org/10.1016/j.semarthrit.2020.11.002

    Article  PubMed  Google Scholar 

  15. Ishii Y, Ishikawa M, Kurumadani H, Hayashi S, Nakamae A, Nakasa T et al (2020) Increase in medial meniscal extrusion in the weight-bearing position observed on ultrasonography correlates with lateral thrust in early-stage knee osteoarthritis. J Orthop Sci 25:640–646. https://doi.org/10.1016/j.jos.2019.07.003

    Article  PubMed  Google Scholar 

  16. Shimozaki K, Nakase J, Asai K, Yoshimizu R, Kimura M, Kanayama T et al (2021) Usefulness of ultrasonography for dynamic evaluation of medial meniscus hoop function in early knee osteoarthritis. Sci Rep 11:20091. https://doi.org/10.1038/s41598-021-99576-3

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Nogueira-Barbosa MH, Gregio-Junior E, Lorenzato MM, Guermazi A, Roemer FW, Chagas-Neto FA et al (2015) Ultrasound assessment of medial meniscal extrusion: a validation study using MRI as reference standard. AJR Am J Roentgenol 204:584–588. https://doi.org/10.2214/AJR.14.12522

    Article  PubMed  Google Scholar 

  18. 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. https://doi.org/10.1016/j.jos.2019.09.009

    Article  PubMed  Google Scholar 

  19. Chiba D, Sasaki T, Ishibashi Y (2022) Greater medial meniscus extrusion seen on ultrasonography indicates the risk of MRI-detected complete medial meniscus posterior root tear in a Japanese population with knee pain. Sci Rep 12:4756. https://doi.org/10.1038/s41598-022-08604-3

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. 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. https://doi.org/10.1007/s00167-018-5341-4

    Article  Google Scholar 

  21. Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16:494–502. https://doi.org/10.1136/ard.16.4.494

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Kawaguchi K, Enokida M, Otsuki R, Teshima R (2012) Ultrasonographic evaluation of medial radial displacement of the medial meniscus in knee osteoarthritis. Arthritis Rheum 64:173–180. https://doi.org/10.1002/art.33319

    Article  PubMed  Google Scholar 

  23. Furumatsu T, Kamatsuki Y, Fujii M, Kodama Y, Okazaki Y, Masuda S et al (2017) Medial meniscus extrusion correlates with disease duration of the sudden symptomatic medial meniscus posterior root tear. Orthop Traumatol Surg Res 103:1179–1182. https://doi.org/10.1016/j.otsr.2017.07.022

    Article  CAS  Google Scholar 

  24. Okazaki Y, Furumatsu T, Shimamura Y, Saiga K, Ohashi H, Uchino T et al (2019) Time-dependent increase in medial meniscus extrusion after medial meniscus posterior root tear analyzed by using magnetic resonance imaging. Knee Surg Relat Res 31:120–125. https://doi.org/10.1186/s43019-019-0007-1

    Article  PubMed  PubMed Central  Google Scholar 

  25. Mochizuki Y, Kawahara K, Samejima Y, Kaneko T, Ikegami H, Musha Y (2021) Short-term results and surgical technique of arthroscopic centralization as an augmentation for medial meniscus extrusion caused by medial meniscus posterior root tear. Eur J Orthop Surg Traumatol 31:1235–1241. https://doi.org/10.1007/s00590-021-02874-9

    Article  PubMed  Google Scholar 

  26. Lerer DB, Umans HR, Hu MX, Jones MH (2004) The role of meniscal root pathology and radial meniscal tear in medial meniscal extrusion. Skeletal Radiol 33:569–574. https://doi.org/10.1007/s00256-004-0761-2

    Article  CAS  Google Scholar 

  27. Yao J, Lancianese SL, Hovinga KR, Lee J, Lerner AL (2008) Magnetic resonance image analysis of meniscal translation and tibio-menisco-femoral contact in deep knee flexion. J Orthop Res 26:673–684. https://doi.org/10.1002/jor.20553

    Article  PubMed  Google Scholar 

  28. Masuda S, Furumatsu T, Okazaki Y, Kodama Y, Hino T, Kamatsuki Y et al (2018) Medial meniscus posterior root tear induces pathological posterior extrusion of the meniscus in the knee-flexed position: an open magnetic resonance imaging analysis. Orthop Traumatol Surg Res 104:485–489. https://doi.org/10.1016/j.otsr.2018.02.012

    Article  CAS  PubMed  Google Scholar 

  29. Jones RS, Keene GCR, Learmonth DJA, Bickerstaff D, Nawana NS, Costi JJ et al (1996) Direct measurement of hoop strains in the intact and torn human medial meniscus. Clin Biomech 11:295–300. https://doi.org/10.1016/0268-0033(96)00003-4

    Article  Google Scholar 

  30. Seitz AM, Lubomierski A, Friemert B, Ignatius A, Dürselen L (2012) Effect of partial meniscectomy at the medial posterior horn on tibiofemoral contact mechanics and meniscal hoop strains in human knees. J Orthop Res 30:934–942. https://doi.org/10.1002/jor.22010

    Article  PubMed  Google Scholar 

  31. 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. https://doi.org/10.1177/0363546514559684

    Article  PubMed  Google Scholar 

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Acknowledgements

We would like to thank Editage (www.editage.com) for English language editing.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-Machi, Kanazawa-Shi, Ishikawa-Ken, 920-8641, Japan

    Kengo Shimozaki, Junsuke Nakase, Tomoyuki Kanayama, Yusuke Yanatori & Hiroyuki Tsuchiya

  2. Department of Orthopedic Surgery, Asanogawa General Hospital, Kanazawa, Japan

    Takeshi Oshima

  3. Department of Orthopedic Surgery, KKR Hokuriku Hospital, Kanazawa, Japan

    Kazuki Asai & Yosuke Shima

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  1. Kengo Shimozaki
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Correspondence to Junsuke Nakase.

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Ethical approval

This cross-sectional study was approved by the ethics committee of our institution (approval no. 2328). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Written informed consent was obtained from all the patients included in this study.

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Shimozaki, K., Nakase, J., Kanayama, T. et al. Ultrasonographic diagnosis of medial meniscus posterior root tear in early knee osteoarthritis: a comparative study. Arch Orthop Trauma Surg 144, 281–287 (2024). https://doi.org/10.1007/s00402-023-05068-6

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