Abstract
BackgroundThe best treatment for degenerative medial meniscus posterior root tear (MMPRT) remains controversial. This study aimed to compare the clinical and radiological outcomes of arthroscopic meniscectomy and conservative treatment for degenerative MMPRT.MethodsFrom January 2007 to December 2014, 146 patients (Meniscectomy group, 90; Conservative group, 56) were evaluated. Clinical outcomes were assessed using the Visual Analog Scale, International Knee Documentation Committee subjective scoring scale, Tegner activity scale, and Lysholm knee scoring scale at the final follow-up. Radiologic outcomes evaluated the progression of osteoarthritis (OA) according to the Kellgren-Lawrence (K-L) classification. We compared the hip-knee-ankle angle (HKAA), medial proximal tibial angle, tibial posterior slope angle, and width of medial joint space. After an average follow-up of 6.3 years, the survivorship was analyzed using the Kaplan–Meier method.ResultsAll clinical outcomes were significantly improved in both groups after treatment, with no significant differences between the two groups at the final follow-up. The progression of OA according to the K-L classification, HKAA and width of medial joint space was significantly advanced in the meniscectomy group (p = 0.03, 0.04, 0.03, respectively). The 10-year survival rates in the meniscectomy and conservative groups were 87 and 88%, respectively.ConclusionsThis study demonstrated that both conservative treatment and meniscectomy provided symptomatic relief. However, it was confirmed that OA progression was more severe in the meniscectomy. We conclude that arthroscopic meniscectomy had no advantage over conservative treatment in terms of clinical outcomes and OA progression in middle-aged patients with MMPRT.Level of evidenceLevel III; retrospective comparative study.
Highlights
The best treatment for degenerative medial meniscus posterior root tear (MMPRT) remains controversial
MMPRT leads to the loss of hoop tension and load transmissibility in the meniscus, which results in a biomechanical condition similar to that observed after total meniscectomy [1]
It is well known that acute traumatic MMPRT without OA should be repaired whenever possible to restore meniscal hoop tension and to prevent early arthritic progression [6,7,8,9]; a large proportion of meniscal root tears seen in clinical practice involve degenerative MMPRTs in middle-aged or older patients [10,11,12]
Summary
The best treatment for degenerative medial meniscus posterior root tear (MMPRT) remains controversial. This study aimed to compare the clinical and radiological outcomes of arthroscopic meniscectomy and conservative treatment for degenerative MMPRT. Treatment options for MMPRT include conservative treatment, meniscectomy, and root repair. Patients with MMPRT have been treated with conservative treatment or a partial meniscectomy [4]. It is well known that acute traumatic MMPRT without OA should be repaired whenever possible to restore meniscal hoop tension and to prevent early arthritic progression [6,7,8,9]; a large proportion of meniscal root tears seen in clinical practice involve degenerative MMPRTs in middle-aged or older patients [10,11,12]. The best treatment for degenerative MMPRT remains controversial [2, 8, 15]
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