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Correlation of factors affecting correction of meniscal extrusion and outcome after medial meniscus root repair

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

Abstract

Introduction

Meniscus extrusion in medial meniscus posterior root tears (MMPRT) is a consistent MRI finding and correction of extrusion is a primary objective of the meniscal root repair. The purpose of the study is to evaluate feasibility of correction of extrusion and correlation of various factors affecting the postoperative extrusion correction and outcomes in all degenerative medial meniscus posterior roots (MMPRTs).

Methods

A retrospective study of patients who presented with degenerative MMPRTs following trivial incident (Jun 2014 and Aug 2018) and included isolated Laprade type 2 root tear with extrusion in MRI. Patients with ligament injuries, tricompartmental arthritis, malalignment (> 50) and irreparable meniscal tears excluded. All patients underwent arthroscopic trans-tibial tunnel suture pull-out repair. A screening MRI was taken at a 6-month follow-up and functional scores (IKDC and Lysholm’s) at final follow-up. The effects of age, gender, duration of symptoms, hip–knee–ankle angle on weight-bearing X-rays, ICRS grading of cartilage status, and MRI data (extrusion distance, tunnel location and healing status of meniscus) on outcomes were analysed.

Results

MMPRT (n = 54) with a mean follow-up of 34.6 months (24–48). Mean functional outcomes improved postoperatively IKDC (43.40 ± 5.16–78.65 ± 5.11, p < 0.001) and Lysholm’s (65.27 ± 4.28–83.16 ± 4.83, p < 0.001) scores at final follow-up. 57.4% (31) had good correction of extrusion, 3.7% (2) no correction and 38.8% (21) showed increase in extrusion postoperatively. Of all the factors we explored, age, ICRS (low grade) and knee varus (less 2.5 degree) affected extrusion correction. Patients with healed (41 patients), partially healed (9 patients) and anatomic tunnel placement (46 patients) had better extrusion correction than those with non-healing (4 patients) and non-anatomical tunnel (8 patients).

Conclusion

Patients younger than 50 years, with low grade cartilage damage (ICRS 1, 2), lower KL grade and varus alignment (< 2.50) had good correction of extrusion. Correction of extrusion/progression of extrusion did not influence the clinical outcome at the short-term. The progression of meniscal extrusion is inevitable even after successful repair in elderly and high-risk patients.

Study design

Retrospective Case series, level of evidence IV.

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Acknowledgements

“Mr.A. S. Sethuraman (third author) was supported by a Fulbright Fellowship jointly funded by the United States Department of State and the Republic of India.”

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  1. Ganga Hospital, 313, Mettupalayam Road, Coimbatore, 641043, India

    Silvampatti Ramsamy Sundararajan, Rajagopalakrishnan Ramakanth, Arvinth Shivaa Sethuraman, Muhil Kannan & Shanmuganathan Rajasekaran

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Correspondence to Silvampatti Ramsamy Sundararajan.

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Supplementary Information

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Supplementary file1 Video1 A short video technique of arthroscopic picture, showing root tear, bed preparation, drilling of tibial tunnel, cinch-type of suture typing, shutting of sutures out through the tibial tunnel and reduction of meniscal root to its attachment. (MP4 9869 kb)

Supplementary file2 Video 2 Out-side picture showing tightening of knot over titanium suture disc. (MP4 3239 kb)

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Sundararajan, S.R., Ramakanth, R., Sethuraman, A.S. et al. Correlation of factors affecting correction of meniscal extrusion and outcome after medial meniscus root repair. Arch Orthop Trauma Surg 142, 823–834 (2022). https://doi.org/10.1007/s00402-021-03870-8

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