Evaluating the Outcome of Meniscus Root Repair Surgery in Patients with Degenerative Meniscus Posterior Root Tears

Document Type : RESEARCH PAPER

Authors

1 Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran

2 Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran - Department of Orthopedic surgery, Farhikhtegan Hospital, Faculty of Medicine, Tehran Medical Sciences Islamic Azad University, Tehran, Iran

3 Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran - Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran

10.22038/abjs.2025.76992.3556

Abstract

Objectives: Transtibial pullout repair provides significant clinical improvement in individuals with meniscal root tears; however, there is no consensus on radiological outcomes. In this research, meniscal extrusion and clinical status were evaluated in a homogeneous series of subjects with degenerative medial meniscus posterior root tears (MMPRT).
Methods: This retrospective-prospective study was conducted on 16 subjects with degenerative posterior root tears of the medial meniscus who underwent transtibial pullout repair at Shafa Yahyaian Hospital from March 2017 to February 2021. The study population included two males and 14 females. The average age of the study participants was 50.9 ± 11 years. ‏The patients were followed up for an average of ‏‎19.7±14.8‎‏ months. ‏The Lysholm knee scoring scale was used for clinical evaluation of the knee. MRI (magnetic resonance imaging) was used both before and after surgery to assess the improvement in meniscal extrusion. ‎
Results: The average total Lysholm knee score increased from ‎49.6±10.5 to 79.1±11.1 (P<0.001). The knee status was poor in one subject, fair in ten subjects, good in two subjects, and excellent in three subjects. In the last follow-up session, all subscales of the Lysholm Knee Scoring Scale showed improvement. The mean meniscal extrusion was 5.7±1.8 mm before surgery and 3.4±2.5 mm after surgery based on MRI results (P=0.008). Improvement in Lysholm score was not correlated with improvement in meniscal extrusion.
Conclusion: Transtibial pullout ‎repair provides significant clinical improvement in degenerative meniscal root tears, even in individuals in whom the meniscal extrusion is not reversed.
        Level of evidence: IV

Keywords

Main Subjects


  1. Fox AJ, Bedi A, Rodeo SA. The Basic Science of Human Knee Menisci: Structure, Composition, and Function. Sports health. 2012;4(4):340-51. doi:10.1177/1941738111429419.
  2. Makris EA, Hadidi P, Athanasiou KA. The knee meniscus: structure-function, pathophysiology, current repair techniques, and prospects for regeneration. Biomaterials. 2011;32(30):7411-31. doi:10.1016/j.biomaterials.2011.06.037.
  3. Lee DW, Ha JK, Kim JG. Medial meniscus posterior root tear: a comprehensive review. Knee Surg Relat Res. 2014;26(3):125-34. doi:10.5792/ksrr.2014.26.3.125.
  4. Labarre C, Kim SH, Pujol N. Incidence and type of meniscal tears in multilligament injured knees. Knee Surg Sports Traumatol Arthrosc. 2023;31(2):465-474. doi: 10.1007/s00167-022-07064-6.
  5. Pache S, Aman ZS, Kennedy M, et al. Meniscal Root Tears: Current Concepts Review. Arch Bone Jt Surg. 2018;6(4):250-259.
  6. Pache S, Aman ZS, Kennedy M, et al. Meniscal root tears: current concepts review. Archives of Bone and Joint Surgery. 2018;6(4):250.
  7. Kim C, Bin S-I, Kim J-M, Lee B-S, Kim T-H. Progression of radiographic osteoarthritis after partial meniscectomy in degenerative medial meniscal posterior root tears was greater in varus- than in neutral-aligned knees: a minimum 5-year follow-up. Knee Surg Sports Traumatol Arthrosc. 2020;28(11):3443-3449. doi: 10.1007/s00167-020-05905-w.
  8. Floyd ER, Rodriguez AN, Falaas KL, et al. The Natural History of Medial Meniscal Root Tears: A Biomechanical and Clinical Case Perspective. Front Bioeng Biotechnol. 2021:9:744065. doi: 10.3389/fbioe.2021.744065.
  9. Neogi DS, Kumar A, Rijal L, Yadav CS, Jaiman A, Nag HL. Role of nonoperative treatment in managing degenerative tears of the medial meniscus posterior root. J Orthop Traumatol. 2013;14(3):193-9. doi: 10.1007/s10195-013-0234-2.
  10. Lim HC, Bae JH, Wang JH, Seok CW, Kim MK. Non-operative treatment of degenerative posterior root tear of the medial meniscus. Knee Surg Sports Traumatol Arthrosc. 2010;18(4):535-9. doi: 10.1007/s00167-009-0891-0.
  11. 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. 2021;29(9):3001-3009. doi: 10.1007/s00167-020-06332-7.
  12. Kamatsuki Y, Furumatsu T, Hiranaka T, et al. Placement of an anatomic tibial tunnel significantly improves the medial meniscus posterior extrusion at 90° of knee flexion following medial meniscus posterior root pullout repair. Knee Surg Sports Traumatol Arthrosc. 2021;29(4):1025-1034. doi: 10.1007/s00167-020-06070-w.
  13. Mochizuki Y, Kawahara K, Samejima Y, Kaneko T, Ikegami H, Musha Y. 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. 2021;31(6):1235-1241. doi: 10.1007/s00590-021-02874-9.
  14. Chung KS, Noh JM, Ha JK, et al. Survivorship Analysis and Clinical Outcomes of Transtibial Pullout Repair for Medial Meniscus Posterior Root Tears: A 5- to 10-Year Follow-up Study. Arthroscopy. 2018;34(2):530-535. doi: 10.1016/j.arthro.2017.08.266.
  15. Fujii M, Furumatsu T, Kodama Y, et al. A novel suture technique using the FasT-Fix combined with Ultrabraid for pullout repair of the medial meniscus posterior root tear. Eur J Orthop Surg Traumatol. 2017;27(4):559-562. doi: 10.1007/s00590-017-1930-z.
  16. Kellgren JH, Lawrence J. Radiological assessment of osteo-arthrosis. Ann Rheum Dis. 1957;16(4):494-502. doi: 10.1136/ard.16.4.494.
  17. Outerbridge R. Further studies on the etiology of chondromalacia patellae. J Bone Joint Surg Br. 1964:46:179-90.
  18. Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res. 1985:(198):43-9.
  19. Costa CR, Morrison WB, Carrino JA. Medial meniscus extrusion on knee MRI: is extent associated with severity of degeneration or type of tear? AJR Am J Roentgenol. 2004;183(1):17-23. doi: 10.2214/ajr.183.1.1830017.
  20. De Smet AA. How I diagnose meniscal tears on knee MRI. AJR Am J Roentgenol. 2012;199(3):481-99. doi: 10.2214/AJR.12.8663.
  21. Kim SB, Ha JK, Lee SW, et al. Medial meniscus root tear refixation: comparison of clinical, radiologic, and arthroscopic findings with medial meniscectomy. Arthroscopy. 2011;27(3):346-54. doi: 10.1016/j.arthro.2010.08.005.
  22. Moon HK, Koh YG, Kim YC, Park YS, Jo SB, Kwon SK. Prognostic factors of arthroscopic pull-out repair for a posterior root tear of the medial meniscus. Am J Sports Med. 2012;40(5):1138-43. doi: 10.1177/0363546511435622.
  23. Seo HS, Lee SC, Jung KA. Second-look arthroscopic findings after repairs of posterior root tears of the medial meniscus. Am J Sports Med. 2011;39(1):99-107. doi: 10.1177/0363546510382225.
  24. Krych AJ, Nauert RF, 3rd, Song BM, et al. Association Between Transtibial Meniscus Root Repair and Rate of Meniscal Healing and Extrusion on Postoperative Magnetic Resonance Imaging: A Prospective Multicenter Study. Orthop J Sports Med. 2021;9(8):23259671211023774. doi: 10.1177/23259671211023774.
  25. Kaplan DJ, Alaia EF, Dold AP, et al. Increased extrusion and ICRS grades at 2-year follow-up following transtibial medial meniscal root repair evaluated by MRI. Knee Surg Sports Traumatol Arthrosc. 2018;26(9):2826-2834. doi: 10.1007/s00167-017-4755-8.
  26. Feucht MJ, Kühle J, Bode G, et al. Arthroscopic Transtibial Pullout Repair for Posterior Medial Meniscus Root Tears: A Systematic Review of Clinical, Radiographic, and Second-Look Arthroscopic Results. Arthroscopy. 2015;31(9):1808-16. doi: 10.1016/j.arthro.2015.03.022.
  27. Makiev KG, Vasios IS, Georgoulas P, Tilkeridis K, Drosos G, Ververidis A. Clinical significance and management of meniscal extrusion in different knee pathologies: a comprehensive review of the literature and treatment algorithm. Knee Surg Relat Res. 2022;34(1):35. doi: 10.1186/s43019-022-00163-1.
  28. Chernchujit B, Agrawal S. Arthroscopic All-Inside Medial Meniscus Extrusion Reduction. Arthrosc Tech. 2019;8(5):e495-e501. doi: 10.1016/j.eats.2019.01.008.