Meniscal Comma Sign Responds to Partial Meniscectomy Despite Increased Levels of Arthritis

Abstract

PurposeTo compare the outcomes of patients undergoing partial meniscectomy preoperatively identified with the “meniscal comma sign” with those undergoing meniscectomy with other tear patterns. MethodsPatients with meniscal “comma sign,” as indicated by a query of MRI reports, were screened using the search terms “meniscotibial recess,” “meniscus perched over the medial tibial margin,” or other search terms by radiologists between January 2008 and November 2019. Patients were matched and chart review was done for demographics, revision surgery, and progression to total knee arthroplasty. Radiographs were used for osteoarthritis grading using the Kellgren-Lawrence (KL) scoring system. Preoperative and postoperative International Knee Documentation Committee (IKDC), Knee Injury and Osteoarthritis Outcome Score (KOOS), Lysholm, and Short Form 12-item Survey (SF-12) scores were collected. Results406 patients met inclusion (comma sign =197; control group n=209). The control group had an increased duration of symptoms at the initial visit (P=0.001). More meniscal comma sign patients received corticosteroid knee injections before surgery (P=0.011). Comma sign patients also had greater mean KL scores (P=0.001) as well as higher KL categorical scores (P=0.002), indicating more advanced levels or arthritis. There were no differences in those receiving physical therapy (PT) before surgery (P=0.966) or those receiving injections or PT after surgery (P=0.631, P=0.37, respectively). IKDC, KOOS, Lysholm, and SF-12 Physical scores improved preoperatively to postoperatively in both groups (P<0.05), and there was no difference between the case and control group (P>0.05). No significant difference was found in revisions or progression to total knee arthroplasty between cohorts. (P=0.676 and P=0.424). ConclusionPatients presenting with preoperative findings of meniscal comma sign fare similarly to those that do not. Patients with this meniscal injury tend to have more advanced grading of osteoarthritic changes in the knee upon presentation and seek care earlier than those without. Arthroscopic meniscectomy is a good treatment option for patients with a meniscal fragment in the meniscotibial recess and shows outcomes comparable to those with other tear patterns. Level of EvidenceLevel III, retrospective cohort