Degenerative Tears Research Articles

Arthroscopic meniscectomy versus non-surgical or sham treatment in patients with MRI confirmed degenerative meniscus lesions: a protocol for an individual participant data meta-analysis

IntroductionArthroscopic partial meniscectomy (APM) after degenerative meniscus tears is one of the most frequently performed surgeries in orthopaedics. Although several randomised controlled trials (RCTs) have been published that showed no...

Progression of radiographic osteoarthritis after partial meniscectomy in degenerative medial meniscal posterior root tears was greater in varus- than in neutral-aligned knees: a minimum 5-year follow-up

To perform a radiographic assessment of osteoarthritis, progression after partial meniscectomy (PM) in degenerative medial meniscus posterior root tears (MMPRTs) in relation to preoperative mechanical axis (MA). The hypothesis is that neutral-aligned knees with degenerative MMPRTs have better radiographic outcomes than those of varus-aligned knees after arthroscopic PM. Records of 114 patients with degenerative MMPRTs and Kellgren-Lawrence (KL) grade ≤ 2 osteoarthritis, who underwent PM, had preoperative weight-bearing hip-to-ankle radiographs from 2004 to 2014, and were followed-up for at least 5 years were reviewed retrospectively. The mean follow-up period was 8.3 ± 2.8years. Preoperative MA values were used to classify the patients into either a Neutral (N valgus 3° to varus 3°; n = 60) or Varus-aligned group (V varus > 3°; n = 54). Joint space width (JSW; mm) and KL grade (0/1/2/3/4) were measured preoperatively and finally on weight-bearing 45° flexion posteroanterior and anteroposterior radiographs, respectively. Preoperative JSW and KL grade did not differ significantly between the groups (N vs V; JSW 3.64 ± 0.83 vs 3.44 ± 0.81, P = 0.201; KL grade, 2/31/27/0/0 vs 0/22/32/0/0, P = 0.162); however, the final JSW and KL grade differed significantly between the groups (N vs V; JSW 3.03 ± 0.78 vs 2.07 ± 0.87; KL grade, 0/21/23/13/3 vs 0/10/26/21/6, both P < 0.001). The N group showed significantly less KL progression compared with the V group (N vs V; progression/no progression, 27/33 vs 42/12, P = 0.001). The progression of radiographic osteoarthritis after PM for degenerative MMPRTs was greater in varus-aligned knees than in neutral-aligned knees. PM should be considered cautiously in patients with varus-aligned knees. Retrospective comparative study, Level III.

Radiological and clinical evaluation of synthetic reinforcement in arthroscopic repair of complete degenerative rotator cuff tears

Background:Rotator cuff tear is the most common shoulder pathology in adults over 45 years of age. In most instances they are chronic and degenerative. The high rate of re- tears after primary repair has led to the use of reinforcement systems such as patches. The objective of this study was to evaluate the effectiveness of a synthetic poly-4-hydroxybutyrate (P4HB) reinforcement patch in arthroscopic repair of degenerative rotator cuff tears.Methods:sixty patients with degenerative, reducible, full thickness supraspinatus tear were repaired with an arthroscopic single-row technique with or without the BioFiber® reinforcement system (Wright medical). A clinical evaluation with measurement of active range of motion, calculation of Constant and Subjective Shoulder Value (SSV) scores and ultrasound evaluation of healing were performed one year postoperatively.Results:Thirty patients were treated with a patch and thirty others formed the control group without a patch. The postoperative adjusted Constant score was 102 % in the patch group (PG) and 101 % in the control group (CG) (P = 0.6670). The postoperative SSV score was 81% in the PG and 88% in the CG (P = 0.029). The ultrasound healing rate was better in the PG and there was no re-tear in this group (P = 0.049).Conclusion:The interposition of the P4HB BioFiber® patch does not seem to provide any added functional value despite the effectiveness in terms of healing in the repair of degenerative, reducible complete tear of the supraspinatus tendon.

Arthroscopic Repair of a "U" Shaped Rotator Cuff Tear: Modified Margin Convergence with a Single Triple-loaded Suture Anchor.

IntroductionRepair of a “U” shaped rotator cuff tear tends to create extreme tensile forces at the central part of the rotator cuff margin, causing tensile overload and may result in subsequent failure. We describe our technique of repairing the “U” shaped tear in which margin convergence is done using Ethibond (Ethicon Inc., New Jersey) and a single triple-loaded suture anchor. It results in the reduction of the strain and also allows the repair of seemingly irreparable tears.Patients and methodWe included 10 patients having a “U” shaped degenerative rotator cuff tear. All patients were assessed preoperatively. The University of California at Los Angeles Shoulder score (UCLA shoulder score) recorded preoperatively and at final follow-up was used to assess functional outcome.ResultOut of 10 patients, six were males and four were females. The mean age was 60 years (range 50-70 years). The average follow-up was for 31 months (range 24 - 48 months). The UCLA score increased from an average of 9 preoperatively (range 8 - 12) to an average of 29.6 (range 27 - 31) at the terminal follow-up. The UCLA increased in the postoperative period and was statistically significant (unpaired t-test; p < 0.0001). All patients had good/excellent outcomes (UCLA score > 27). Abduction increased from average 27 degree preoperatively (range 20 degree - 35 degree) to an average 131 degree (range 125 degree - 140 degree) at final follow-up (unpaired t-test; p < 0.0001).ConclusionOur technique of modified margin convergence achieves low tension repair and anatomical footprint reconstruction with good clinical outcomes using a single triple-loaded anchor.

Statistical analysis plan for the 5-year and 10-year follow-up assessments of the FIDELITY trial

BackgroundThe research objectives of the 5-year and 10-year assessments in the Finnish degenerative meniscal lesion study (FIDELITY) are twofold: (1) to assess the long-term efficacy of arthroscopic partial meniscectomy (APM) in adults (age 35 to 65 years) with a degenerative meniscus tear and (2) to determine the respective effects of APM and degenerative meniscus tear on the development of radiographic and clinical knee osteoarthritis (OA).Methods and designFIDELITY is an ongoing multi-center, randomized, participant and outcome assessor blinded, placebo-surgery-controlled trial in 146 patients. This statistical analysis plan (SAP) article describes the overall principles for analysis of long-term outcomes (5-year and 10-year follow up), including how participants will be included in each analysis, the primary and secondary outcomes and their respective analyses, adjustments for covariates, and the presentation of the results. In addition, we will present the planned sensitivity and subgroup analyses.DiscussionTo assess the long-term efficacy of APM on knee symptoms and function we are carrying out a long-term (5-year and 10-year) follow up of our placebo-surgery-controlled FIDELITY trial according to statistical principles outlined in detail in this document. As our second primary objective, whether APM (resection of torn meniscus tear) accelerates or delays the development of knee osteoarthritis in patients with an arthroscopically verified degenerative tear of the medial meniscus, a pre-registered follow-up is also carried out.Trial registrationClinicalTrials.gov, NCT00549172 (Arthroscopy in the Treatment of Degenerative Medial Meniscus Tear). Registered on 25 October 2007 (NCT00549172). ClinicalTrials.gov, NCT01052233 (Development of Knee Osteoarthritis After Arthroscopic Partial Resection of Degenerative Meniscus Tear). Registered on 20 January 2010.

Surgery and physiotherapy were both successful in the treatment of small, acute, traumatic rotator cuff tears: a prospective randomized trial

Previous randomized trials on cuff repair have included mainly degenerative tears, but studies on acute traumatic tears are lacking. We aimed to compare early surgical repair with nonoperative treatment for traumatic supraspinatus tears. We did a 2-center randomizedcontrolled trial of patients with small rotator cuff tears mainly involving supraspinatus, comparing surgical repair (n = 32) and physiotherapy (n = 26). The primary outcome was a group difference in the Constant-Murleyscore at 12-monthfollow-up. Secondary outcomes were differences in the Western Ontario Rotator Cuff index, pain (Numerical Rating Scale 0-10), and Euro quality-of-life-visual analog scale. We used magnetic resonance imaging to assess retear rate, tear progression, fatty infiltration, and atrophy. The mean age was 59.7 years (range, 44-77 years), median sagittal tear size was 9.7 mm (range, 4-21 mm), and baseline characteristics were well balanced between the 2 groups. The repair group had a median Constant-Murley of 83 (25 quartile range[QR]) and the physiotherapy group 78 (QR, 22) at 12 months, with the between-group difference in medians of 4.5 (-5 to 9, 95% confidence interval; P = .68). The corresponding values for the Western Ontario Rotator Cuff index were 91% (QR, 24) vs. 86% (QR, 24), with the between-group difference of 5.0 (-4 to 9, 95% confidence interval; P = .62). There was no difference in Numerical Rating Scale or in Euro quality-of-life-visual analog scale. Retear was found in 6.5% of repaired patients and tear progression >5 mm in 29.2% of unrepaired patients. We found no significant differences in clinical outcomes between cuff repair and nonoperative treatment at 12-monthfollow-up. Approximately one third of unrepaired patients had a tear enlargement of more than 5 mm.

Degenerative rotator cuff tear, repair or not repair? A review of current evidence.

We review the literature and highlight the important factors to consider when counselling patients with non-traumatic rotator cuff tears on which route to take. Factors include the clinical outcomes of surgical and non-surgical routes, tendon healing rates with surgery (radiological outcome) and natural history of the tears if treated non-operatively. A PRISMA-compliant search was carried out, including the online databases PubMed and Embase™ from 1960 to the end of June 2018. A total of 49 of the 743 (579 PubMed and 164 Embase™) results yielded by the preliminary search were included in the review. There is no doubt that the non-surgical route with an appropriate physiotherapy programme has a role in the management of degenerative rotator cuff tears. This is especially the case in patients with significant risk factors for surgery, those who do not wish to go through a surgical treatment and those with small, partial and irreparable tears. However, rotator cuff repair has a good clinical outcome with significant improvements in pain, range of motion, strength, quality of life and sleep patterns.

Risk Factors for Early Total Knee Replacement after Ipsilateral Knee Arthroscopy in Patients over 55 Years of Age

Arthroscopic knee surgery (AKS) is often not successful in elderly patients with osteoarthritis and degenerative meniscus tears. Many patients require subsequent total knee replacement (TKR). We performed a case-control study to identify risk factors for early TKR following AKS in patients over 55. Data were collected on patients in an integrated healthcare system who underwent AKS between January 2010 and December 2012, and then had ipsilateral total knee replacement (TKR) within one year. Controls were matched from patients who did not have TKR within one year. Of the 7,301 AKS patients, 453 (6.2%) went on to TKR. We matched 390 cases with controls (780 total subjects); 186 subjects were excluded due to inadequate radiographs or medical records resulting in a cohort of 594 patients. Statistical analysis showed that a Kellgren-Lawrence score of 3 or 4 (OR 1.9 CI 1.3-2.8, p &lt; 0.01), age greater than 65 (OR 2.2, CI 1.5-3.2, p &lt; 0.01), contralateral TKR (OR 2.3, CI 1.1-5.0, p &lt; 0.04) were associated with a higher likelihood of early TKR. Sex, race, diagnosis of diabetes, prior ipsilateral knee surgery, and prior contralateral knee surgery were not associated with early TKR. When considering AKS for older patients with degenerative arthritis and meniscus tears, care providers should consider the risk of early TKR. Older patients with advanced arthritis and a diagnosis of osteoarthritis, or combined with a meniscus tear, are especially at risk for early TKR.

The effect of previous arthroscopic surgery on total knee arthroplasty outcomes and complication rates

Aim: This study aimed to evaluate the effect of previous arthroscopic surgery on total knee arthroplasty outcomes and complication rates.Material and Methods: This retrospective study included patients who underwent total knee arthroplasty due to grade 4 osteoarthritis, according to the Kellgren-Lawrance classification system in a tertiary hospital, between January 2012 and December 2016. The patients were divided into two groups according to whether or not they had undergone previous knee arthroscopy. The arthroscopic procedure included degenerative meniscus tear subtotal excision and synovectomy. The data of the two groups were compared. Outcome measures were the visual analog scale, McMaster Universities Osteoarthritis Index, Knee Society scoring system and knee range of motion.Results: The previous arthroscopy-free group comprised 94 patients (35 males, 59 females), and the previous undergoing arthroscopy group included 73 patients (23 males, 50 females). The mean age of previous arthroscopy-free group was 63.12 ± 2.8 years (range, 57 to 68), and the mean age of previous undergoing arthroscopy group was 62.42 ± 3.9 years (range, 55 to 73). The groups were similar in terms of age, gender, body mass index, follow-up periods, sides, and complications (p > 0.05 for all). In assessments at the end of 4 years, the groups were similar in respect of visual analog scale, McMaster Universities Osteoarthritis Index, Knee Society scoring system and knee range of motion. Conclusions: The results of this study showed that clinical outcomes and complications were similar in patients with primary total knee arthroplasty and no previous procedure and those who had previously undergone knee arthroscopy. In the light of these preliminary results, previous knee arthroscopy has no negative effect on the outcomes of total knee arthroplasty and complication rates.

The acromion-greater tuberosity impingement index: A new radiographic measurement and its association with rotator cuff pathology.

Several radiographic parameters describe humeral head coverage by the acromion. We describe a new radiographic measurement, the acromion-greater tuberosity impingement index (ATI), and its ability to predict rotator cuff pathology. The ATI was measured with magnetic resonance imaging (MRI) and X-ray analysis in 83 patients with rotator cuff pathology and 76 patients with acute rotator cuff tears. The lateral acromial angle (LAA), acromion type, the acromion index (AI) and the critical shoulder angle (CSA) were measured to assess their correlations with the ATI. Receiver operating characteristic (ROC) curves were used to predict degenerative rotator cuff pathology. The change in the ATI after acromion surgery was evaluated in both groups. According to the ROC curves, the ATI is a good predictor of degenerative rotator cuff pathology on both X-ray (cut-off, 0.865) and MRI (cut-off, 0.965). Patients with degenerative rotator cuff pathology had a significantly higher average ATI compared to the trauma group (p = 0.001 for X-ray and MRI). The degenerative group had a significantly lower LAA (p = 0.001) and a higher ratio of type III acromion (p = 0.035) than the trauma group. The ATI on X-ray was negatively related to the LAA and positively related to the AI, the CSA and acromion type (each p < 0.05). The ATI on MRI was negatively related to the LAA and positively related to the AI and acromion type (each p <0.05). More patients in the degenerative group than the trauma group needed acromioplasty or acromion decompression (p < 0.05). The ATI on MRI was significantly lower after acromion surgery compared to before surgery in both groups (p < 0.05). The ATI is a good predictor of degenerative supraspinatus tendon tears or subacromial impingement syndrome. The ATI on MRI is more accurate and can precisely guide acromion surgery.

Non-inferiority and cost-effectiveness trial of isolated biceps tenotomy versus tenotomy with rotator cuff repair in patients with stage 2–3 Goutallier fatty degenerative cuff lesions (TenCuRe study): protocol of a multicentre randomised controlled trial

IntroductionFor patients who are diagnosed with lesions of the rotator cuff that present advanced levels of fatty degeneration, arthroscopic repair of the rotator cuff remains controversial. This controversy can be...

Possibility of Meniscal Repair for Degenerative and Horizontal Tears

Background:Poor long-term clinical results have been reported following partial and total menisectomy. To preserve the meniscus, many surgeons perform meniscal repairs when possible. However, meniscal repair for degenerative tears and white-white tears is challenging.Methods:15 patients underwent meniscal repair for degenerative and horizontal tears. Follow-up evaluation included clinical assessment and Magnetic Resonance Imaging examination. The mean follow-up time was 11.9 months (from 8 months to 13 months).Result:The healing rate on clinical assessment was 86.6% 12 months after surgery. MRI showed partial healing in 12 patients, complete healing in 1 and no healing in 2 after 12 months.Conclusion:The findings suggest that it may be possible to repair degenerative and horizontal meniscal tears.

Degenerative Meniscus Lesions: An Expert Consensus Statement Using the Modified Delphi Technique

The purpose of this study was to perform an evidence-based, expert consensus survey using the Delphi panel methodology to develop recommendations for the treatment of degenerative meniscus tears. Twenty panel members were asked to respond to 10 open-ended questions in rounds 1 and 2. The results of the first 2 rounds served to develop a Likert-style questionnaire for round 3. In round 4, the panel members outside consensus were contacted and asked to either change their score in view of the group's response or argue their case. The level of agreement for round 4 was defined as 80%. There was 100% agreement on the following items: insidious onset, physiological part of aging, tears often multiplanar, not all tears cause symptoms, outcomes depend on degree of osteoarthritis, obesity is a predictor of poor outcome, and younger patients (<50years) have better outcomes. There was between 90% and 100% agreement on the following items: tears are nontraumatic, radiographs should be weightbearing, initial treatment should be conservative, platelet-rich plasma is not a good option, repairable and peripheral tears should be repaired, microfracture is not a good option for chondral defects, the majority of patients obtain significant improvement and decrease in pain with surgery but results are variable, short-term symptoms have better outcomes, and malalignment and root tears have poor outcomes. This consensus statement agreed that degenerative meniscus tears are a normal part of aging. Not all tears cause symptoms and, when symptomatic, they should initially be treated nonoperatively. Repairable tears should be repaired. The outcome of arthroscopic partial meniscectomy depends on the degree of osteoarthritis, the character of the meniscus lesion, the degree of loss of joint space, the amount of malalignment, and obesity. The majority of patients had significant improvement, but younger patients and patients with short-term symptoms have better outcomes. Level V - expert opinion.

Surgery for rotator cuff tears

Surgery for rotator cuff tears

Epidemiology, Injury Patterns, and Treatment of Meniscal Tears in Pediatric Patients: A 16-Year Experience of a Single Center.

Background:Meniscal injuries in children continue to increase, which may be attributable to increasing levels of athletic participation and may be associated with additional injuries or need for additional surgeries.Purpose:To better understand the patterns of pediatric meniscal injuries by analyzing tear location, morphologic features, and associated injury patterns over a 16-year period.Study Design:Case series; Level of evidence, 4.Methods:Pediatric patients were identified and were included in the study if age at the time of initial surgery for meniscal tear was between 5 and 14 years for female patients and 5 and 16 years for male patients. Patients were observed until age 18, and any subsequent surgeries were noted. Demographic factors, tear type and location, associated injuries, and treatment type were analyzed.Results:Mean patient age at surgery was 13.3 years, and 37% of patients were female. A total of 1040 arthroscopic meniscal surgeries in 880 pediatric patients were evaluated. There were 160 reoperations in 138 patients, representing a reoperation rate of 15%. These included 98 reoperations on the ipsilateral knee in 88 patients and 62 operations for injuries to the contralateral knee in 50 patients; 53% of surgeries were meniscal repair, as opposed to partial meniscectomy, and the most common technique was an all-inside repair (91%). Significant differences were identified between male and female patients. Male patients were more likely to have lateral meniscus (74% vs 65%), posterior horn (71% vs 60%), peripheral (45% vs 30%), and vertical tears (31% vs 21%); concomitant ACL injury (50% vs 40%); and an associated osteochondritis dissecans lesion (7% vs 4%). Female patients were more likely to have medial meniscus (24% vs 17%), anterior horn (25% vs 15%), and degenerative tears (34% vs 26%); discoid meniscus (33% vs 24%); and isolated meniscal tears (47% vs 33%).Conclusion:This evaluation of a large series of patients has helped characterize injury patterns associated with pediatric meniscal surgeries. Most meniscal tears were repaired (53%) and were associated with additional injuries (62%), especially anterior cruciate ligament injuries (48%). More than 25% of patients had a discoid meniscus. Injury patterns differed significantly between male and female patients.

Is Bony Morphology and Morphometry Associated With Degenerative Full-Thickness Rotator Cuff Tears? A Systematic Review and Meta-analysis

To scope the scientific literature and analyze the influence of bony risk factors for degenerative full-thickness primary rotator cuff tear. A systematic review of databases PubMed, Scopus, EMBASE, and Cochrane Library was performed up to June 30, 2018. Meta-analysis was performed with mean difference (MD) or risk ratio for degenerative full-thickness rotator cuff injury, and when there were ≥3 studies for the considered potential risk factor. Methodologic quality was assessed using the Newcastle-Ottawa scale. We analyzed 34 studies comprising 5,916 shoulders (3,369 shoulders with rotator cuff tear and 2,546 controls) and identified 19 potential risk factors for degenerative full-thickness rotator cuff tears. There was moderate evidence that a higher critical shoulder angle (MD= 4.41, 95% confidence interval [CI] 3.43 to 5.39), higher acromion index (MD= 0.06, 95% CI 0.04 to 0.09), and lower lateral acromion angles (MD=-7.11, 95% CI-8.32 to-5.90) were associated with degenerative full-thickness rotator cuff tears compared with controls. Moderate evidence showed that a type III acromion significantly increases the risk for full-thickness degenerative rotator cuff tear (risk ratio= 2.26, 95% CI 1.38 to 3.70). There is moderate evidence that larger critical shoulder angle, higher acromion index, lower lateral acromion angles, and a type III acromion are significantly associated with degenerative full-thickness rotator cuff tears. Other potential risk factors identified showed insufficient evidence. Level IV, systematic review of level II to IV studies.

Viewing perspective malrotation influences angular measurements on lateral radiographs of the scapula

Accurate and reliable assessment of acromial tilt (ATA) and slope (ASA) angles have been important in the clinical evaluation of degenerative and traumatic rotator cuff tears. This study analyzed the influence of radiographic viewing perspective on the ATA and ASA and developed criteria to identify true lateral (TL) view radiographs. Three-dimensional computed tomographic (CT) reconstructions of 52 scapulae without rotator cuff tears or osteoarthritis were studied. Digitally reconstructed radiographs (DRRs) were aligned to obtain a TL view. In 10 random scapulae, incremental ante- and retroversion and up- and downward rotation views were generated (10° increments, ±30°), and ATA and ASA were measured by 2 observers. Clinically applicable criteria were developed and validated to identify TL views. The mean ATA and ASA on TL views were 33°±4° (range 23°-42°) and 22°±7° (8°-43°), respectively. Mixed effect models showed that DRRs malpositioned in 20° and 30° anteversion and downward rotation decreased the ATA (P ≤ .030). DRRs malpositioned in anteversion and >10° of up- and downward rotation demonstrated a significantly decreased ASA (P ≤ .047). Intra- and interobserver reliability was excellent for TL views (intraclass correlation coefficient ≥ 0.95) but decreased with increasing viewing angle. Anatomic landmark criteria were capable of identifying TL-view radiographs with sensitivity of 81% and specificity of 82%. Both ATA and ASA were significantly affected by malposition in anteversion and downward rotation of the scapula. Reliable ASA measurement was more susceptible in up- and downward rotation than the ATA. New visual criteria can identify TL-view radiographsand should be used in future studies to ensure consistency in ATA and ASA measurement.

Critical shoulder angle: what do radiologists need to know?

The critical shoulder angle (CSA) constitutes a straightforward and highly reproducible tool. Degenerative rotator cuff tears (RCT) are associated with a significantly larger CSA. In this review, the most relevant features of the CSA are summarized: (1) the relationship between the CSA and RCT pathophysiology, (2) accurate measurement of the CSA according to various imaging modalities, (3) the contribution of the CSA in predicting the occurrence of RCT, and (4) RCT recurrence after surgical repair.

Effect of medial meniscus extrusion on arthroscopic surgery outcome in the osteoarthritic knee associated with medial meniscus tear: a minimum 4-year follow-up.

Background:The potential benefit of arthroscopic surgery for osteoarthritic knee associated with medial meniscus tear is controversial. This study was conducted to determine the effect of pre-operative medial meniscus extrusion (MME) on arthroscopic surgery outcomes in the osteoarthritic knee associated with medial meniscus tear during a minimum 4-year follow-up.Methods:This was a retrospective review of a total of 131 patients diagnosed with osteoarthritic knee associated with medial symptomatic degenerative meniscus tear who underwent arthroscopic surgery from January 2012 to December 2014 and were observed for more than 4 years. Patients were classified into two groups: MME ≥3 mm (major MME group, n = 54) and MME <3 mm (non-major MME group, n = 77). Clinical assessments, including the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and radiographic assessments, including the Kellgren-Lawrence (K-L) grade and medial joint space width (JSW), were evaluated pre-operatively and at final follow-up. The longitudinal changes of clinical and radiographic parameters (WOMAC and the medial JSW change, K-L grade progression) were compared between groups unadjusted and adjusted for age, sex, and body mass index. Four-year survival rates (without progression to knee replacement [KR]) were also evaluated using a log-rank test and Cox proportional hazard regression model.Results:Major MME was present in 41% of patients. After a minimum 4-year follow-up, the mean WOMAC total and pain scores improved significantly in both groups. However, the medial JSW and K-L grade worsened significantly. Patients with pre-operative major MME worsened more in WOMAC total (adjusted mean difference [MD] 3.800, 95% confidence interval [CI]: 0.900, 11.400; P = 0.037) and function (adjusted MD 3.100, 95% CI: 0.700, 6.300; P = 0.038) scores than patients with pre-operative non-major MME, and no significant difference was observed in WOMAC pain and stiffness score between groups. The group with major MME had significantly higher joint space narrowing (adjusted MD −0.630, 95% CI: −1.250, −0.100; P = 0.021) and K-L rate progression (adjusted mean relative risk [RR] 1.310, 95% CI: 1.100, 1.600; P = 0.038) than the group with non-major MME. There was a significantly more KR progression in patients with major MME compared with those with non-major MME (adjusted RR 3.100, 95% CI: 1.100, 9.200; P = 0.042 and adjusted hazard ratio 3.500, 95% CI 1.100, 9.500; P = 0.022).Conclusions:Osteoarthritic knee patients associated with medial meniscus tear with non-major MME are more responsive to arthroscopic surgery in terms of the clinical and radiologic outcomes and survival for at least 4-year follow-up; however, in terms of pain relief, arthroscopic surgery in patients with major MME is also beneficial as well as in patients with non-major MME.

Écartement des berges méniscales et degré d’arthrose sont corrélés avec l’extrusion méniscale dans les lésions dégénératives de la racine postérieure du ménisque médial

IntroductionMeniscal extrusion is a typical finding of medial meniscus posterior root tear, and it causes loss of the chondroprotective function of the meniscus as well as progression of osteoarthritis; it is therefore associated with poor clinical outcomes. The purpose of this study was to investigate factors associated with meniscal extrusion in degenerative medial meniscus posterior root tear. It was hypothesized that larger displacement from the posterior root insertion was associated with larger meniscal extrusion. Materials and methodsOne hundred-nine knees with degenerative medial meniscus posterior root tears were retrospectively reviewed. Multiple regression analysis was used to determine whether factors such as age, weight, body mass index, chondral wear at surgery, Kellgren-Lawrence (KL) grade, alignment, tibial slope, and tear gap on performing magnetic resonance imaging (MRI) were associated with meniscal extrusion. Subjects were divided based on the amount of displacement (displaced group: tear gap≥1mm, non-displaced group: tear gap<1mm) to compare meniscal extrusion, chondral wear, and severity of arthritis. ResultsThe mean age of the patients was 58.14±9.64 years, the mean absolute extrusion was 4.02±1.22mm, the mean relative percentage of extrusion was 44.53±13.09 %, and the mean tear gap was 2.39±2.42mm. Multiple regression analysis showed that absolute extrusion was only associated with tear gap on MRI (B=0.242, p=0.001) and that the relative percentage of extrusion was associated with tear gap (B=1.894, p=0.001) and the K-L grade (B=4.492, p=0.024). Absolute extrusion was significantly higher in the displaced group than in the non-displaced group (4.29±1.04mm vs. 3.01±1.35mm, p=0.001). Relative percentage of extrusion was also significantly higher in the displaced group than in the non-displaced group (47.70±11.44 % vs. 36.17±13.65 %, p=0.001). The proportion of chondral wear (Outerbridge grade III and IV) on the medial femoral condyle and K-L grade III and IV were significantly greater in the displaced group than in the non-displaced group (76 % vs. 53.3 %, p=0.023 and 13.9 % vs. 0 %, p=0.001, respectively). DiscussionGreater tear gap is significantly associated with increasing meniscal extrusion in medial meniscus posterior root tear. Additionally, severity of arthritis is significantly associated with increasing relative percentage of extrusion. Chondral wear and severity of arthritis tended to be significantly worse in the displaced group than in the non-displaced group. Level of evidenceIII, comparative retrospective study.