Medial Meniscal Root Repair Research Articles

Early outcome of medial meniscus posterior root repair in elderly- a clinical and radiological study

Meniscus functions as a load distribution, shock absorption, proprioception, lubrication, and stabilization. Meniscal roots anchor the medial and lateral menisci to the tibial plateau, allowing the meniscus to disperse axial loads into hoop stresses. Currently, repair of meniscus root is the treatment of choice for meniscus root tears. The aim of this study is to evaluate the clinical and radiological outcome of medial meniscus posterior root repair in elderly patients. Material and Methods: It is a prospective clinical and radiological study in 10 consecutive patients, who met the inclusion criteria and operated between June 2017 to June 2018 by a single surgeon. Patients were followed up for clinical and radiological evaluation by MRI. Duration of follow up ranges from 24 to 36 months. Results: Of the 10 patients (2 male and 8 female) with the mean age of 64 years. Mean follow-up period is 30 months. Mean BMI of the patients is 26.14 + 1.95 kg/m2. The difference in pre-operative and post-operative patient’s IKDC and Lysholm scores are significant (p value < 0.05). 2 patient showed complete healing of meniscus root, 8 patients showed partial healing and there was no repeat tear. Meniscus extrusion decreased from 5.2 + 0.8 mm preoperatively to 4.13 + 0.55 mm postoperatively. Conclusion: In this study, the outcomes after posterior medial meniscus root repair in elderly results in significant improvements in function, symptoms of pain, and activity level in spite of partial root healing in MRI in this short term follow up.

Posterior Root Medial Meniscus Tear With Medial Opening Wedge High Tibial Osteotomy: A Step-By-Step Systematic Arthroscopic Repair Technique

Medial meniscus root repair is often combined with correction of knee varus alignment by performing an opening wedge high tibial osteotomy (HTO) in patients with varus knee malalignment, particularly in those with suspected long-term medial meniscus root tear (MRT). Before planning a corrective alignment treatment, radiographic imaging of the knee alignment is recommended to assess a medial joint space and the tibiofemoral axis. Because HTO can reduce pressure on the repair site, new alignment may promote healing in the attachment of the MR repair. When HTO is used with meniscus root repair (MRR), the tunnel convergence remains a major concern. We describe an arthroscopic technique for treating chronic MRT with knee malalignment using the technique of arthroscopic posterior MRR with HTO. This approach was used to enhance anatomic healing of the meniscus root, decrease the load to the medial knee compartment to achieve MRR, and stop progressive osteoarthritis of the medial knee compartment.

Posterior-Medial Meniscal Root Repair Through Lateral Tibial Tunnel Combined With Medial Opening Osteotomy and Homologous Graft

When there is a rupture in the meniscal roots or close to them, the menisci suddenly and considerably reduce their capacity to absorb the axial mechanical load that passes through the knee, quickly leading to the development of a process of chondral degeneration. The varus deformity of the lower limb (when the mechanical axis crosses the medial compartment of the knee) favors this type of injury owing to the overload in the medial compartment. When the patient has both varus deformity and medial meniscal posterior root injury, there is a clear indication for surgical realignment of the affected lower limb. There is still not a consensus regarding combining meniscal root repair with corrective osteotomy, although there is a tendency to perform both procedures aiming at long-term joint preservation. We present a safe alternative technique for simultaneous medial meniscal posterior root repair using a lateral tibial transosseous tunnel associated with a valgus-producing high tibial osteotomy with homologous bone grafting, allowing a full return to daily activities and sports.

Prognostic Factors and Midterm Clinical Outcome of Transtibial Pullout and Partial Meniscectomy for Medial Meniscus Posterior Root Tears in Middle-Aged Patients.

The purpose of this study was to compare clinical and radiological outcomes of transtibial pullout technique and partial meniscectomy, and to establish prognostic factors in middle-aged patients with mild knee osteoarthritis. A comparative case-control analysis was conducted. 65 patients between 40 and 60years of age were included into two groups: 30 patients who underwent transtibial pullout technique (group 1) and 35 patients who underwent partial meniscectomy (group 2). Mean follow-up was set at 27.2months. Primary clinical outcomes included Knee injury and Osteoarthritis Outcome Score and Lysholm Knee Questionnare. Preoperative MRI and intraoperative arthroscopic findings were recorded. The correlation between these findings and patient-reported subjective outcome were assessed. The transtibial pullout group exhibited significantly greater improvement in clinical outcomes. A univariate model revealed that the presence of preoperative meniscal extrusion, body mass index (> 30), osteochondral defect, and female gender were predictors of poor clinical outcome. Multivariate regression analysis showed meniscal extrusion and osteochondral defect as significant prognostic factors for both study groups. Medial meniscus root repair leads to significantly improved clinical outcomes compared to partial meniscectomy in middle-aged patients with mild kneeosteoarthritis. Presence of meniscal extrusion, osteochondral defect, BMI > 30, and female gender were deemed as predictors of poor postoperativepatient-reported outcome. III therapeutic case-control study.

Paper 17: Optimal Tibial Tunnel Placement for Medial and Lateral Meniscal Root Repair in the Setting of Multiligament Reconstructions of the Knee

Objectives:Although the risk of tibial tunnel convergence in the setting of multiligament reconstruction has been reported in the literature, the risk of tunnel convergence in the setting of posterior cruciate ligament (PCL), anterior cruciate ligament (ACL), and medial and lateral meniscal root repair has not been defined. The purpose of this study was to examine the risk of tunnel convergence and to determine optimal tunnel placement for ACL and PCL reconstruction performed in conjunction with posterior medial and lateral meniscal root repairs in the proximal tibia.Methods:Three-dimensional tibial models were created using computed tomography scans of twenty cadaveric specimens. After determining optimal tunnel entry and exit points for ACL and PCL reconstructions, and medial and lateral meniscal root repair on the models, Mimics software was used to create root tunnels. The meniscal root repair tunnels were then re-oriented to be parallel to the ACL tunnel. The initial and re-oriented configurations are illustrated in Figure 1. Tunnel convergence risk was analyzed with single and double tunnel techniques in both case scenarios.Results:There were no cases of convergence between the ACL and medial meniscal root tunnels in any of the configurations. The greatest distance between the tunnels was achieved with the single tunnel technique in parallel orientation (12.09 ± 2.78 mm). All specimens demonstrated convergence between the ACL and lateral meniscal root tunnels when the sagittal plane entry was not taken into consideration and only the anatomic root attachment was accounted for, for single and double tunnel techniques, but no convergence was seen between these tunnels with the parallel orientation in the sagittal plane. Figure 2 illustrates the reduction in the convergence risk when the meniscal root tunnels are reoriented as parallel to the ACL tunnel. There were no cases of convergence between the PCL and medial meniscal root tunnels in the original orientation, but 2/20 specimens demonstrated convergence in the parallel orientation with the double tunnel technique and no cases of convergence in the single tunnel technique. The PCL and lateral meniscal root tunnels did not demonstrate convergence in any configuration. Table 1 demonstrates the mean, minimum and maximum distances of each tunnel configuration as well as the number of cases where the distance between tunnels was <2mm. A summary of the preferred tunnel configurations for each setting, ranked by greatest tunnel distance conferred and cases of convergence, is reported in Table 2.Conclusions:There is a high risk of convergence between ACL and posterior meniscus root tunnels. Re-orienting meniscal root tunnels parallel to ACL tunnels may help reduce this risk. When PCL reconstruction is performed with ACL reconstruction and medial and lateral meniscal root repair, the single tunnel root repair technique may pose less risk over the double tunnel technique to prevent tunnel convergence between the meniscal root repair and PCL tunnels in the tibia.Figure 1. Illustration of the reconstruction of the tunnels. (A) Initial orientation where the meniscal root tunnels’ entry points on the anteromedial aspect of the tibia were created above the ACL tunnel. (B) The meniscal root tunnels re-orientated and were placed parallel to that of the ACL and aimed to exit at the anatomic attachment of the posterior roots of the meniscus. (Gold guide for the creation of the ACL tunnel and silver guide for the creation of the meniscal root tunnel)

How to Perform Concomitant Medial Meniscus Pull-Out Repair With Medial Open-Wedge High Tibial Osteotomy Without Technical Failure

Varus alignment of the knee joint (varus >5°) is known as a poor prognostic factor for medial meniscus root repair, and alignment correction is recommended in patients with varus deformity and medial meniscus root tears. However, simultaneous medial meniscus pull-out repair and high tibial osteotomy are technically demanding procedures due to the long surgical time, poor visualization, and breaking of the pull-out sutures during high tibial osteotomy procedures. In the present Technical Note, we will introduce a surgical method to perform 2 procedures simultaneously without technical difficulty. The main surgical techniques are as follows. (1) Release the superficial medial collateral ligament before arthroscopic medial meniscus pull-out repair, which secures sufficient working space and visualization. Therefore, the operation time could also be reduced by performing the arthroscopic procedure with the anterior portal. (2) Protect the pull-out sutures with an ENDOBUTTON reamer, which prevents pull-out sutures from breaking during the high tibial osteotomy procedure.

Arthroscopic Medial Meniscus Posterior Root Repair with Centralization Using Knotless Suture Anchors

Medial meniscus posterior root tears can lead to rapid progression of knee arthritis because of loss of the stress distribution function of the meniscus. Medial meniscus root repair can restore stress distribution and improve clinical outcome. In cases of medial meniscus root tears with meniscal extrusion, centralization may help reduce extrusion and protect the root repair. Presented here is a technique for transtibial medial meniscus root repair with centralization using knotless suture anchors, building on previously developed techniques.

Prospective Consecutive Clinical Outcomes After Transtibial Root Repair for Posterior Meniscal Root Tears: A Multicenter Study.

Background:Prospective evaluation of clinical outcomes after posterior meniscal root repair utilizing a transtibial pullout technique is limited, and factors that may contribute to outcomes are unclear.Hypothesis:It was hypothesized that there would be an overall significant improvement in outcomes after root repair and that differences in clinical outcomes would correlate with age, body mass index (BMI), sex, and meniscal extrusion.Study Design:Case-control study; Level of evidence, 3.Methods:Consecutive patients undergoing transtibial medial or lateral meniscal root repair were enrolled prospectively at 2 orthopaedic centers between March 2017 and January 2019. Pre- and postoperative magnetic resonance imaging (MRI) were obtained to assess for meniscal healing, quantification of extrusion, articular cartilage grade, and subchondral bone changes. Patient-reported outcomes including International Knee Documentation Committee (IKDC) scores, Tegner activity scale, and visual analog scale (VAS) for pain were collected preoperatively and 2 years postoperatively. Patients were then subdivided by clinical and demographic characteristics to determine factors associated with clinical outcomes.Results:Included were 45 patients (29 female, 16 male; mean age, 42.3 ± 12.9 years; mean BMI, 31.6 kg/m2) who underwent 47 meniscal root repairs (29 medial and 16 lateral; 2 had both). Significant improvements at 2-year follow-up were seen in IKDC score (41.1 vs 78.4; P < .001), Tegner activity level (3 vs 4; P < .001), and VAS pain (2.8 vs 0.7; P < .001). BMI, preoperative malalignment, cartilage status, and progressive meniscus extrusion (Δ = 0.7 mm) did not have a negative impact on IKDC and Tegner scores 2 years postoperatively. Age greater than or equal to 50 years and extrusion pre- and postoperatively were associated with decreased Tegner scores. Progressive meniscal extrusion was associated with a decreased overall improvement in Tegner scores.Conclusion:Transtibial root repair for medial and lateral posterior meniscal root tears demonstrated significantly improved clinical outcomes at 2 years postoperatively. Increased age, increased BMI, cartilage status, and meniscal extrusion did not have a negative impact on short-term functional outcomes (IKDC), but age greater than or equal to 50 years and extrusion negatively influenced patient activity level (Tegner).Registration:NCT03037242 (ClinicalTrials.gov identifier).

Comparative study between isolated medial meniscus root repair versus open-wedge high tibial osteotomy versus combined approach in patients with root tears, 2-year follow-up

Background Medial meniscus root tears usually lead to loss of hoop tension of the meniscus and result in high-contact pressure in the medial compartment of the knee. Surgical management of those types of tears is mandatory to restore hope tension and to save medial compartment. This study was done to evaluate the necessity of medial root repair with high tibial osteotomy (HTO) for treatment of medial meniscus root tears. Patients and methods This is a prospective comparative study over 60 patients with medial meniscal root tears. The patients were classified randomly into three groups. The first group (group A) was treated with isolated medial meniscus posterior root tear repair (n=20). The second group (group B) was treated with isolated open-wedge high HTO (n=20). The third group (group C) was treated using combined medial meniscal root repair with high tibial open-wedge osteotomy (n=20). A clinical evaluation was made using range of motion (ROM) and pain assessment. Functional evaluation was done using Lysholm score and Hospital for Special Surgery score. Radiological evaluation was done using follow-up standing Lyon–Schuss films. Results Regarding the patients’ reported outcome measures, one-way analysis of variance was calculated to compare means between the three groups. The results of isolated root repair were the worst and there was no statistically significant difference between groups B and C. Conclusion Results recommend isolated HTO as a solo fast-attack procedure with reliable durable clinical and radiological outcomes for the treatment of root tears of the posterior horn of the medial meniscus.

Meniscal Root Repair

Background: Meniscal root tears typically result from a hyperflexion/squatting injury or are in conjunction with ligamentous knee injury. Once a complete tear occurs, the meniscus is unable to convert axial loads to transverse hoop stresses which result in increased tibiofemoral contact pressure and osteoarthritis. The goal of a meniscal root repair is to anatomically reattach the meniscal root to the tibia plateau. Complete and partial healing occurs in over 93% of cases with retear rates ranging from 0% to 7%. Indications: We present a case of a highly active 21-year-old male collegiate soccer play that sustained a medial meniscal root tear after slipping on ice. Technique: An anatomic medial meniscal root repair was performed using a transtibial guide and 2 loop sutures tied over a button. Results: Full anatomic footprint coverage was able to be achieved intraoperatively and gentle range of motion from 0 to 90° of flexion did not result in gap formation. Discussion/Conclusion: Successful outcomes with full anatomic footprint coverage of the medial meniscal root can be achieved with 2-loop suture button configuration.

ICRS scores worsen between 2-year short term and 5-year mid-term follow-up after transtibial medial meniscus root repair despite maintained functional outcomes.

The purpose of this study was to evaluate the mid-term results of posterior medial meniscal root tear (PMMRT) repair through assessment of functional outcome scores and magnetic resonance imaging (MRI). This was a single-center, retrospective study evaluating patients that had undergone a PMMRT. This was a follow-up to a previously published 2-year outcome study (all original patients were invited to participate). Clinical outcomes included pre- and postoperative International Knee Documentation Committee (IKDC) and Lysholm scores. Root healing, meniscal extrusion, and cartilage degeneration via International Cartilage Repair Society Scale (ICRS) grades were assessed on MRI by two musculoskeletal fellowship-trained radiologists. 10 of the original study's 18 patients were able to participate. Mean age and BMI was 48.4 ± 12.0years and 29.5 ± 4.5, respectively, with mean follow-up 65.5 ± 8.3months (range 52.0-75.8) (60% female). The IKDC significantly increased from 43 ± 13 preoperatively to 75 ± 16 at 5-year follow-up (p < 0.001). There was no significant change in IKDC score between 2-year and 5-year follow-up [75 ± 16 vs 73 ± 20, (n.s)]. TheLysholm also significantly increased between preoperative and 5-year follow-up (49 ± 7 vs 84 ± 11, p < 0.001). There was no significant change between Lysholm score at 2-year and 5-year follow-up [84.0 ± 11 vs 82 ± 13, (n.s)]. Mean extrusion did not significantly change from the preoperative state to 5-year follow-up [4.80mm ± 1.9 vs 5.0mm ± 2.5, (n.s.)]. Extrusion also did not significantly change between 2-and 5-year follow-up [6.1 ± 3.2mm vs 5.0mm ± 2.5, (n.s.)]. No patients with > 3mm of extrusion on preoperative MRI had < 3mm of extrusion on postoperative MRI. Both medial femoral condyle and medial tibial plateau ICRS grades significantly increased from preoperative to 2-year follow-up (p = 0.038, p = 0.023, respectively). Medial femoral condyle and medial tibial plateau ICRS grades again significantly increased between 2-year and 5-year follow-up (p = 0.014, p = 0.034). Patients treated with the transtibial suture pullout technique with two locking cinch sutures had maintenance of clinical outcome improvements at 5-year follow-up. However, extrusion was widely prevalent,with worsening progression of femoral and tibial chondral disease. Level 4.

Functional outcome of medial meniscus root repair in medial compartment osteoarthritic knee and it’s correlation with preexisting comorbidities

Objective: The knee joint is one of the most commonly affected joints of the body and this can be attributed to its exposure to external forces and the high functional demands placed on the joint. Meniscal root tears have conventionally been treated with menisectomy and in this study we evaluate the effects of repairing the torn posterior medial meniscal root. We also study the effects of age and body mass index on the postoperative outcome of the patient. Methods: 35 patients with posterior horn medial meniscus root tear were operated with root repair with either a fibre wire/ fibre tape or their pre and post-operative tegner lysholm scores were evaluated. Results and Conclusions: The evaluation was suggestive that medial meniscus root repair improved outcomes. Additionally, a relationship was established between the body mass index and patient age with that of the post-operative function.

Investigating the Chronology of Meniscus Root Tears: Do Medial Meniscus Posterior Root Tears Cause Extrusion or the Other Way Around?

Objectives:Meniscus root tears are increasingly being recognized. Meniscus extrusion has previously been associated with medial root tears; however, the relationship between secondary meniscus restraints, such as the meniscotibial (MT) ligament, extrusion, and root tears has yet to be formally evaluated. The purpose of this study was to better understand the association between MT ligament competence, medial meniscus extrusion, and medial meniscus posterior root tears (MMPRT), as well as to determine the progression of meniscus extrusion over time.Methods:Serial MRI’s from our institution were reviewed for patients who showed evidence of medial meniscus extrusion and MMPRT on at least one of 2+ available MRI’s. All patients were symptomatic at the time of diagnosis. All MRI’s were analyzed independently by two board-certified musculoskeletal radiologists. MT ligament disruption, medial meniscus extrusion, and MMPRT presence was recorded for each MRI. The time between MRI’s, presence of insufficiency fractures, and Outerbridge classification for the medial femur and tibia were also evaluated.Results:27 knees in 26 patients were included in this study, with a total of 63 MRI’s analyzed (21 knees with 2 MRI’s, 3 with 3 MRI’s, and 3 with 4 MRI’s). All patients demonstrated clear medial meniscus extrusion and meniscotibial ligament disruption prior to the subsequent development of MMPRTs (p < 0.001). Mean extrusion at the time of initial MRI was 3.3 ± 1.1 mm, and increased significantly to 5.5 ± 1.8 mm at the time of first imaging with an identified MMPRT (p < 0.001). The average time between initial MRI and the first identification of MMPRT on a later MRI was 1.7 ± 1.6 years.Conclusions:In a sample of 27 symptomatic knees with serial MRI’s both before and after MMPRT diagnosis, all patients demonstrated MT ligament disruption and associated meniscus extrusion prior to the development of subsequent medial meniscus root tears. These findings suggest that MT ligament disruption and medial meniscus extrusion represent early and predisposing events contributing to MMPRT. Therefore, this provides a possible explanation of why meniscus extrusion is not corrected with medial meniscus root repair.

Correlation of factors affecting correction of meniscalextrusion and outcome after medial meniscus root repair.

Meniscus extrusion in medial meniscus posterior root tears (MMPRT) is a consistent MRI finding and correction of extrusion is a primary objective of the meniscal root repair. The purpose of the study is to evaluate feasibility of correction of extrusion and correlation of various factors affecting the postoperative extrusion correction and outcomes in all degenerative medial meniscus posterior roots (MMPRTs). A retrospective study of patientswho presented with degenerative MMPRTsfollowing trivial incident (Jun 2014 and Aug 2018) andincluded isolated Laprade type 2 root tear with extrusionin MRI. Patients with ligament injuries, tricompartmental arthritis, malalignment (> 50) and irreparable meniscal tears excluded. All patients underwent arthroscopic trans-tibial tunnel suture pull-out repair. A screening MRI was taken at a 6-month follow-up and functional scores (IKDC and Lysholm's) at final follow-up. The effects of age, gender, duration of symptoms, hip-knee-ankle angle on weight-bearing X-rays, ICRS grading of cartilage status, and MRI data (extrusion distance, tunnel location and healing status of meniscus) on outcomes were analysed. MMPRT (n = 54) with a mean follow-up of 34.6months (24-48). Mean functional outcomes improved postoperatively IKDC (43.40 ± 5.16-78.65 ± 5.11, p < 0.001) and Lysholm's (65.27 ± 4.28-83.16 ± 4.83, p < 0.001) scores at final follow-up. 57.4% (31) had good correction of extrusion, 3.7% (2) no correction and 38.8% (21) showed increase in extrusion postoperatively. Of all the factors we explored, age, ICRS (low grade)and knee varus(less 2.5 degree) affected extrusion correction. Patients with healed (41 patients), partially healed (9 patients)and anatomic tunnel placement (46 patients) had better extrusion correction than those with non-healing (4 patients) and non-anatomical tunnel (8patients). Patients younger than 50years, with low grade cartilage damage (ICRS 1, 2), lower KL grade and varus alignment (< 2.50) had good correction of extrusion. Correction of extrusion/progression of extrusion did not influence the clinical outcome at the short-term. The progression of meniscal extrusion is inevitable even after successful repair in elderly and high-risk patients. Retrospective Case series, level of evidence IV.

Arthroscopic Medial Meniscal Posterior Root Repair With Transtibial Luggage-Tag and Horizontal Mattress Sutures

Medial meniscal posterior root repair techniques have shown positive yet varied results in the literature. The decision to perform repair has improved clinical outcomes in many situations, although the healing rate is approximately 64% and the repair strength is roughly one-third of the native root strength, with meniscal extrusion being common. We present a technique based on biomechanical evidence to obtain a strong anatomic posterior root repair to restore nearly normal knee mechanics, combining an increased size of footprint under the lateral aspect of the medial meniscal horn for healing and a luggage-tag suture with a posteriorly placed horizontal mattress suture. The horizontal mattress suture is passed to capture the circumferential fibers of the meniscus and the luggage-tag suture is passed to capture the radial fibers of the meniscal body, through a single transtibial tunnel. The aim of this repair is to restore the normal meniscal function.

Investigating the Chronology of Meniscus Root Tears: Do Medial Meniscus Posterior Root Tears Cause Extrusion or the Other Way Around?

Background:Meniscus root tears are increasingly being recognized. Meniscal extrusion has previously been associated with medial root tears; however, the relationship between secondary meniscal restraints, such as the meniscotibial (MT) ligament, extrusion, and root tears has yet to be formally evaluated.Purpose:To better understand the association between MT ligament competence, medial meniscal extrusion, and medial meniscus posterior root tears (MMPRTs) as well as to determine the progression of meniscal extrusion over time.Study Design:Case series; Level of evidence, 4.Methods:Serial magnetic resonance imaging (MRI) scans were reviewed for patients who showed evidence of medial meniscal extrusion and MMPRTs on at least 1 of ≥2 available MRI scans. All patients were symptomatic at the time of diagnosis. All MRI scans were analyzed independently by 2 board-certified musculoskeletal radiologists. MT ligament disruption, medial meniscal extrusion, and MMPRTs were recorded for each MRI scan. The time between MRI scans, presence of insufficiency fractures, and Outerbridge classification for the medial femur and tibia were also evaluated.Results:Overall, 27 knees in 26 patients were included in this study, with a total of 63 MRI scans analyzed (21 knees with 2 MRI scans, 3 with 3 MRI scans, and 3 with 4 MRI scans). All patients demonstrated clear medial meniscal extrusion and MT ligament disruption before the subsequent development of MMPRTs (P < .001). Mean extrusion at the time of initial MRI was 3.3 ± 1.1 mm and increased significantly to 5.5 ± 1.8 mm at the time of first imaging with an identified MMPRT (P < .001). The mean time between initial MRI and the first identification of an MMPRT on later MRI was 1.7 ± 1.6 years.Conclusion:In a sample of 27 symptomatic knees with serial MRI scans both before and after an MMPRT diagnosis, all patients demonstrated MT ligament disruption and associated meniscal extrusion before the development of subsequent medial meniscus root tears. These findings suggest that MT ligament disruption and medial meniscal extrusion represent early and predisposing events contributing to MMPRTs. Therefore, this provides a possible explanation of why meniscal extrusion is not corrected with medial meniscus root repair.

Effet de l’atélocollagène sur la cicatrisation des réparations de la racine méniscale médiale à l’aide du point Mason–Allen modifié

IntroductionAddition of collagen during medial meniscal root repair (MMRR) may improve meniscal root healing minimizing fibrous scar tissue formation. The purpose of this study was to verify the effect of atelocollagen on MMRR using the modified Mason–Allen stitch when compared with that of the conventional pull-out repair by assessing the clinical and radiological outcomes. HypothesisIt was hypothesized that atelocollagen would enhance the healing effect on the meniscal root following MMRR. Moreover, we presumed that MMRR with atelocollagen application might reduce meniscal extrusion by promoting healing. Materials and methodsA total of 47 patients who underwent MMRR using the modified Mason–Allen stitch between 2015 and 2016 were included, and they were divided into group A (atelocollagen application; n=25) and group R (MMRR without atelocollagen application; n=22). The postoperative clinical outcomes, radiological outcomes, and meniscal root healing and medial compartment cartilage status on follow-up magnetic resonance imaging (MRI) were compared between the two groups. ResultsMean follow-up duration was 26.4±4.8 months in group A and 27.1±5.2 months in group R (p=0.598). Mean duration from surgery to follow-up MRI was 12.5±1.4 months in group A and 12.7±1.2 months in group R (p=0.604). The subjective knee scores improved significantly in both groups at the last follow-up (all, p<0.001). The Kellgren–Lawrence (K-L) grade progressed in 16% and 22.7% in group A and group R, respectively (p=0.351). Follow-up MRI showed progression of cartilage loss in the medial compartment in 28% and 40.9% in group A and group R, respectively (p=0.355). In terms of meniscal root healing, 18 (72%) and 12 (54.5%) patients had complete healing, and 6 (24%) and 8 (36.4%) patients had partial healing in groups A and R, respectively. The mean value of the intrameniscal signal intensity (IMSI) of the meniscal root based on MRI in group A was significantly lower than that in group R (p<0.001). The medial meniscal extrusion in groups A and R decreased by 0.2±0.1mm and 0.1±0.3mm following MMRR without significant differences (p=0.056 and p=0.229, respectively). The IMSI presented significant negative correlations with the root healing status and significant positive correlations with K-L grade progression (p<0.05). DiscussionAtelocollagen application during MMRR yielded lower IMSIs, suggesting better healing, than did conventional pull-out root repair. However, this technique could not demonstrate beneficial effects on meniscal extrusion. Level of evidenceIII, retrospective case-control study.

Effect of atelocollagen on the healing status after medial meniscal root repair using the modified Mason–Allen stitch

IntroductionAddition of collagen during medial meniscal root repair (MMRR) may improve meniscal root healing minimising fibrous scar tissue formation. The purpose of this study was to verify the effect of atelocollagen on MMRR using the modified Mason–Allen stitch when compared with that of the conventional pullout repair by assessing the clinical and radiological outcomes. HypothesisIt was hypothesised that atelocollagen would enhance the healing effect on the meniscal root following MMRR. Moreover, we presumed that MMRR with atelocollagen application might reduce meniscal extrusion by promoting healing. Materials and methodsA total of 47 patients who underwent MMRR using the modified Mason–Allen stitch between 2015 and 2016 were included, and they were divided into group A (atelocollagen application; n=25) and group R (MMRR without atelocollagen application; n=22). The postoperative clinical outcomes, radiological outcomes, and meniscal root healing and medial compartment cartilage status on follow-up magnetic resonance imaging (MRI) were compared between the two groups. ResultsMean follow-up duration was 26.4±4.8 months in group A and 27.1±5.2 months in group R (p=0.598). Mean duration from surgery to follow-up MRI was 12.5±1.4 months in group A and 12.7±1.2 months in group R (p=0.604). The subjective knee scores improved significantly in both groups at the last follow-up (all, p<0.001). The Kellgren–Lawrence (K–L) grade progressed in 16% and 22.7% in group A and group R, respectively (p=0.351). Follow-up MRI showed progression of cartilage loss in the medial compartment in 28% and 40.9% in group A and group R, respectively (p=0.355). In terms of meniscal root healing, 18 (72%) and 12 (54.5%) patients had complete healing, and 6 (24%) and 8 (36.4%) patients had partial healing in groups A and R, respectively. The mean value of the intra-meniscal signal intensity (IMSI) of the meniscal root based on MRI in group A was significantly lower than that in group R (p<0.001). The medial meniscal extrusion in groups A and R decreased by 0.2±0.1mm and 0.1±0.3mm following MMRR without significant differences (p=0.056 and p=0.229, respectively). The IMSI presented significant negative correlations with the root healing status and significant positive correlations with K–L grade progression (p<0.05). DiscussionAtelocollagen application during MMRR yielded lower IMSIs, suggesting better healing, than did conventional pullout root repair. However, this technique could not demonstrate beneficial effects on meniscal extrusion. Level of evidenceIII, retrospective case-control study.

Peripheral Stabilization Suture to Address Meniscal Extrusion in a Revision Meniscal Root Repair: Surgical Technique and Rehabilitation Protocol

Meniscal root tears are an increasingly recognized condition. These tears can cause the meniscus to become extruded outside the joint, which can diminish the biomechanical functionality of the meniscus. Anatomic repair of the meniscal root has previously been described, but this surgical procedure may not adequately address severe extrusion of the meniscal tissue. Additionally, when a primary anatomic repair fails, meniscal extrusion can increase, which can possibly accelerate joint degeneration if untreated. Therefore, the purpose of this Technical Note is to describe our surgical technique for revision medial meniscal root repair with a peripheral stabilization suture to address medial meniscal root tears with severe meniscal extrusion.

Loop-Post Construct, A Novel Technique for Medial Meniscus Root Repair.

Surgical reattachment of medial meniscus posterior root tear (MMPRT) with transtibial sutures can delay the presence of medial knee joint compartment osteoarthritis. Most suture configurations are placed five mm away from the torn margin in the meniscal substance which is already degenerated and may decrease the pull out strengths of repair construct. The number of meniscus penetration may also be important considering meniscus tissue damage with more complex suture techniques impose the risk of suture cut out through the meniscus substance. We introduce our loop postsuture construct technique which is simple, cheap and reproducible.