Abstract
Purpose
To assess the effects of transtibial pullout repair for medial meniscus posterior root tears (MMPRTs) among patients with early osteoarthritis of the knee as measured by the meniscus healing score and to determine whether the meniscus healing score correlates with the International Cartilage Repair Society (ICRS) grade progression.
Methods
Forty-seven patients with mild osteoarthritic knees (Kellgren–Lawrence grade ≤ 2 and varus alignment < 5°) who underwent transtibial pullout repair less than 3 months after MMPRT onset were assessed. The association between meniscus healing scores at 1 year postoperatively and cartilage damage of the medial compartment (medial femoral condyle [MFC] and medial tibial plateau [MTP]) were evaluated. The MFC was divided into six zones (A to F) and the MTP into two zones (G and H). The mean ICRS grade for each zone was compared between the primary surgery and second-look arthroscopy. The correlation between cartilage damage and meniscus healing status at the time of second-look arthroscopy in each zone was analysed.
Results
The mean time interval from injury to surgery was 63 days, and all clinical scores showed significant improvement. There were no significant differences in the extent of cartilage damage in areas B, C, E, or F (n.s.) for MFC or in areas G and H (n.s.) for MTP. The meniscus healing score and cartilage damage were correlated in the loading areas (B, C, E, and H; − 0.53, − 0.45, − 0.33, and − 0.38, respectively; p < 0.05).
Conclusion
Transtibial pullout repair of MMPRTs among patients with mild osteoarthritic knees improved the clinical outcomes and showed a negative correlation between high meniscus healing scores and ICRS grades in the medial compartment loading area. This study suggests that early surgery should be undertaken for patients with mild osteoarthritic knee who develop MMPRTs.
Level of evidence
Level IV.
Similar content being viewed by others
Code availability
Not applicable.
References
Ahn JH, Jeong HJ, Lee YS, Park JH, Lee JW, Park J-H, Ko TS (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. https://doi.org/10.1007/s00402-015-2269-8
Alhalki MM, Howell SM, Hull ML (1999) How three methods for fixing a medial meniscal autograft affect tibial contact mechanics. Am J Sports Med 27:320–328. https://doi.org/10.1177/03635465990270030901
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. https://doi.org/10.2106/jbjs.g.00748
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
Bonasia DE, Pellegrino P, D’Amelio A, Cottino U, Rossi R (2015) Meniscal root tear repair: why, when and how? Orthop Rev (Pavia) 7:5792. https://doi.org/10.1177/0363546514524162
Cerminara AJ, LaPrade CM, Smith SD, Ellman MB, Wijdicks CA, LaPrade RF (2014) Biomechanical evaluation of a transtibial pull-out meniscal root repair: challenging the bungee effect. Am J Sports Med 42:2988–2995. https://doi.org/10.1177/0363546514524162
Choi SH, 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
Chung KS, Ha JK, Ra HJ et al (2018) 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. https://doi.org/10.1007/s00167-018-5024-1
Chung KS, Ha JK, Yeom CH 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. https://doi.org/10.1007/s00167-018-5024-1
Chung KS, Noh JM, Ha JK, Ra HJ, Park SB, Kim HK, Kim JG (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. https://doi.org/10.1016/j.arthro.2017.08.266
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
Furumatsu T, Kamatsuki Y, Fujii M, Kodama Y, Okazaki Y, Masuda S, Ozaki T (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
Furumatsu T, Kodama Y, Fujii M 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 103:367e71. https://doi.org/10.1016/j.rcot.2017.09.313
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
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. https://doi.org/10.1007/s00264-018-4071-z
Han SB, Shetty GM, Lee DH et al (2010) Unfavorable results of partial meniscectomy for complete posterior medial meniscus root tear with early osteoarthritis: a 5- to 8-year follow-up study. Arthroscopy 26:1326–1332. https://doi.org/10.1016/j.arthro.2010.01.032
Hino T, Furumatsu T, Miyazawa S et al (2019) A histological study of the medial meniscus posterior root tibial insertion. Connect Tissue Res 61(6):546–553
Jones C, Reddy S, Ma CB (2010) Repair of the posterior root of the medial meniscus. Knee 17:77–80. https://doi.org/10.1016/j.knee.2009.06.010
Jung YH, Choi NH, Oh JS, Victoroff BN (2012) All-inside repair for a root tear of the medial meniscus using a suture anchor. Am J Sports Med 40:1406–1411. https://doi.org/10.1177/0363546512439181
Kim JH, Chung JH, Lee DH, Lee YS, Kim JR, Ryu KJ (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. https://doi.org/10.1016/j.arthro.2011.06.033
Kim JY, Bin SI, Kim JM, Lee BS, Oh SM, Park MH (2019) Tear gap and severity of osteoarthritis are associated with meniscal extrusion in degenerative medial meniscus posterior root tears. Orthop Traumatol Surg Res 105(7):1395–1399. https://doi.org/10.1016/j.otsr.2019.09.015
Kodama Y, Furumatsu T, Kamatsuki Y et al (2019) Preliminary diagnosis of medial meniscus posterior root tears using the Rosenberg radiographic view. Knee Surg Relat Res 31:1–8. https://doi.org/10.1186/s43019-019-0011-5
Kodama Y, Furumatsu T, Masuda S 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. https://doi.org/10.1007/s00167-019-05810-x
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. https://doi.org/10.1007/s00167-017-4454-5
Krych AJ, Reardon PJ, Johnson NR, Mohan R, Peter L, Levy BA, Stuart MJ (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
Kwon OJ, Bin SI, Kim JM et al (2020) There is no difference in radiographic outcomes after average 9 years after arthroscopic partial medial meniscectomy for both posterior horn tears and posterior horn root tears. Arthroscopy 36:524–532. https://doi.org/10.1016/j.arthro.2019.08.039
LaPrade CM, LaPrade MD, Turnbull TL, 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. https://doi.org/10.1177/0363546514563278
Lee JK, Jung M, Yang JH 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 99:e19499. https://doi.org/10.1097/md.0000000000019499
Lim HC, Bae JH, Wang JH, Seok CW, Kim MK (2010) Non-operative treatment of degenerative posterior root tear of the medial meniscus. Knee Surg Sports Traumatol Arthrosc 18:535–539. https://doi.org/10.1007/s00167-009-0891-0
Neogi DS, Kumar A, Rijal L, Yadav CS, Jaiman A, Nag HL (2013) Role of nonoperative treatment in managing degenerative tears of the medial meniscus posterior root. J Orthop Traumatol 14:193–199. https://doi.org/10.1007/s10195-013-0234-2
Okazaki Y, Furumatsu T, Kamatsuki Y et al (2020) Differences between the root and horn cells of the human medial meniscus from the osteoarthritic knee in cellular characteristics and responses to mechanical stress. J Orthop Sci. https://doi.org/10.1016/j.jos.2020.02.015
Okazaki Y, Furumatsu T, Kodama Y, Kamatsuki Y, Masuda S, Ozaki T (2019) Description of a surgical technique of medial meniscus root repair: a fixation technique with two simple stitches under an expected initial tension. Eur J Orthop Surg Traumatol 29:705–709. https://doi.org/10.1007/s00590-018-2347-z
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. https://doi.org/10.1007/s00167-008-0569-z
Seo JH, LiG SGM et al (2009) Effect of repair of radial tears at the root of the posterior horn of the medial meniscus with the pullout suture technique: a biomechanical study using porcine knees. Arthroscopy 25:1281–1287. https://doi.org/10.1016/j.arthro.2009.05.014
Stärke C, Kopf S, Gröbel KH, Becker R (2010) The effect of a nonanatomic repair of the meniscal horn attachment on meniscal tension: a biomechanical study. Arthroscopy 26:358–365. https://doi.org/10.1016/j.arthro.2009.08.013
Acknowledgements
We would like to thank Editage (https://www.editage.jp) for English language editing.
Funding
No funding was received for this study.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
All authors declare that they have no conflict of interest.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional review board.
Informed consent
Informed consent was obtained from all individual participants included in this study.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Kodama, Y., Furumatsu, T., Okazaki, Y. et al. Transtibial pullout repair of medial meniscus posterior root tears: effects on the meniscus healing score and ICRS grade among patients with mild osteoarthritis of the knee. Knee Surg Sports Traumatol Arthrosc 29, 3001–3009 (2021). https://doi.org/10.1007/s00167-020-06332-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00167-020-06332-7