Abstract
PurposeThe main purpose of this study was to investigate clinical and radiological outcomes of medial meniscus posterior root tear (MMPRT) repair in knees with advanced articular cartilage degeneration and osteoarthritis compared to those with minimal degenerative change.MethodsThirty-three knees underwent MMPRT repair using an arthroscopic pullout repair tibial tunnel technique. Clinical scores including Lysholm Score, International Knee Documentation Committee (IKDC) Score and Knee injury and Osteoarthritis Outcome (KOOS) Score were collected preoperatively and sequentially at 6 months, 12 months and mean final follow-up of 39.4 months. Kellgren-Lawrence (K-L) osteoarthritis grade, Outerbridge classification of cartilage degeneration and the presence of bone marrow oedema on MRI were also evaluated.ResultsAll clinical scores improved at final follow-up for knees with K-L grade ≥ 2 osteoarthritis (p < 0.001), with no significant difference compared to K-L 0/1. Patients with Outerbridge class 3/4 cartilage degeneration also reported improvements in clinical scores, albeit lower than those with class 2 degeneration (p < 0.05). During recovery, the majority of patients reported clinical improvements by 6 months, and six patients further improved by at least 15 points in IKDC score between 6 and 12 months. Osteoarthritis progressed in 10 of 31 knees (32%), with an overall mean pre-operative K-L grade of 1.6 ± 0.9 compared to 2.0 ± 0.9 at final follow-up (n.s.). No knees progressed to K-L 4 or underwent re-operation. Pre-operative bone marrow oedema was present in 17 knees (52%), all of which had signal localised to the medial tibia or femur. Oedema had resolved in all but 5 knees post-operatively (p < 0.01).ConclusionArthroscopic repair of medial meniscus posterior root tears is associated with improved outcomes in knees with advanced cartilage degeneration and osteoarthritis. Meaningful improvements in clinical outcomes can be achieved beyond 6 months, thus success of the operation is best determined at the 12-month mark. Oedema signal significantly improved post-operatively, however a relatively high proportion of knees had K-L progression.Level of evidenceIV – Case Series.
Highlights
Integrity of the posterior root of the medial meniscus is essential for normal meniscal function, through maintaining circumferential hoop tension and preventing meniscal extrusion [13, 17]
All patients at arthroscopy had at least small areas of fragmentation/ fissuring of articular cartilage (Outerbridge class 2), with varying degrees of osteoarthritis evident on pre-operative radiographs (K-L grade 0–3). 17 knees (52%) had bone marrow oedema on MRI scans preoperatively; all of which had signal localised to the medial tibia or femur with varying degrees of intensity and depth
Knee injury and Osteoarthritis Outcome (KOOS), Lysholm and International Knee Documentation Committee (IKDC) Scores all significantly improved at a mean final follow-up of 39.4 months (Table 2), regardless of articular cartilage degeneration or osteoarthritic change at time of operation
Summary
Integrity of the posterior root of the medial meniscus is essential for normal meniscal function, through maintaining circumferential hoop tension and preventing meniscal extrusion [13, 17]. Without a functional root preventing meniscal extrusion, tibiofemoral contact area decreases and in turn, markedly increases contact pressure [12]. This leads to a pattern of accelerated articular cartilage degeneration [14] and osteoarthritis [2, 17] that is typically seen with this type of injury. Partial meniscectomy, which has traditionally been the treatment for medial meniscus root tears, is associated with poor clinical outcomes [29], and 5-year arthroplasty rates have been reported as high as 35-54% [8, 21]
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