Posterior Root Tear Research Articles

Effectiveness of Rehabilitation for Knee Osteoarthritis Associated With Isolated Meniscus Injury: A Scoping Review.

Meniscus tear is the most common type of injury to the meniscus and occurs more frequently on the medial compartments than the lateral compartments. Further, it is often caused by trauma or degenerative processes and can occur anywhere on either the meniscus, anterior horn, posterior horn, or midbody. Treatment of meniscus injuries is likely to greatly impact the evolution of osteoarthritis (OA) as meniscus injuries can gradually progress to knee OA. Hence, treatment of these injuries is important for managing the progression of OA. While the types of meniscus injuries and symptoms have been reported previously, the effectiveness of rehabilitation according to the degree of meniscus injury (e.g., vertical, longitudinal, radial, and posterior horn tears) remains unknown. In this review, we aimed to investigate whether rehabilitation for knee OA associated with isolated meniscus injuries varies with the degree of injury and determine the effects of rehabilitation on outcomes. We searched PubMed, Cumulative Index to Nursing and Allied Health Literature, Web of Science, and Physiotherapy Evidence Database for studies published before September 2021. Studies on ≥40-year-old patients with knee OA and isolated meniscus injury were included for analysis. The types of meniscus injury were classified as longitudinal, radial, transverse, flap, combined, or avulsion of the anterior and posterior roots of the medial meniscus, and assigned knee arthropathy grades of 0-4 according to the Kellgren-Lawrence classification. The exclusion criteria were meniscus injury, combined meniscus and ligament injury, and knee OA associated with combined injury in patients <40 years of age. There were no restrictions on the region, race, or gender of participants, or language or research format of the studies. The outcome measures were the Knee Osteoarthritis Outcome Score, Western Ontario and McMaster Universities Osteoarthritis Index Score, Visual Analog Scale or Numeric Rating Scale, Western Ontario Meniscal Evaluation Tool, International Knee Documentation Committee Score, Lysholm Score, 36-Item Short-Form Health Survey, one-leg hop test, timed up and go test, and re-injury and muscle strength. A total of 16 reports met these criteria. In studies that did not classify or distinguish degrees of meniscus injury, the effects of rehabilitation were generally favorable in the medium-to-long term. In cases where the intervention was not sufficiently effective, patients were recommended either arthroscopic partial meniscectomy or total knee replacement. Studies on medial meniscus posterior root tear did not confirm the effectiveness of rehabilitation due to the short intervention period. Further, Knee Osteoarthritis Outcome Score cut-offs, clinically important differences in Western Ontario and McMaster Universities Osteoarthritis Index, and minimum important changes in patient-specific functional scales were reported. Of the 16 studies reported in this review, nine met the definition. This scoping review has a few limitations such as the effect of rehabilitation alone could not be examined, and the intervention effectiveness differed at short-term follow-up. In conclusion, there was a gap in evidence regarding the rehabilitation of knee OA after isolated meniscus injury due to differences in intervention duration and methods. In addition, on short-term follow-up, intervention effects varied across studies.

Medial joint space narrowing progresses after pullout repair of medial meniscus posterior root tear.

The extent to which arthropathic changes progress after medial meniscus posterior root tear (MMPRT) repair remains controversial. This retrospective study assessed medial joint space (MJS) narrowing progression after pullout repair for MMPRT and identified the correlating factors. We included 56 patients who underwent pullout repair for MMPRT. The MJS of the bilateral knees was assessed with radiography using the fixed-flexion view. A second-look arthroscopy was performed one year post-operatively for all patients. The baseline characteristics, clinical scores, Kellgren-Lawrence (KL) grade, and medial meniscus extrusion (MME) were identified. Statistical comparisons and correlation analyses were conducted. The MJS narrowing width was significantly larger in MMPRT knees than in contralateral knees (0.51 ± 0.85 mm vs. 0.09 ± 0.49 mm, p < 0.001). KL grade progression was observed in 23.2% (13/56) of patients. There was a significant difference between pre- and post-operative MME values, indicating MME progression (p < 0.001). Each clinical score showed significant improvement one year post-operatively (p < 0.001). Positive correlations were found between MJS narrowing and pre-operative MJS (coefficient = 0.510, p < 0.001), rate of change in MJS (coefficient = 0.929, p < 0.001), and increase in MME (ΔMME) (coefficient = 0.506, p < 0.001). Knees that underwent pullout repair for MMPRT showed progression of MJS narrowing by 0.51 mm at one year post-operatively, although clinical scores markedly improved. Correlating factors for MJS narrowing were pre-operative MJS, rate of change in MJS, and ΔMME. Preventing MME progression is essential for preventing arthropathic changes.

The effects of lateral meniscus posterior root tears or repair with anterior cruciate ligament reconstruction on the pressure of the patellofemoral joint: A biomechanical evaluation.

The aim of our study was to evaluate the effect of tear and repair of the lateral meniscal posterior root (LMPR) on the patellofemoral contact pressure of the knee after anterior cruciate ligament (ACL) reconstructed. This was a descriptive study. Six fresh-frozen cadaveric knees collected by The Third Hospital of Hebei Medical University from January 2019 and January 2022 were placed on a customized testing rig. Patellofemoral contact pressures were measured at 30°, 60°, and 90° of flexion using pressure-sensitive film inserted between the patella and trochlea. The following knee states were tested: ACL reconstruction and intact lateral meniscus, ACL reconstruction, and LMPR tear, and ACL reconstruction and LMPR repair. Pressure measurements were recorded for each state. In the ACL-reconstructed knee, a tear of the LMPR increased patellofemoral contact pressure at 30° of knee flexion. The repair of the posterior root by transosseous pull-out suture reduced the patellofemoral contact pressure as the status of intact lateral meniscal posterior root at 30° of knee flexion. There was no statistical difference between ACL reconstruction with the intact meniscal root and with the meniscal root tear and with the meniscal root repair at 60° and 90° of knee flexion. The posterior root tear and repair of the lateral meniscus could have an influence on patellofemoral contact stress of the knee after ACL reconstruction at 30° of knee flexion.

Lateral-medial asymmetry of posterior tibial slope and small lateral tibial plateau articular surface depth are morphological factors of lateral meniscus posterior root tears in ACL-injured patients.

To investigate whether knee morphological features, patient characteristics, and intraoperative findings are associated with a lateral meniscus (LM) posterior root tear (LMPRT) in anterior cruciate ligament (ACL) injuries with the integrated data from two academic centres. This retrospective study used registry data acquired prospectively at two academic centres. Patients with ACL reconstruction (ACLR) with LMPRT and no other LM injury were selected (LMPRT group) from each database. The control group included patients who underwent ACLR without LM tears. Patients were matched to the LMPRT group according to age and gender (1:1). Morphological factors evaluated on preoperative magnetic resonance image scans included lateral femoral condyle (LFC) anterior-posterior diameter, height, and depth; lateral tibial plateau (LTP) articular surface (AS) depth and sagittal plane depth; and lateral and medial posterior tibial slopes (PTSs). LFC height and depth ratios, LTP AS depth and sagittal plane depth ratios, and lateral-to-medial slope asymmetry were computed from previous measurements. Patient characteristics and intraoperative findings were extracted and compared between both groups. The study included 252 patients (126 in each group). The lateral-medial asymmetry of PTS was greater in the LMPRT group (1.2° vs 0.3°, p < 0.05), and the LTP AS depth was smaller in the LMPRT group (31.4mm vs 33.2mm, p < 0.01). There were no differences in LFC morphology between the control and LMPRT groups. Pivot shift grade (p < 0.05), percentage of complete ACL tears (p < 0.05), and medial meniscus ramp lesions (p < 0.05) were significantly higher in the LMPRT group. LMPRT was associated with significantly increased lateral-medial asymmetry of PTS and significantly smaller LTP AS depth. LMPRT was also associated with an increase in the preoperative pivot shift grade and the presence of a medial meniscus ramp lesion. These morphological characteristics are rather simple to measure and would serve as helpful indicators to preoperatively detect LMPRT, which is frequently challenging to diagnose preoperatively. Level III.

Case report: unusual posteromedial capsular lesion with posterior lateral meniscus root tear in two patients with constitutional genu recurvatum presenting after an acute ACL injury

Ramp lesions of the medial meniscus and posterior lateral meniscus root tears (LMPRT) can be present simultaneously in up to 8% of patients undergoing anterior cruciate ligament (ACL) reconstruction. The prevalence of these complex and highly unstable meniscal tears increases exponentially with the severity of the injury. The posteromedial capsule (PMC) has often been disregarded in the past when discussing ligamentous and meniscal injuries, but the recent interest in ramp lesions has drawn surgeons’ attention to the posteromedial structures of the ACL injured knee. While the meniscocapsular junction is commonly repaired in unstable ramp lesions, in the current literature there is no report regarding proximal PMC lesions, be they in isolation or associated with complex meniscal injuries.We report here two cases of proximal posteromedial capsular lesions associated with medial meniscus instability and posterior lateral root tears after ACL injury. The first case involves a meniscus ramp lesion associated with a proximal PMC tear and a posteromedial fluid collection in the muscle plane on magnetic resonance in a 22-year-old male soccer player. The second case involves a 21-year-old female soccer player who presented with a PMC lesion after hyperextension/valgus knee injury. The capsular lesions were repaired to restore capsular tension and improve medial meniscus posterior horn stability.

Controversial Treatment Choice to Manage Lateral Meniscus Posterior Root Tear: A Case Report

Introduction: Meniscus root tears are defined as radial tears within 1 cm of the meniscus insertion, or avulsions at the insertion of the meniscus. Based on tear morphology, there are 2 classification system for both medial and lateral posterior root tears. Lateral meniscus posterior root tear (LMPRT) is usually traumatic in nature and has been reported to occur in 7-10% of patients with anterior cruciate ligament (ACL) injury. The most commonly utilized treatments for LMPRT include non-operative treatment, partial meniscectomy, or repair. However, studies evaluating the clinical success of partial meniscectomy for LMPRT are contradictory. Case Report: A 18 years old man came to the orthopaedic clinic with complaints of pain in the right knee, after 2 months excessive physical training to join the police academy. Physical examination of the right knee showed positive results on McMurray and Thesaly’s test. According the combination of the cleft, truncated triangle, and ghost signs on the patient’s MRI examination which showed there was a lateral meniscus posterior root tear of the right knee without ACL injury. Meniscus repair was performed for this patient at the beginning, but apparently the meniscus can not be repositioned. Therefore, we decided that Arthroscopy Partial Meniscectomy (APM) was the best option for this patient. Conclusion: Even though APM long term outcomes is still controversial, when repair is not possible, APM is preferred to get short term benefits after the surgery, such as shorter recovery time and less revision surgery rates.

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

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

Hidden Meniscus Problems: Ramp Lesion and Posterior Meniscus Medial Root Tear

Ramp lesion (RL) is a peripheral tear affecting the posterior horn of the medial meniscus in the setting of ACL tears. Posterior meniscus medial root tear (PMMRT) is defined as an avulsion of the attachment, or a complete radial tear within 1 cm of the posterior tibial attachments of the meniscus. Both are not uncommonly found. The prevalence of RL existing in conjunction with ACL tears ranges from 9 to 42%. On the other hand, PMMRT contributes up to 10 to 21% of all meniscus tears. Both RL and PMMRT have significant consequences. RT increases anterior tibia translation and internal rotation after ACL reconstruction which may increase graft failure. PMMRT may accelerate the progress of medial knee osteoarthritis. Unfortunately, both conditions are frequently overlooked from physical examination, MRI reading, and arthroscopy procedures, due to the low sensitivity, unfamiliarity, and hidden location of the lesions. Posteromedial tibia edema finding on MRI images in a complete ACL tear in young patients increases the risks of RL. Ghost sign and medial femorotibial edema found on MRI may indicate PMMRT. RL and PMMRT may not be identifiable from the standard arthroscopic view. The trochlear view may be needed for RL and MCL trephination is almost always needed for PMMRT. The stability of both lesions should be assessed by meniscus probing, and repair is the gold standard for unstable lesions. RL can be repaired with sutures from the anterior or posterior. PMMRT is usually repaired using the transtibial pull-out suture technique.

Arthroscopy Revision of Medial Meniscus Posterior Root (MMPR) Reconstruction Using Gracillis Tendon Graft. A Case Report

The techniques for medial meniscal posterior roots (MMPR) repair can vary in relationship to the surgical approach, type of suture, device used, and fixation technique. Anatomic reduction, meniscal root fixation, and prevent extursion are possible by the trans-tibial pull-out repair procedure for MMPR tears. But it has been found that it has a substantially weaker than the natural root with unsactisfactory healing rates. Objective: We purposed this technique to reduce the failure of meniscus repair with a more anatomical, better healing and reproducible outcome Case Presentation: A 60-year-old female patient with Medial Meniscus Posterior Root tear LaPrade classification type 2. She had arthroscopic transtibial pull-out meniscal root repair using Ethibond No. 5 non-absorbable suture material. Six months after surgery, she had retear on MMPR and we performed the arthroscopic MMPR reconstruction with gracilis tendon graft. 3 months after surgery, patient has a good function and MRI evaluation. Conclusion: This arthroscopic medial meniscus posterior root reconstruction using gracilis graft is provide an anatomical repair, a more strong with a biological healing than previous repair techniques.

The Efficacy of High Tibial Osteotomy with or without Post-root Medial Meniscus Repair: A Systematic Review

Background: High tibial osteotomy (HTO) is a knee joint treatment modality for medial compartment arthritis, aiming to improve articular cartilage healing by shifting the lower limb’s axis. It is commonly used in younger patients with pain and active lifestyles, preventing advanced cartilage deterioration. Varus malalignment may often be accompanied with medial meniscus root tears. In recent years, meniscus root tears are often been repaired. However, the efficacy of medial meniscus repairs with high tibial in varus malalignment with medial meniscal tears remains a controversy. Purpose: The purpose is to study the functional outcomes of concurrent medial meniscus root repair with HTO versus HTO alone. Study design: Systematic review. Methods: According to Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines, we searched PubMed, Embase, Web of Science, and the Cochrane Library databases for studies reporting the outcomes of medial meniscus posterior root tear (MMPRT) repair with HTO versus HTO alone and extracted data about characteristics of patients, clinical functional scores, and radiologic outcomes. One reviewer extracted data and 1 reviewer assessed the risk of bias and performed a synthesis of the evidence. Articles were eligible if they reported the functional outcome of HTO alone or HTO and MMPRT repair in patients of varus malalignment and medial meniscus root tears. Results: 6 studies with 264 patients were identified. Data from these studies were segregated in HTO only and HTO with medial meniscus repair group. The findings of this systematic review suggest that the outcomes of HTO with MMPHRR and of only HTO are not statistically significant, meaning that doing valgus osteotomy only in patients with varus knee and MMPHRT can give good results regardless of not repairing the meniscus. Conclusion: HTO with medial meniscus posterior horn root repair seems to have no significant improvement in the functional outcomes of the patient. However, long-term studies need to be performed. Keywords: High tibial osteotomy, medial meniscus, root repair, arthroscopy, varus malalignment, meniscus, root tear

Concomitant posterior anchoring further reduces posterior meniscal extrusion during pullout repair of medial meniscus posterior root tears: a retrospective study.

Transtibial pullout repair improves the clinical outcomes of medial meniscus (MM) posterior root tears (PRTs); however, reducing MM extrusion remains challenging. Thus, the purpose of this study was to examine the role of additional posterior anchoring (PA) during pullout repair in reducing the severity of MM extrusion compared to pullout repair alone. Patients who underwent pullout repair with two-cinch stitches (TCS) only or TCS combined with PA (TCS-PA)-deployment of an additional suture anchor in the posteromedial corner of MM-were included retrospectively. MM medial and posterior extrusion (MMME and MMPE), MM extrusion and remaining volume (MMEV and MMRV), and corresponding ratios were evaluated pre-operatively and threemonths post-operatively using a three-dimensional meniscal model at 10° and 90° of knee flexion and compared within and between groups. A total of 15 and 16 patients treated with TCS and TCS-PA, respectively, were enrolled. At 90° knee flexion, both techniques significantly reduced MMPE (TCS: 4.2 ± 0.7mm to 3.5 ± 0.6mm, p < 0.05; TCS-PA: 3.7 ± 0.8mm to 2.8 ± 0.7mm, p < 0.05) at threemonths post-operatively. TCS-PA reduced MMPE more significantly than TCS alone (p < 0.05). Only TCS-PA significantly improved the MMEV and MMRV ratios (39.6 ± 8.9% to 28.1 ± 6.0%, p < 0.05 and 60.4 ± 8.9% to 71.9 ± 6.0%, p < 0.05, respectively). Significance was not found in all other comparisons. Both techniques improved MMPE at knee flexion at the threemonth follow-up, with TCS-PA providing significantly superior results. Our findings support the evidence that the application of PA may be an effective surgical option for alleviating persistent MMPE.

The clinical and radiographic outcomes of type 2 medial meniscus posterior root tears following transtibial pullout repair.

The aim of this study was to compare the clinical outcomes of different subtypes of type 2 medial meniscus posterior root tears following transtibial pullout repair. In total, 147 patients (mean age: 66.2 ± 8.3years) who were diagnosed with type 2 medial meniscus posterior root tears and underwent transtibial pullout repair were included. Patients were divided into 2A (n = 31), 2B (n = 90), and 2C (n = 26) groups according to tear type. Clinical outcomes were assessed pre-operatively and at second-look arthroscopy using the Knee injury and Osteoarthritis Outcome Score. The meniscal healing status was evaluated at second-look arthroscopy. Medial meniscus extrusion was calculated using magnetic resonance imaging pre-operatively and at second-look arthroscopy. No significant differences in pre-operative or post-operative clinical scores were observed between each subtype, although clinical scores improved post-operatively for each subtype. Significant differences were noted in the anteroposterior width of the bridging tissues at second-look arthroscopy (2A, 7.1 ± 1.2; 2B, 6.2 ± 1.7; and 2C, 6.2 ± 1.7mm; p = 0.045); type 2A tears were the widest. There was a significant difference in post-operative medial meniscus extrusion (2A, 3.2 ± 0.9; 2B, 4.0 ± 1.2; and 2C, 4.0 ± 1.4mm; p = 0.004) and its progression (2A, 0.7 ± 0.6; 2B, 1.2 ± 0.8; and 2C, 1.2 ± 0.8mm; p = 0.008), and type 2A tears were the shortest. Although there was no significant difference in the post-operative clinical scores among different type 2 tears in the short term, type 2A tears showed better healing and medial meniscus extrusion progression prevention, thus indicating the usefulness of classifying tear type in estimating post-operative outcomes. III.

Meniscal Extrusion Measurements After Posterior Medial Meniscus Root Tears: A Systematic Review and Meta-analysis

Background: Meniscal extrusion has become increasingly utilized when evaluating meniscus root abnormalities. However, no consensus definition or approach exists on how to measure extrusion. Purpose/Hypothesis: The purpose of this study was to evaluate the extent of heterogeneity in meniscal extrusion measurement techniques and reported extrusion values in knees with posterior medial meniscus root tears (PMMRTs). We hypothesized that meniscal extrusion measurement techniques would vary considerably throughout reported studies, with resultant wide-ranging published extrusion values. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. The inclusion criteria consisted of all clinical and cadaveric studies reporting on meniscal extrusion after PMMRTs, excluding studies lacking data in full extension, those presenting only semiquantitative analyses, articles reporting only differences in meniscal extrusion, and review articles. Results: A total of 45 studies were included. Imaging modality types included magnetic resonance imaging (89%), 3-dimensional reconstruction with computed tomography (7%), linear displacement transducers (2%), and a combination of magnetic resonance imaging and ultrasound (2%). The 3 most commonly used landmarks to acquire coronal images for meniscal extrusion measurements were the medial collateral ligament (38%), the midpoint of the anterior-posterior length of the medial meniscus (23%), and the middle of the medial femoral condyle (19%). The pooled mean extrusion values according to the measurement location were 3.5 ± 0.7 mm, 3.9 ± 0.8 mm, and 4.5 ± 2.1 mm, respectively, with no significant differences noted between the modality types (P = .23). The pooled mean meniscal extrusion from all included studies was 3.2 ± 2.0 mm. Conclusion: Substantial variation exists in measurement techniques for meniscal extrusion, particularly as it relates to the coronal cross-sectional reference location. Further studies should aim to provide clear descriptions of the measurement method and have uniform measurement methodology to allow comparisons and pooling between studies.

Medial meniscus posterior root tears and partial meniscectomy significantly increase stress in the knee joint during dynamic gait.

As a simple and invasive treatment, arthroscopic medial meniscal posterior horn resections (MMPHRs) can relieve the obstructive symptoms of medial meniscus posterior root tears (MMPRTs) but with the risk of aggravating biomechanical changes of the joint. The aim of this study was to analyze dynamic simulation of the knee joint after medial meniscus posterior root tear and posterior horn resection. This study established static and dynamic models of MMPRTs and MMPHRs on the basis of the intact medial meniscus model (IMM). In the finite element analysis, the three models were subjected to 1000N axial static load and the human walking gait load defined by the ISO14243-1 standard to evaluate the influence of MMPRTs and MMPHRs on knee joint mechanics during static standing and dynamic walking. In the static state, the load ratio of the medial and lateral compartments remained nearly constant (2:1), while in the dynamic state, the load ratio varied with the gait cycle. After MMPHRs, at 30% of the gait cycle, compared with the MMPRTs condition, the maximum von Mises stress of the lateral meniscus (LM) and the lateral tibial cartilage (LTC) were increased by 166.0% and 50.0%, respectively, while they changed by less than 5% during static analysis. The maximum von Mises stress of the medial meniscus (MM) decreased by 55.7%, and that of the medial femoral cartilage (MFC) increased by 53.5%. After MMPHRs, compared with MMPRTs, there was no significant stress increase in articular cartilage in static analysis, but there was a stress increase and concentration in both medial and lateral compartments in dynamic analysis, which may aggravate joint degeneration. Therefore, in clinical treatments, restoring the natural structure of MMPRTs is first recommended, especially for physically active patients.

Biomechanical assessment of disease outcome in surgical interventions for medial meniscal posterior root tears: a finite element analysis

BackgroundThe adverse consequences of medial meniscus posterior root tears have become increasingly familiar to surgeons, and treatment strategies have become increasingly abundant. In this paper, the finite element gait analysis method was used to explore the differences in the biomechanical characteristics of the knee joint under different conditions.MethodsBased on CT computed tomography and MR images, (I) an intact knee (IK) model with bone, cartilage, meniscus and main ligaments was established. Based on this model, the posterior root of the medial meniscus was resected, and (ii) the partial tear (PT) model, (iii) the entire radial tear (ERT) model, and (iv) the entire oblique tear (EOT) model were established according to the scope and degree of resection. Then, the (v) meniscus repair (MR) model and (vi) partial meniscectomy (PM) model were developed according to the operation method. The differences in stress, displacement and contact area among different models were evaluated under ISO gait loading conditions.ResultsUnder gait loading, there was no significant difference in the maximum stress of the medial and lateral tibiofemoral joints among the six models. Compared with the medial tibiofemoral joint stress of the IK model, the stress of the PM model increased by 8.3%, while that of the MR model decreased by 18.9%; at the same time, the contact stress of the medial tibiofemoral joint of the ERT and EOT models increased by 17.9 and 25.3%, respectively. The displacement of the medial meniscus in the ERT and EOT models was significantly larger than that in the IK model (P < 0.05), and the tibial and femoral contact areas of these two models were lower than those of the IK model (P < 0.05).ConclusionsThe integrity of the posterior root of the medial meniscus plays an important role in maintaining normal tibial-femoral joint contact mechanics. Partial meniscectomy is not beneficial for improving the tibial-thigh contact situation. Meniscal repair has a positive effect on restoring the normal biomechanical properties of the medial meniscus.

Medial meniscus posterior root tear reconstructed with gracilis autograft improve healing rate and patient reported outcome measures

BackgroundMany surgeries have not reversed or prevented progressive symptomatic knee arthritis, and there is no consensus regarding the ideal repair or reconstruction technique for meniscal root treatment. Additionally, there is a lack of studies comparing the clinical efficacy evaluation of different repair techniques. The aim of the present study is to compare the clinical efficacy and healing rates of meniscus root in the treatment of medial meniscus posterior root tear (MMPRT) with the arthroscopically assisted meniscus root reconstruction with gracilis autograft and transtibial pull-out technique.MethodsPatients with MMPRT (type II) who received treatment of posterior meniscus root attachment point through the tibial tunnel between January 2018 and April 2019 were included in this study. Patients were divided into 2 groups (arthroscopically assisted gracilis autograft reconstruction technique: 29 cases; transtibial pull-out technique group: 35 cases) according to the different treatment methods. The mean follow-up period was 26.9 ± 2.3 months. The demographics, functional recovery of the knee, and meniscus root healing rates (assessed using knee magnetic resonance imaging (MRI) at the final follow-up) were compared between the two groups.ResultsThere was a statistically significant improvement in the Lysholm score, international knee documentation committee (IKDC) score, and visual analogue scale (VAS) score (P < 0.001 in both groups). Additionally, compared with the transtibial pull-out repair group, the arthroscopically assisted reconstruction with gracilis autograft showed significant improvement in the meniscus root healing rates, Lysholm score, and IKDC score at the end of follow-up (P < 0.05).ConclusionsCompared with the transtibial pull-out technique, the arthroscopically assisted meniscus root reconstruction with gracilis autograft was advantageous for treating these patients with superior clinical outcome and higher meniscus root healing rates.Level of evidenceLevel III.

Outcomes of Arthroscopic All-Inside Repair Are Improved Compared to Transtibial Pull-Out Repair of Medial Meniscus Posterior Root Tears

The purpose of the present study was to compare the clinical outcomes of patients who underwent an all-inside repair (with a bony trough) versus transtibial pull-out repair in medial meniscus posterior root tears (MMPRTs). We retrospectively investigated consecutive patients who underwent MMPRT repairs in nonacute tears in age over 40 from November 2015 to June 2019. All patients were divided into a transtibial pull-out repair group and an all-inside repair group. Different surgical techniques were used during different time frames. All patients were followed-up for a minimum of 2 years. The data collected included the International Knee Documentation Committee (IKDC) Subjective, Lysholm, and Tegner activity scores. Magnetic resonance imaging (MRI) was performed at the 1-year follow-up to assess meniscus extrusion, signal intensity, and healing. The final cohort consisted of 28 patients in the all-inside repair group and 16 in the transtibial pull-out repair group. In the all-inside repair group, the IKDC Subjective, Lysholm, and Tegner scores improved significantly at the 2-year follow-up. In the transtibial pull-out repair group, the IKDC Subjective, Lysholm, and Tegner scores did not improve significantly at the 2-year follow-up. Postoperative extrusion ratio increased in both groups, and patient-reported outcomes at follow-up did not differ between the two groups The change in the extrusion ratio was significantly less in the all-inside repair group (P= .009), as was the postoperative meniscus signal (P= .011). Postoperative MRI revealed significantly better healing in the all-inside group (P= .041). All-inside repair improved the functional outcome scores. Radiologically, all-inside repair was better than transtibial pull-out repair. All-inside repair may be a viable MMPRT treatment option. III, retrospective cohort study.

Age and Meniscal Extrusion Are Determining Factors of Osteoarthritis Progression after Conservative Treatments for Medial Meniscus Posterior Root Tear.

With a growing understanding of biomechanical disadvantages following medial meniscus posterior root tear (MMPRT), recent studies have focused on surgical repair of MMPRT. Because not all tears are repairable, surgical indications can be properly established when the outcomes of conservative treatments are revealed. This study tried to identify risk factors for osteoarthritis progression after conservative treatments for isolated MMPRT. Patients who had conservative treatments for isolated MMPRT during 2013-2016 were retrospectively reviewed. To evaluate osteoarthritis progression, those who were followed up for ≤3 years and those who already showed advanced osteoarthritis of Kellgren--Lawrence (K-L) grade 4 at the time of diagnosis were excluded. Because patients with varus malalignment were candidates for realignment osteotomy, conservative treatments for MMPRT were applied to patients with well-aligned knees. Osteoarthritis progression was determined based on the K-L grading system, and risk factors including age, sex, body mass index, lower limb alignment, preoperative K-L grade, meniscal extrusion, and the presence of subchondral bone marrow lesion (BML) were analyzed using logistic regression analyses. A total of 42 patients were followed up for 57.4 ± 26.8 months. During that period, osteoarthritis progression was noted in 17 (40.5%) patients. Based on univariate analyses for each risk factor, age, meniscal extrusion, and the presence of subchondral BML were included in the multivariate logistic regression analysis. The results showed that age (p = 0.028, odds ratio = 0.87) and meniscal extrusion (p = 0.013, odds ratio = 9.65) were significant risk factors. A receiver operating characteristic curve found that the cutoff age was 63.5 years, with the area under the curve being 0.72 (sensitivity, 68.0%; specificity, 70.6%). About two-fifths of patients who had conservative treatments for MMPRT underwent osteoarthritis progression in the mid to long term. Age and meniscal extrusion were determining factors of osteoarthritis progression. The risk for osteoarthritis progression was decreased when the age of patients was over 63.5 years.

Changes in Bone Marrow Lesions Following Root Repair Surgery Using Modified Mason-Allen Stitches in Medial Meniscus Posterior Root Tears.

Root repair can prevent osteoarthritis (OA) by restoring hoop tension in medial meniscus posterior root tears (MMPRTs). This study aims to investigate bone marrow edema (BME) lesions known to be associated with OA following MMPRTs. Methods: Thirty patients with transtibial pull-out repair were recruited. Subchondral BME lesions were evaluated using magnetic resonance imaging (MRI) at 1-year follow-ups. Participants were categorized into three groups: no change of BME lesions (group one), improved BME lesions (group two) and worsened BME lesions (group three). Clinical scores and radiological outcomes, specifically Kellgren-Lawrence grade, medial joint space width and cartilage grade and meniscal extrusion were evaluated and compared between groups. Results: After surgery, twenty-three patients with no BME, three patients with BME lesions on the medial femoral condyle, one patient with BME lesions on the medial tibia plateau and three patients with BME lesions on both were investigated. A total of 20 patients in group one (66.7%) showed no change in BME lesions. In group two, seven patients (23.3%) presented with improved BME lesions. Only three patients (10%) showed worsened BME lesions (group three). Moreover, Lysholm scores and the rate of progression of cartilage grades were significantly worse in group three patients. Meniscal extrusion was significantly reduced in group two, whereas extrusion was significantly progressed in group three. Conclusion: Patients with worsened BME lesions showed less favorable outcomes than other patients. A decrease in meniscal extrusion can have a positive effect on BME lesions after root repair.

The Role of the Medial Meniscus in Anterior Knee Stability.

Few studies have compared the force distribution between the anterolateral, posterolateral, and medial structures of the knee. To investigate the important structures in an intact knee contributing to force distribution in response to anterior tibial load. Controlled laboratory study. Nine fresh-frozen cadaveric knee specimens underwent robotic testing. First, 100 N of anterior tibial load was applied to the intact knee at 0°, 15°, 30°, 60°, and 90° of knee flexion. The anterior cruciate ligament (ACL), anterolateral capsule, lateral collateral ligament, popliteal tendon, posterior root of the lateral meniscus, superficial medial collateral ligament, posterior root of the medial meniscus (MM), and posterior cruciate ligament were then completely transected in sequential order. After each transection, the authors reproduced the intact knee motion when a 100-N anterior tibial load was applied. By applying the principle of superposition, the resultant force of each structure was determined based on the 6 degrees of freedom force/torque data of each state. At every measured knee flexion angle, the resultant force of the ACL was the largest of the tested structures. At knee flexion angles of 60° and 90°, the resultant force of the MM was larger than that of all other structures with the exception of the ACL. The MM was identified as playing an important role in response to anterior tibial load at 60° and 90° of flexion. In clinical settings, the ACL of patients with a poorly functioning MM, such as tear of the MM posterior root, should be monitored considering the large resultant force in response to an anterior tibial load.