Complex Tears Research Articles

Biomechanical Outcomes of Surgically Repaired TFCC Palmer Type 1B Tears: A Systematic Review of Cadaver Studies.

Palmer type 1B triangular fibrocartilage complex (TFCC) tears are a common cause of distal radioulnar joint (DRUJ) instability. Unfortunately, the best surgical technique for TFCC reinsertion is still unknown, and up to a quarter of patients report instability after repair. The purpose of this systematic review of cadaver studies was to compare the biomechanical outcomes of different surgical techniques used for Palmer 1B TFCC tears. A systemic review of all cadaver studies published before January 2022 was performed using the PubMed and EMBASE databases. Only cadaver studies on reinsertion techniques for Palmer type 1B lesions were included. Biochemical outcome parameters evaluated were stability of the DRUJ and strength of the repair. A total of 248 articles were identified. Five articles fulfilled the inclusion criteria. Four different surgical techniques were identified. In 3 studies, transosseous tunnel repair was tested and resulted in the most stable DRUJ and strongest TFCC repair compared with the suture anchor repair, the peripheral capsular repair, and the outside-in repair. These results suggest that the transosseous tunnel repair might be a good technique for restoring DRUJ stability. However, more cadaver studies are needed to identify the most optimal technique.

Clinical Outcomes for Open Hip Abductor Repair Using Tenodesis and Bone Trough Repair Techniques.

Hip abductor complex tears remain an injury without a clear consensus on management. Surgical treatment has been recommended after unsuccessful nonoperative management. This study evaluates both tenodesis and bone trough techniques, with treatment choices guided by previously described tear classification. This is a retrospective cohort study of 45 hips in 44 patients who underwent surgical treatment for symptomatic, chronic hip abductor tear unresponsive to nonoperative treatment. Demographics and preoperative and postoperative values (including visual analog scale pain scores, gait assessment, and muscle strength) were evaluated. Type I tears were treated using tendon tenodesis. Type II tears were treated through a bone trough repair. Forty-five hips (44 patients) were operated on with a minimum of 6-month follow-up. There were 27 type I and 18 type II tears. Eighty-seven percent of patients were female. Twenty-eight percent of type II patients (5/18) had a preexisting arthroplasty in place. Significant improvements in pain (P < .001), gait (P < .001), and muscle strength (P < .001) were achieved in both the tear types. Type I repairs showed superior results to type II repairs. However, both showed significant improvements. Postoperative magnetic resonance imaging at 6 months showed healed tenodesis in 81% (17/21) of type I tears and 50% (5/10) of type II tears. Our study shows improvement in pain and function after surgical repair of hip abductor tendon injuries in both simple and complex tears. This improvement is seen even during ongoing surgical site healing. Magnetic resonance imaging findings may remain abnormal for more than 1 year after surgery and do not clearly denote repair failure.

Transtibial single-tunnel all-inside technique for repair of a complete radial meniscal tear

IntroductionRadial meniscus tears significantly compromise knee biomechanics due to loss of the circumferential fiber connections and have been shown to be biomechanically equivalent to a total meniscectomy. There is a paucity of data regarding the biomechanical performance of radial meniscal repairs and numerous technical challenges associated with surgical repair. Further, current repair methods have been shown to lead to high rates of incomplete, nonanatomical healing of the meniscus and can potentially cause progressive joint degeneration and osteoarthritis. This is particularly true for the avascular portions of the meniscus. As a result, such injuries have been historically treated with a partial meniscectomy. There has been a growing interest in transtibial repair mechanisms as a potential solution to this challenging pathology. ObjectivesThe purpose of this technical note is to detail a method for repairing a complete radial tear of the medial meniscus using a single-tunnel transtibial technique. MethodsAfter a thorough history and clinical examination, and imaging, the patient was diagnosed with a complex medial meniscal tear with a primary radial tear component. A single tunnel transtibial meniscal repair was indicated and performed. ResultsAn anatomic repair was achieved with tension across the defect. The patient successfully returned to activities. ConclusionsSingle-tunnel transtibial repairs of radial tears in the meniscus may provide increased stability by anchoring the meniscal leaflets to the tibia as well as a potential biological benefit by releasing growth factors and progenitor cells from the bone marrow.

Development of convolutional neural network model for diagnosing meniscus tear using magnetic resonance image

BackgroundDeep learning (DL) is an advanced machine learning approach used in diverse areas, such as image analysis, bioinformatics, and natural language processing. A convolutional neural network (CNN) is a representative DL model that is advantageous for image recognition and classification. In this study, we aimed to develop a CNN to detect meniscal tears and classify tear types using coronal and sagittal magnetic resonance (MR) images of each patient.MethodsWe retrospectively collected 599 cases (medial meniscus tear = 384, lateral meniscus tear = 167, and medial and lateral meniscus tear = 48) of knee MR images from patients with meniscal tears and 449 cases of knee MR images from patients without meniscal tears. To develop the DL model for evaluating the presence of meniscal tears, all the collected knee MR images of 1048 cases were used. To develop the DL model for evaluating the type of meniscal tear, 538 cases with meniscal tears (horizontal tear = 268, complex tear = 147, radial tear = 48, and longitudinal tear = 75) and 449 cases without meniscal tears were used. Additionally, a CNN algorithm was used. To measure the model’s performance, 70% of the included data were randomly assigned to the training set, and the remaining 30% were assigned to the test set.ResultsThe area under the curves (AUCs) of our model were 0.889, 0.817, and 0.924 for medial meniscal tears, lateral meniscal tears, and medial and lateral meniscal tears, respectively. The AUCs of the horizontal, complex, radial, and longitudinal tears were 0.761, 0.850, 0.601, and 0.858, respectively.ConclusionOur study showed that the CNN model has the potential to be used in diagnosing the presence of meniscal tears and differentiating the types of meniscal tears.

Revisiting Kümmell's disease: MRI findings beyond the intraosseous cavity for improved diagnosis.

The diagnostic tool for Kümmell's disease (KD), including the intravertebral vacuum cavity on imaging, is still limited. The purpose of this study was to find other magnetic resonance imaging (MRI) findings that could help the diagnosis of KD. A total of 289 patients (103 males and 186 females with a mean age of 69 ± 15years) with thoracolumbar compression fracture were included. Medical records were reviewed to note symptom duration. MRIs were analyzed for intraosseous cavities (IOC), prevertebral soft-tissue changes (PreSC), posterior wall fracture (PoF), and posterior ligamentous complex tear (PLCT). KD was diagnosed based on surgical findings or clinical report. MRI findings and symptom duration in the presence or absence of KD were compared with chi-squared test, logistic regression, and Student's t-test and area under the curve (AUC) analyses. KDwas diagnosed in 55 cases. IOC was noted in 33 (60%) cases in the KD group and 82 (35%) cases in non-KD group. Definite PreSC was noted in 44 (80%) cases in the KD group and 94 (40%) cases in the non-KD group. PoF was seen in 36 (65%) and 140 (60%) cases, and PLCT was seen in 7 (13%) and 26 (11%) cases in KD and non-KD groups, respectively. The IOC and PreSC MRI findings were significantly correlated with KD(p < 0.001), but not with PoF (p = 0.539) or PLCT (p = 0.814). AUC of combined IOC and PreSC was 0.72, higher than that of IOC alone (0.63) or PreSC alone (0.69) (both p < 0.001). The average duration of symptom was 64days in the KD group and 14days in the non-KD group (p < 0.001). Positive IOC and PreSC findings were associated with longer symptom duration (p < 0.001). Prevertebral soft-tissue changes and intraosseous cavity areassociated with KD. Combinedfindings of prevertebral soft-tissue changes and intraosseous cavity can help the diagnosis of KD.

Medial meniscus extrusion and stage are related to the size of spontaneous osteonecrosis of the knee in patients who underwent high tibial osteotomy

PurposeSpontaneous osteonecrosis of the knee (SONK) causes acute atraumatic knee pain, and meniscus tears may be associated with the pathogenesis of SONK. The purpose of this study was to investigate the relationship of the type of meniscus tear and medial meniscus extrusion with SONK on the medial femoral condyle in patients who underwent surgical treatment with high tibial osteotomy due to severe knee pain. MethodsWe enrolled 98 patients with 102 knees who underwent medial opening wedge high tibial osteotomy (OWHTO) under the diagnosis of medial femoral condyle osteonecrosis at our hospital from December 2003 to January 2020. Based on the Koshino classification, cases of SONK were classified as stage 1–4. The relationships of demographic data, X-rays and MRI images, including femorotibial angle (FTA), meniscus tear type, and medial meniscus extrusion (MME), with the stage and volume of SONK were investigated. ResultsNinety-eight patients (29 males and 69 females), with an average age at surgery of 69.2 ± 9.6 years and Body mass index(BMI) of 61.0 ± 17.6 kg/m2. In 102 cases of SONK, 11 knees, 18 knees, 46 knees, and 27 knees were classified as stage 1–4, respectively. The mean SONK volume was 2161.61 µm (range 95.67–7484.68 µm) on preoperative MRI. The preoperative FTA (mean 180.86°, range 172–187°) was not associated with the stage or volume of SONK. Meniscus tears were found in all cases of SONK and consisted of 2 degenerations, 2 horizontal tears, 0 vertical tears, 40 radial tears, 4 complex tears, and 54 medial meniscus posterior root tears (MMPRTs). In addition, 99% (101/102) of knees showed more than 3 mm of meniscus extrusion. Although the meniscus tear type was not associated with SONK stage, there was a high rate of tears that caused disruption of the hoop strain, such as MMPRTs (52.9%) or radial tears (39.2%). MME was significantly related to SONK volume (r = 0.387, p < 0.001). ConclusionAll patients with SONK had coexisting meniscus tears, most menisci had medial extrusion, and a positive correlation was observed between MME and SONK volume.

AB123. SOH22ABS172. A comparison magnetic resonance imaging (MRI) of and in wrist arthroscopy the diagnosis of Triangular Fibrocartilaginous Complex (TFCC) tears: an Irish perspective

Background: The Triangular Fibrocartilaginous Complex (TFCC) is a load bearing structure that functions as a stabilizer of the ulnar aspect of the wrist and supports the distal radio-ulnar joint (DRUJ). TFCC injuries are common and often occur post trauma. Arthroscopy is the gold standard of diagnosis however many investigate patients with magnetic resonance imaging (MRI) to support a clinical suspicion. Sensitivity for MRI varies widely with recent systematic review reporting MRI sensitivity ranging from 44–93%. TFCC tears associated with distal radius fractures range from 38–78%. Ireland sees approximately 2,475 operatively treated distal radius fractures per year. We can infer that a certain number of these patients have suffered concurrent trauma to their TFCC and as such may present with wrist pain. The aim of this study is to compare MRI and arthroscopy in diagnosing TFCC tears in an Irish patient cohort.

Stabilization of the Distal Radioulnar Joint with or without Triangular Fibrocartilage Complex Tear by an External Wrist Band Brace: A Cadaveric Study.

The purpose of this study was to investigate whether a watch-shaped external wrist band brace improves distal radioulnar joint (DRUJ) stability. Seven fresh cadaveric arms were used. Using a customized testing system, volar and dorsal translation forces were applied to the radius externally while the ulna was fixed. The test was performed with the forearm in neutral, 60° pronated, and 60° supinated positions, once without the brace and once with the brace applied. In each condition, the amount of translation was measured. Then, the triangular fibrocartilage complex (TFCC) was detached from the ulnar styloid process and the fovea ulnaris, and the same tests were performed again. Detachment of the TFCC significantly increased volar and dorsal translations in all forearm rotations compared to the intact condition (p < 0.05), except for the pronated dorsal translation of the radius (p = 0.091). Brace application significantly reduced volar and dorsal translations in all forearm rotations both in intact specimens and in TFCC-detached specimens (p < 0.05), except for pronated volar and dorsal translations in TFCC-detached specimens (p = 0.101 and p = 0.131, respectively). With the brace applied, the TFCC-detached specimens showed no significant difference in volar or dorsal translation in all forearm rotations compared to the intact specimens (p > 0.05). The external wrist band brace improved DRUJ stability in both normal and TFCC-torn wrists and reduced the DRUJ instability caused by TFCC tear to a near-normal level.

Surveying the Use and Perceptions of Wrist Arthroscopy Among Upper Extremity Surgeons.

This study describes current trends in the skill acquisition and practice patterns for wrist arthroscopy among upper extremity surgeons. A survey was sent to the membership of the American Association for Hand Surgery (AAHS). A total of 104 responses were available for analysis. Of those respondents who did not use wrist arthroscopy, lack of educational training was cited as the most common reason. Of those who did use arthroscopy, fellowship training was credited as the primary source. However, most of those who completed an instructional course felt immediately able to perform arthroscopy. Triangular fibrocartilage complex tears were recorded as the most common indication. Surgeons frequently evaluated the midcarpal joint, but did not frequently use arthroscopy for distal radio-ulnar joint or carpometacarpal joint pathology. Ultimately, this highlights an area of improvement for residency and fellowship education. [Orthopedics. 2022;45(5):310-313.].

Les déchirures radiales du tiers antérieur du ménisque latéral sont fréquemment associées à des déchirures horizontales

IntroductionRadial tears of the lateral meniscus are often located in the junction of the middle and posterior third or posterior tibial attachment. However, we observed that a few cases of radial tears occurred in the anterior third of the lateral meniscus, and in many cases, they were accompanied by horizontal tears. HypothesisRadial tears are more frequently accompanied by horizontal tears in the anterior third of the lateral meniscus than in other regions. Material and methodsFrom July 2006 to May 2019, patients who underwent arthroscopic surgery for radial tears of the lateral meniscus were included. Patients with radial tears in the anterior third of the lateral meniscus were classified into the anterior group and those with radial tears in the middle and posterior third were classified into the comparison group. Magnetic resonance imaging and arthroscopic findings were reviewed to evaluate whether radial tears were accompanied by other types of tears, especially horizontal tears. The incidence of complex tears between the two groups was compared. ResultsEighty knees in 79 patients were included. The mean age at the time of surgery was 44.1±16.9 years. The anterior group included 30 knees, and 19 (63.3%) of those also had horizontal tears. In the anterior group, all complex tears were accompanied by horizontal tears, and no other types of accompanying tears were observed. The comparison group included 50 knees, and 16 (32%) of those also had other types of tears. Of the 16 complex tears, 14 had horizontal tears and 2 had longitudinal tears. The incidence of complex tear was significantly higher in the anterior group than in the comparison group (p<0.001). ConclusionRadial tears occurring at the anterior third of the lateral meniscus are frequently accompanied by a horizontal tear. It is important to be aware and predict the occurrence of such characteristic tears and to do proper surgical procedures. Level of proofIV; Cross-sectional study.

Radial Sided Triangular Fibrocartilage Complex Tears: A Comprehensive Review.

When evaluating the available literature on the diagnosis and management of triangular fibrocartilage complex tears (TFCC), ulnar tears comprise the major focus of TFCC literature. Radial-sided (Class 1D) tears are seldom researched or discussed. The purpose of this study was to review the methods for identifying and treating radial-sided TFCC lesions, by examining the anatomy of the TFCC, the pathology of its radial portion, diagnostic techniques, and both surgical and nonoperative treatments. The avascular nature of the radial TFCC may influence its healing potential. Magnetic resonance arthrogram is the gold standard for non-invasively diagnosing a radial-sided tear. Non-operative management should be exhausted prior to surgical intervention, which commonly involves an inside-out repair involving radial trans-osseous sutures. Still, the literature is limited by patient sample size and therefore requires a greater population of class 1-D tears to confirm optimal diagnostic and treatment methods.

Open Foveal Repair of the Triangular Fibrocartilage Complex Tears Associated with Symptomatic Ulnar Styloid Non-union.

Background: Symptomatic ulnar styloid non-union can be treated by excision of the ulnar styloid fragment. For combined triangular fibrocartilage complex (TFCC) tears, several repair techniques such as arthroscopic repair, open repair to the fracture site or reconstruction using a tendon graft have been introduced. This study reports the technique and outcomes of open foveal repair of the TFCC with excision of the ulnar styloid fragment in patients with symptomatic ulnar styloid non-union and distal radioulnar joint (DRUJ) instability. Methods: Consecutive patients with symptomatic ulnar styloid non-union with TFCC tears and DRUJ instability who underwent excision of the ulnar styloid fragment and open foveal repair of the TFCC were retrospectively reviewed. After excising the ulnar styloid fragment, a capsular window was created between the triquetrum and TFCC, followed by attaching the TFCC to the fovea using three sutures through a bone tunnel from the ulnar cortex to the fovea. Additional ulnar shortening osteotomies were performed in patients with positive ulnar variance and ulnar impaction test. The outcomes were evaluated in terms of DRUJ stability and the Quick Disabilities of the Arm, Shoulder and Hand (DASH) scores. Results: In total, 21 patients with a mean age of 40 were enrolled in the study. All patients demonstrated DRUJ stability at a mean follow-up duration of 14 months. The mean Quick DASH score significantly improved from 18.9 ± 11.7 to 2.5 ± 4.1 (p < 0.05). Eleven patients underwent combined ulnar shortening osteotomies, and no difference in the Quick DASH score was found between patients who underwent ulnar shortening osteotomy and those who did not. Conclusions: This study demonstrates that open foveal repair of the TFCC with ulnar styloid fragment excision is an effective strategy to surgically treat patients with symptomatic ulnar styloid non-union with TFCC tear and DRUJ instability. Level of Evidence: Level III (Therapeutic).

Arthroscopic-Assisted Foveal Reattachment of Triangular Fibrocartilage Complex Tears With Distal Radioulnar Joint Instability: A Comparison of Suture Anchors and Transosseous Sutures

To compare the clinical outcomes of arthroscopically-assisted suture anchor repair and transosseous sutures for repair of foveal triangular fibrocartilage complex tears in patients with distal radioulnar joint (DRUJ) instability. Sixty patients with triangular fibrocartilage complex foveal detachment associated with DRUJ instability were prospectively recruited and randomized into 2 equal groups-the anchor repair group and the transosseous repair group. The primary outcome was DRUJ function after 2 years, which was assessed by the DRUJ evaluating system. The secondary outcomes were grip strength, visual analog scale for pain, Mayo Modified Wrist ScorePatient-Rated Wrist Evaluation score, and the Disabilities of the Arm, Shoulder, and Hand score. There were no significant differences between the groups for any of the outcome measures. Good-to-excellent outcomes (according to the DRUJ evaluation system) were achieved in 27 (90%) patients in the anchor repair group and 26 (86.7%) patients in the transosseous repair group. Fewer complications were observed in the anchor repair group. Both techniques yielded good and comparable outcomes with a lesser incidence of early complications in the anchor repair group. Therapeutic II.

Retraction Note to: Prognostic factors for the outcome of arthroscopic capsular repair of peripheral triangular fibrocartilage complex tears.

Retraction Note to: Prognostic factors for the outcome of arthroscopic capsular repair of peripheral triangular fibrocartilage complex tears.

Retraction Note to: Prevalence and clinical characteristics of radiographic central triangular fibrocartilage complex tears in symptomatic and asymptomatic individuals younger than 50years.

Retraction Note to: Prevalence and clinical characteristics of radiographic central triangular fibrocartilage complex tears in symptomatic and asymptomatic individuals younger than 50years.

Radial tears in the anterior third of the lateral meniscus are frequently combined with horizontal tears

IntroductionRadial tears of the lateral meniscus are often located in the junction of the middle and posterior third or posterior tibial attachment. However, we observed that a few cases of radial tears occurred in the anterior third of the lateral meniscus, and in many cases, they were accompanied by horizontal tears. HypothesisRadial tears are more frequently accompanied by horizontal tears in the anterior third of the lateral meniscus than in other regions. Material and methodsFrom July 2006 to May 2019, patients who underwent arthroscopic surgery for radial tears of the lateral meniscus were included. Patients with radial tears in the anterior third of the lateral meniscus were classified into the anterior group and those with radial tears in the middle and posterior third were classified into the comparison group. Magnetic resonance imaging and arthroscopic findings were reviewed to evaluate whether radial tears were accompanied by other types of tears, especially horizontal tears. The incidence of complex tears between the two groups was compared. ResultsEighty knees in 79 patients were included. The mean age at the time of surgery was 44.1±16.9 years. The anterior group included 30 knees, and 19 (63.3%) of those also had horizontal tears. In the anterior group, all complex tears were accompanied by horizontal tears, and no other types of accompanying tears were observed. The comparison group included 50 knees, and 16 (32%) of those also had other types of tears. Of the 16 complex tears, 14 had horizontal tears and 2 had longitudinal tears. The incidence of complex tear was significantly higher in the anterior group than in the comparison group (p<.001). ConclusionRadial tears occurring at the anterior third of the lateral meniscus are frequently accompanied by a horizontal tear. It is important to be aware and predict the occurrence of such characteristic tears and to do proper surgical procedures. Level of proofIV; Cross-sectional study.

Distal Radioulnar Joint Instability: Diagnosis and Treatment.

Distal radioulnar joint (DRUJ) instability and triangular fibrocartilage complex (TFCC) tears are more usual than estimated and are frequently overlooked. Diagnosis is often clinical, which can be confirmed using computed tomography (CT) scan and magnetic resonance imaging (MRI). In doubtful cases, bilateral computed tomography in neutral forearm rotation, supination, and pronation should also be performed. Wrist arthroscopy can be diagnostic and therapeutic for ulnar-sided wrist pain. Two systematic reviews showed equivalent outcomes between open and arthroscopic repair of the TFCC. There is scant proof to advise one technique over the other in clinical practice. TFCC repair and reconstruction are contraindicated when there is a bony deformation of the radius or ulna or osteoarthritis of the DRUJ. With the advancement of implant arthroplasty, salvage procedures are less desirable. Constrained distal radioulnar arthroplasty is stable, and the longevity is encouraging.

Travel Distance Does Not Affect Outcomes After Arthroscopic Rotator Cuff Repair

PurposeTo determine the effect of travel distance on achieving the minimal clinically important difference (MCID) on patient-reported outcome measures (PROMs) at least 1 year after arthroscopic rotator cuff repair (RCR).MethodsPatients undergoing primary arthroscopic RCR with a minimum 1-year follow-up at a high-volume tertiary referral center between May 2017 and June 2019 were retrospectively reviewed. Patients were divided into two groups: driving distance of >50 miles from the institution (referral group) and <50 miles (local group). American Shoulder and Elbow Score (ASES), Single Assessment Numeric Evaluation (SANE) score and Constant score at minimum 1-year follow-up were assessed. Chi-square analysis was used to analyze achievement of MCID on any PROM. Subgroup analysis by tear complexity (1 tendon vs. >2 tendons torn) was conducted. Logistic regression was performed to determine whether travel distance and other variables of interest had an effect on achieving MCID.ResultsOf 996 patients reviewed, 385 patients (38.7%) had minimum 1-year follow-up. Of these, 62 (16%) traveled >50 miles to their orthopedic provider, and 212 (55%) had a complex tear. MCID for at least one PROM was reached by 305 (94%) patients in the local group and 56 (90%) patients in the referral group. There was no significant difference between groups in reaching MCID for any PROM. Subgroup analysis by tear complexity revealed no significant difference in preoperative PROMs or achieving MCID postoperatively between referral groups. There was no significant difference between groups when controlling for age, sex, adjusted gross income (AGI), primary health insurance, tear chronicity, and tear complexity.ConclusionsWhen controlling for age, sex, AGI, primary health insurance, tear chronicity, and tear complexity, distance to a high-volume shoulder arthroscopy surgery center did not have an effect on achieving the MCID for any PROM at least 1 year after arthroscopic RCR.Level of EvidenceLevel III, retrospective cohort study.

Functional Outcomes Are Similar After Arthroscopic Capsular Repair of Triangular Fibrocartilage Complex Tears Between Outside-In Technique and All-Inside Technique Using Pre-Tied Suture Device

To compare outcomes of arthroscopic triangular fibrocartilage complex capsular repair at 2-year follow-up between outside-in and all-inside techniques. In total, 58 consecutive patients (wrists) with a Palmer 1B triangular fibrocartilage complex tear without symptomatic distal radioulnar joint instability underwent arthroscopic suture repair from 2011 to 2019 including 31 patients via the outside-in technique (group A) and 27 via the all-inside technique using a pre-tied needle device (group B). Two-year follow-up included visual analog scale (VAS) pain score, motion range, grip strength, Mayo Modified Wrist Score (MMWS), the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, and complication rate. Correlation between functional result and patient satisfaction was analyzed. Score changes in VAS, wrist flexion-tension, supination-pronation, grip strength, MMWS, and QuickDASH at 2-year follow-up were not significantly different between group A (3.4 ± 0.8, 18.4 ± 17.5, 12.9 ± 13.3, 30.7 ± 11.2, 26.6 ± 7.9 and 19.4 ± 9.9 and group B (3.4 ± 1.0, 18.5 ± 18.3, 15.6 ± 13.7, 30.8 ± 11.4, 28.1 ± 8.6, and 7.6 ± 7.2) with P values of .400, .489, .223, .486, .240, and .223 respectively. Surgical time averaged 105 minutes (78 to 136) in group A and 94 minutes (61-126) in group B with significant difference (P= .012). Patient satisfaction averaged 1.1 (0-3.5) in group A and 1.0 (range 0-3.0) in group B. Satisfaction score was more strongly correlated with QuickDASH (coefficients: 0.863 in group A and 0.918 in group B) than with MMWS (-0.693 in group A and -0.465), grip strength (-0.619 in group A and -0.417 in group B) and VAS score (0.607 in group A and 0.222 in group B). Both techniques achieved comparable outcomes with shorter surgical time in all-inside repair using pre-tied needle device. Patient satisfaction was strongly correlated with QuickDASH score. Level III, retrospective therapeutic comparative investigation.

Extent of Preoperative Medial Meniscal Extrusion Influences Intermediate-Term Outcomes After Medial Opening-Wedge High Tibial Osteotomy.

The purpose of the present study was to determine the relationship between preoperative medial meniscal extrusion, as classified according to magnetic resonance imaging (MRI), and medial opening-wedge high tibial osteotomy outcomes at intermediate-term follow-up. We reviewed the records for 212 patients who had undergone medial opening-wedge high tibial osteotomy for the treatment of medial compartment osteoarthritis between January 2009 and September 2014, with a minimum duration of follow-up of 5 years. Patients were divided into 2 groups according to the presence of pathologic medial meniscal extrusion (>3 mm). Moreover, patients were divided into 4 groups according to MRI Osteoarthritis Knee Score (MOAKS) criteria and relative medial meniscal extrusion values. Associations between the extent of preoperative medial meniscal extrusion and clinical outcomes over a mean duration of follow-up of 8.1 years were evaluated with use of Spearman rank correlation analysis. Regression analyses were performed to determine preoperative characteristics relevant to medial meniscal extrusion. Clinical outcomes were assessed with use of the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Tegner activity scale score. Postoperative KOOS pain scores were significantly different in the pathologic and non-pathologic medial meniscal extrusion groups (69.9 ± 18.0 versus 79.2 ± 11.4, respectively; p < 0.001). Additionally, the degree of preoperative medial meniscal extrusion based on both classification methods and the postoperative KOOS pain score were significantly correlated (r = -0.404 and -0.364; p < 0.001). Despite the inferior clinical outcomes associated with greater preoperative medial meniscal extrusion, medial opening-wedge high tibial osteotomy was associated with significant improvement in all outcome measures between the preoperative and latest follow-up assessments (p < 0.001). Preoperative meniscal patterns, including horizontal flap, complex, and root tears (p = 0.001), and increased Kellgren-Lawrence grade (p < 0.001) were related to the severity of medial meniscal extrusion. The survival rate was 94.8% at a mean of 8.1 years, and survival was not associated with the grade of medial meniscal extrusion as assessed with either classification scheme. At intermediate-term follow-up, greater preoperative medial meniscal extrusion was related to inferior postoperative clinical outcomes, specifically pain, after medial opening-wedge high tibial osteotomy. Despite the inferior results associated with preoperative medial meniscal extrusion, medial opening-wedge high tibial osteotomy was associated with a satisfactory survival rate after a mean of 8.1 years, regardless of the extent of medial meniscal extrusion. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.