Medial meniscal posterior root attachment repair in degenerative patient to slower the progression of knee osteoarthritis

Abstract

Introduction: Meniscal root tear is frequently misdiagnosed and often lead to knee osteoarthritis. Historically, such entity was often treated nonoperatively or with partial meniscectomy. We reported a case of a 78-year-female with osteoarthritis of the knee and meniscal root tear treated with transtibial double tunnel pullout technique. Case Report: A 78-year-old female presenting with left knee pain. One month ago, the patient fell in her bathroom. Physical examination demonstrated locking knee, positive McMurray test. Radiograph suggested osteoarthritis of the left knee Kellgren-Lawrence (KL) grade 2. Magnetic resonance imaging demonstrated traumatic medial posterior meniscal root tear. The patient then underwent meniscal root repair using transtibial double-tunnel pullout technique. Postoperatively, the patient’s knee was placed in a brace and she was kept non-weight-bearing for 6 weeks. At six months of follow-up, the patient no longer complained of pain and locking knee. The Knee Injury and Osteoarthritis Outcome Score (KOOS) also improved from 50 to 90 after six months of follow up. She could weightbear and perform daily activities. Discussion: Meniscal root tear is commonly underdiagnosed, and it often go unnoticed on magnetic resonance imaging and arthroscopy in large part due to the lack of anatomic understanding. Surgery is worthwhile in this case, as it may prevent osteoarthritis from getting worsen. Repairing the meniscal root with a transtibial pullout repair may restore contact pressures to those of the intact states and allow for the dispersion of hoop stresses across the meniscus. In this report, the patient had satisfactory outcome at 6 months of follow-up, where she no longer felt pain and locking knee. Conclusions: Transtibial double-tunnel pullout technique may be treatment of choice for those with meniscal root tear and may provide the greatest improvement in function and lowest risk of conversion to Total Knee Arthroplasty. Further clinical studies are required to investigate the comparative benefit of the transtibial repair technique.