Unfavorable Results of Partial Meniscectomy for Complete Posterior Medial Meniscus Root Tear With Early Osteoarthritis: A 5- to 8-Year Follow-Up Study

doi:10.1016/j.arthro.2010.01.032

Arthroscopy: The Journal of Arthroscopic & Related Surgery

Volume 26, Issue 10, October 2010, Pages 1326-1332

https://doi.org/10.1016/j.arthro.2010.01.032 Get rights and content

Purpose

The aim of this retrospective study was to evaluate the clinical and radiographic outcomes of arthroscopic partial meniscectomy for complete posterior medial meniscus root tear (PMMRT) in patients with early radiographic evidence of knee osteoarthritis at a minimum follow-up of 5 years.

Methods

Forty-six cases had complete PMMRT with follow-up of at least 5 years and were treated with arthroscopic partial meniscectomy. On the basis of medical records, we reviewed the arthroscopic findings of joint degeneration (Outerbridge grading), clinical results using the modified Lysholm (ML) knee score and a patient questionnaire, and radiographic evaluation of degeneration using Kellgren-Lawrence (KL) grading.

Results

The incidence of complete PMMRT in the study population was 15%. At a mean follow-up of 78 months (range, 60 to 103 months), the mean ML score significantly improved from 72 (range, 62 to 78) preoperatively to 77 (range, 70 to 98) at final follow-up (P < .01), 16 patients (35%) showed progression of degeneration from KL grade 0 to 2 preoperatively to KL grade 2 to 4, 56% of patients indicated improvement in pain, 67% of patients were satisfied with the results of the procedure, and 19% of patients underwent reoperation. There was a significant negative correlation between chondral wear during arthroscopy (ρ = −0.516, P = .002) and preoperative KL grade (ρ = −0.429, P = .004) with ML score at final follow-up.

Conclusions

Although arthroscopic partial meniscectomy for complete PMMRT significantly improved ML scores postoperatively, only 56% of patients had improvement in pain, 67% were satisfied with the outcome of the procedure, and 35% showed radiographic progression of osteoarthritis at a mean follow-up of 77 months.

Level of Evidence

Level IV, therapeutic study.

Section snippets

Methods

From December 1999 to April 2003, arthroscopic partial meniscectomy was performed on 460 knees at 1 institution. We reviewed the records of these patients after institutional review board approval was obtained. The inclusion criteria were complete PMMRT and a minimum follow-up period of 5 years. Among the 71 knees (15%) diagnosed as having PMMRT, 68 (15%) were found to have complete tears. Patients with considerable articular cartilage degeneration defined as KL grade greater than 2; those with

Results

All 46 patients in our study had complete PMMRT as confirmed by magnetic resonance imaging and arthroscopy (Fig 1) and underwent arthroscopic partial meniscectomy. Of the patients, 13 (28%) had normal articular cartilage (Outerbridge grade 0), 9 (19%) had Outerbridge grade I articular cartilage, 12 (26%) had Outerbridge grade II articular cartilage, 8 (17%) had Outerbridge grade III changes in articular cartilage, and 4 (9%) had Outerbridge grade IV changes on the medial compartment of the knee

Discussion

Radial tears of the medial meniscus have been reported commonly in elderly patients who complain of severe knee pain.4, 19, 20 The incidence of complete PMMRT in the current series was 15%. In our study arthroscopic partial meniscectomy was performed in patients with OA KL grade 0 to 2 on standing anteroposterior knee radiographs. On arthroscopy, 12 of 46 patients (26%) had Outerbridge grade III or IV degenerative changes. According to the patient questionnaire, 67% of patients were satisfied

Conclusions

References (33)

S.I. Bin et al.
Radial tears of the posterior horn of the medial meniscus
Arthroscopy
(2004)
R.S. Jones et al.
Direct measurement of hoop strains in the intact and torn human medial meniscus
Clin Biomech (Bristol, Avon)
(1996)
J.H. Ahn et al.
Arthroscopic all inside repair of the lateral meniscus root tear
Knee
(2009)
J.H. Koenig et al.
Meniscal root tears: Diagnosis and treatment
Arthroscopy
(2009)
J.H. Seo et al.
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
(2009)
X. Crevoisier et al.
Arthroscopic partial meniscectomy in patients over 70 years of age
Arthroscopy
(2001)
E.O. Pearse et al.
Partial meniscectomy in the presence of severe osteoarthritis does not hasten the symptomatic progression of osteoarthritis
Arthroscopy
(2003)
F. Chatain et al.
A comparative study of medial versus lateral arthroscopic partial meniscectomy on stable knees: 10-year minimum follow-up
Arthroscopy
(2003)
S.I. Bin et al.
Results of arthroscopic medial meniscectomy in patients with grade IV osteoarthritis of the medial compartment
Arthroscopy
(2008)
Y.M. Kim et al.
Arthroscopic pullout repair of a complete radial tear of the tibial attachment site of the medial meniscus posterior horn
Arthroscopy
(2006)

J.H. Lee et al.

Arthroscopic pullout suture repair of posterior root tear of the medial meniscus: Radiographic and clinical results with a 2-year follow-up

Arthroscopy

(2009)

T. Fukubayashi et al.

The contact area and pressure distribution pattern of the kneeA study of normal and osteoarthrotic knee joints

Acta Orthop Scand

(1980)

G.A. Paletta et al.

The effect of allograft meniscal replacement on intraarticular contact area and pressures in the human kneeA biomechanical study

Am J Sports Med

(1997)

A.M. Ahmed et al.

In-vitro measurement of static pressure distribution in synovial joints—Part I: Tibial surface of the knee

J Biomech Eng

(1983)

W. Petersen et al.

Age-related blood and lymph supply of the knee menisciA cadaver study

Acta Orthop Scand

(1995)

I.D. McDermott et al.

The consequences of meniscectomy

J Bone Joint Surg Br

(2006)

Cited by (119)

Platelet-rich plasma for nonoperative management of degenerative meniscal tears: A systematic review
2024, Journal of Orthopaedics
Meniscus tears are a common cause of knee pain encountered in orthopedics and sports medicine. There are numerous management strategies, from physical therapy and oral medications to surgery. Recent evidence is more favorable for conservative management, as operative treatment has limited clinical benefits and is associated with an accelerated progression toward osteoarthritis. Injections with orthobiologic therapies, such as platelet-rich plasma (PRP), are emerging as an alternative therapeutic tool for degenerative tears. This study aims to evaluate the latest evidence regarding the efficacy of PRP injections for the nonoperative management of degenerative meniscal pathology.
Articles were obtained from Embase, PubMed, World of Science, Cochrane, and Galileo databases after searching “Platelet-rich plasma” AND “Meniscus.” Inclusion criteria consisted of original, human studies evaluating the use of platelet-rich plasma for nonoperative management of meniscus tears.
A total of 384 articles were screened, with ten studies selected for final inclusion. The pooled study population comprised 686 patients, with an average age ranging from 33 to 53 years, and a 38% female population. Three different injection approaches were utilized, categorized as intra-articular alone (IA), intra-meniscal alone (IM), or a combination of both. Most studies demonstrated improved pain and functionality by 3 months that persisted for at least one year. Within the IA and IM groups, the majority of patients were either radiographically stable (30–70%) or demonstrated interval healing (40–60%). Several studies within IM and combined treatment groups evaluated rates and time to arthroscopy, and found lower failure rates and greater arthroscopy-free survival time than control comparison groups.
PRP appears to be a safe and efficacious treatment strategy for degenerative meniscal pathology. However, due to diverse periprocedural techniques, PRP injectate characteristics, and a lack of high-quality studies, additional trials are needed to provide greater a degree of confidence in PRP's clinical impact on patients with meniscus tears.
Systematic Review.
Transosseous Repair of Isolated Posterior Medial Meniscal Root Injuries in Children and Adolescents
2024, Arthroscopy Techniques
The meniscal roots are critically important for maintaining knee stability, functional load distribution, and proper knee kinematics. Although adult meniscal root injuries have been a topic of increasing research, medial meniscus injuries also occur in pediatric and adolescent patients, with up to 2% of meniscal injuries involving root attachments. The purpose of this Technical Note is to demonstrate the transosseous repair of isolated posterior medial meniscal root injuries in children and adolescents, including tear visualization on magnetic resonance imaging and during arthroscopy, operative technique, and postoperative management.
Medial Meniscus Posterior Root Repair Restores Contact Pressure and Contact Area to Its Native State Even After Opening-Wedge High Tibial Osteotomy: A Cadaveric Biomechanical Study
2023, Arthroscopy - Journal of Arthroscopic and Related Surgery
To elucidate the effect of medial meniscus posterior root (MMPR) repair during opening-wedge high tibial osteotomy (OWHTO) in terms of contact pressure (CP) and contact area (CA).
Nine fresh-frozen human cadaveric knee specimens were included. Each specimen was tested under 9 conditions comprising 3 different degrees of correction during OWHTO (neutral, 5° of valgus, and 10° of valgus) and 3 different types of MMPR conditions (intact, torn, and repaired). The prepared specimens were attached to a customized tibiofemoral jig in a fully extended state. The CP and CA generated by a tibiofemoral axial load of 650 N was recorded using the Tekscan sensor’s pressure mapping software. Statistical analysis was performed using a repeated measures analysis of variance.
The increased CP and decreased CA in torn MMPR was decreased and increased, respectively, to the intact MMPR after repairing, irrespective of whether OWHTO was performed. The mean CP at a correction angle of 5° of valgus was 0.4067 ± 0.0768 MPa for intact MMPR, which increased to 0.7340 ± 0.1593 MPa for the torn MMPR and decreased to 0.3614 ± 0.0639 MPa for the repaired MMPR. In addition, the proportion of decrease in CP and increase in CA after MMPR repair was constant, compared with the torn MMPR, irrespective of the degree of correction during OWHTO.
MMPR repair decreases CP and increases CA, irrespective of whether OWHTO is performed. The biomechanical advantage of repairing torn MMPR is maintained, regardless of the degree of correction during OWHTO.
Both OWHTO and MMPR repair are known to protect the medial compartment of the knee. However, there are concerns in performing 2 procedures simultaneously. Results of our study showed that concurrent repair of the MMPR during OWHTO is useful for protecting the medial compartment of the knee with respect to tibiofemoral contact biomechanics.
Posterior Root Medial Meniscus Tear With Medial Opening Wedge High Tibial Osteotomy: A Step-By-Step Systematic Arthroscopic Repair Technique
2022, Arthroscopy Techniques
Citation Excerpt :
HTO has a role for younger and more active patients, as it combines cartilage operations, meniscal allograft transplantation, and chronic instability into a single-stage procedure.15 The alignment must be corrected first (which includes medial MRR) for patients who arrive at the physician's surgery after the secondary varus knee malalignment has occurred.16,17 The author prefers to combine HTO and posterior meniscus root repair in a single-stage procedure to improve knee function and decrease deterioration of the medial knee compartment.
Medial meniscus root repair is often combined with correction of knee varus alignment by performing an opening wedge high tibial osteotomy (HTO) in patients with varus knee malalignment, particularly in those with suspected long-term medial meniscus root tear (MRT). Before planning a corrective alignment treatment, radiographic imaging of the knee alignment is recommended to assess a medial joint space and the tibiofemoral axis. Because HTO can reduce pressure on the repair site, new alignment may promote healing in the attachment of the MR repair. When HTO is used with meniscus root repair (MRR), the tunnel convergence remains a major concern. We describe an arthroscopic technique for treating chronic MRT with knee malalignment using the technique of arthroscopic posterior MRR with HTO. This approach was used to enhance anatomic healing of the meniscus root, decrease the load to the medial knee compartment to achieve MRR, and stop progressive osteoarthritis of the medial knee compartment.
The Prevalence of Tibiofemoral Knee Osteoarthritis Following Arthroscopic Partial Meniscectomy Is Variably Reported in General, and Over Time: A Systematic Review With a Minimum of 5-Year Follow-Up
2022, Arthroscopy, Sports Medicine, and Rehabilitation
To assess the prevalence of tibiofemoral (TF) osteoarthritis (OA) following arthroscopic partial meniscectomy (APM) with a minimum follow-up of 5 years, to explore the prevalence of symptomatic TF OA, and to identify potential risk factors for the development of TF OA following APM.
An electronic search was conducted using PubMed, CINAHL, Pedro, AMED, Embase, the Cochrane Library, and clinicaltrials.gov. Prospective/retrospective studies including participants with a mean age ≥18 years old, undergoing isolated APM, reported radiographic assessment of knee OA as an outcome, had at least 5-year follow-up, and were written in English were included. Two authors extracted relevant data. Four authors assessed methodologic quality using the Center of Reviews and Dissemination and the Downs and Black checklist. The prevalence of TF OA after APM was reported for each study, with the range provided across studies for each time period (5 years to <10 years, 10 years to <15 years, ≥15 years).
Twenty-two studies were included. Radiologic TF OA prevalence following APM ranged from 35% to 90%, 23% to 100%, and 52% to 57.7% at an average follow-up of 5 years to <10 years, 10 years to <15 years, and ≥15 years, respectively. Prevalence of symptomatic TF OA ranged from 24.1% to 67% according to individual operational definitions, with 2 studies reporting correlations between function and radiological findings.
APM results in a prevalence of radiographic TF OA ranging from 23% to 100% across follow-up periods of 5 or more years with the lowest prevalence reported between 5 and <10 years and the highest prevalence reported between 10 and <15 years follow-up. Considerably less data was available to assess symptomatic TF OA or risk factors associated with TF OA.
Level III, systematic review of Level II and III studies.
A posterior anchoring method decreases pullout suture translation of the medial meniscus posterior root repair during knee flexion
2022, Knee
The medial meniscus (MM) translates posteriorly and extrudes severely from the medial tibial plateau (MTP) during knee flexion in the MM posterior root tear (PRT) knee. Transtibial pullout repair of the MMPRT has been performed to regulate MM extrusion. This study aimed to evaluate pullout suture translation during knee flexion before and after posterior anchoring during pullout repair. We hypothesized that suture translation after posterior anchoring would be significantly decreased relative to that before posterior anchoring.
Thirty-five patients who underwent MM posterior root repair were prospectively investigated. Pullout repair was performed using two cinch sutures (outer and inner sutures) and posterior anchoring through the MM posterior horn and an additional bone tunnel on the MTP. The translation of the outer suture from 0° to 90° of knee flexion was measured and compared before and after posterior anchoring intraoperatively. The MM morphologic features were measured using preoperative magnetic resonance imaging, and the correlation between these values and outer suture translation was evaluated.
The average outer suture translation after posterior anchoring (1.6 ± 1.5 mm) was significantly decreased relative to that before posterior anchoring (2.5 ± 1.7 mm, P < 0.01). No significant correlations were observed between the MM morphological features and outer suture translation.
The posterior anchoring method with an MM posterior root repair is useful in decreasing posterior translation of the pullout suture during knee flexion, which might have an advantage in preventing suture pullout from the repaired MM, leading to good clinical outcomes.

View all citing articles on Scopus

: Supported by 2009 Inje University, Korea, research grant. The authors report no conflict of interest.

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Original ArticleUnfavorable Results of Partial Meniscectomy for Complete Posterior Medial Meniscus Root Tear With Early Osteoarthritis: A 5- to 8-Year Follow-Up Study

Purpose

Methods

Results

Conclusions

Level of Evidence

Section snippets

Methods

Results

Discussion

Conclusions

Arthroscopy

Clin Biomech (Bristol, Avon)

Knee

Arthroscopy

Arthroscopy

Arthroscopy

Arthroscopy

Arthroscopy

Arthroscopy

Arthroscopy

Arthroscopy

The contact area and pressure distribution pattern of the kneeA study of normal and osteoarthrotic knee joints

Acta Orthop Scand

The effect of allograft meniscal replacement on intraarticular contact area and pressures in the human kneeA biomechanical study

Am J Sports Med

In-vitro measurement of static pressure distribution in synovial joints—Part I: Tibial surface of the knee

J Biomech Eng

Age-related blood and lymph supply of the knee menisciA cadaver study

Acta Orthop Scand

The consequences of meniscectomy

J Bone Joint Surg Br

Original Article
Unfavorable Results of Partial Meniscectomy for Complete Posterior Medial Meniscus Root Tear With Early Osteoarthritis: A 5- to 8-Year Follow-Up Study