Écartement des berges méniscales et degré d’arthrose sont corrélés avec l’extrusion méniscale dans les lésions dégénératives de la racine postérieure du ménisque médial

Abstract

IntroductionMeniscal extrusion is a typical finding of medial meniscus posterior root tear, and it causes loss of the chondroprotective function of the meniscus as well as progression of osteoarthritis; it is therefore associated with poor clinical outcomes. The purpose of this study was to investigate factors associated with meniscal extrusion in degenerative medial meniscus posterior root tear. It was hypothesized that larger displacement from the posterior root insertion was associated with larger meniscal extrusion. Materials and methodsOne hundred-nine knees with degenerative medial meniscus posterior root tears were retrospectively reviewed. Multiple regression analysis was used to determine whether factors such as age, weight, body mass index, chondral wear at surgery, Kellgren-Lawrence (KL) grade, alignment, tibial slope, and tear gap on performing magnetic resonance imaging (MRI) were associated with meniscal extrusion. Subjects were divided based on the amount of displacement (displaced group: tear gap≥1mm, non-displaced group: tear gap<1mm) to compare meniscal extrusion, chondral wear, and severity of arthritis. ResultsThe mean age of the patients was 58.14±9.64 years, the mean absolute extrusion was 4.02±1.22mm, the mean relative percentage of extrusion was 44.53±13.09 %, and the mean tear gap was 2.39±2.42mm. Multiple regression analysis showed that absolute extrusion was only associated with tear gap on MRI (B=0.242, p=0.001) and that the relative percentage of extrusion was associated with tear gap (B=1.894, p=0.001) and the K-L grade (B=4.492, p=0.024). Absolute extrusion was significantly higher in the displaced group than in the non-displaced group (4.29±1.04mm vs. 3.01±1.35mm, p=0.001). Relative percentage of extrusion was also significantly higher in the displaced group than in the non-displaced group (47.70±11.44 % vs. 36.17±13.65 %, p=0.001). The proportion of chondral wear (Outerbridge grade III and IV) on the medial femoral condyle and K-L grade III and IV were significantly greater in the displaced group than in the non-displaced group (76 % vs. 53.3 %, p=0.023 and 13.9 % vs. 0 %, p=0.001, respectively). DiscussionGreater tear gap is significantly associated with increasing meniscal extrusion in medial meniscus posterior root tear. Additionally, severity of arthritis is significantly associated with increasing relative percentage of extrusion. Chondral wear and severity of arthritis tended to be significantly worse in the displaced group than in the non-displaced group. Level of evidenceIII, comparative retrospective study.