Purpose
To compare the clinical and radiologic results of partial meniscectomy with those
of refixation in patients with medial meniscus posterior root tears (MMPRTs) at a
minimum 5-year follow-up.
Methods
Between 2005 and 2009, patients with MMPRTs who had been followed up for at least
5 years after a partial meniscectomy (group M, n = 20) or pullout repair (group R,
n = 37) were recruited. The mean follow-up duration was 67.5 months in group M and
72.0 months in group R. Clinical assessments, including the Lysholm score and International
Knee Documentation Committee (IKDC) Subjective Knee Form score, and radiographic assessments,
including the Kellgren-Lawrence (K-L) grade and medial joint space width, were evaluated
preoperatively and at final follow-up. We compared the preoperative results with the
final results in each group, and we compared the final results of groups M and R.
Five-year survival rates were also evaluated.
Results
The mean Lysholm score (P = .039) and IKDC score (P = .037) improved significantly. However, the width of the medial joint space (P < .001) and K-L grade (P < .001) worsened significantly in both groups. When we compared the final results,
group R had significantly better Lysholm scores (P = .002) and IKDC scores (P < .001) than group M. Group R showed less K-L grade progression (P = .005) and less medial joint space narrowing (P < .001) than group M. The rate of conversion to total knee arthroplasty was 35% in
group M, whereas there was no conversion to total knee arthroplasty in group R. The
5-year survival rates in groups M and R were 75% and 100%, respectively (P < .001).
Conclusions
For MMPRTs, refixation was more effective than partial meniscectomy in terms of the
clinical and radiologic outcomes and survival for at least 5 years' follow-up. Refixation
slowed the progression of arthritic changes compared with partial meniscectomy, although
it did not prevent the progression of arthrosis completely.
Level of Evidence
Level III, retrospective comparative study.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to ArthroscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Material properties and structure-function relationships in the menisci.Clin Orthop Relat Res. 1990; : 19-31
- Meniscal root tears: Diagnosis and treatment.Arthroscopy. 2009; 25: 1025-1032
- Biomechanical consequences of a tear of the posterior root of the medial meniscus. Similar to total meniscectomy.J Bone Joint Surg Am. 2008; 90: 1922-1931
- Radial tears of the posterior horn of the medial meniscus.Arthroscopy. 2004; 20: 373-378
- Tibiofemoral contact mechanics following posterior root of medial meniscus tear, repair, meniscectomy, and allograft transplantation.Knee Surg Sports Traumatol Arthrosc. 2013; 21: 2121-2125
- Meniscal extrusion and spontaneous osteonecrosis with root tear of medial meniscus: Comparison with horizontal tear.Arthroscopy. 2013; 29: 726-732
- Meniscal root tears: Significance, diagnosis, and treatment.Am J Sports Med. 2014; 42: 3016-3030
- Role of nonoperative treatment in managing degenerative tears of the medial meniscus posterior root.J Orthop Traumatol. 2013; 14: 193-199
- Non-operative treatment of degenerative posterior root tear of the medial meniscus.Knee Surg Sports Traumatol Arthrosc. 2010; 18: 535-539
- Unfavorable results of partial meniscectomy for complete posterior medial meniscus root tear with early osteoarthritis: A 5- to 8-year follow-up study.Arthroscopy. 2010; 26: 1326-1332
- Medial meniscus root tear refixation: Comparison of clinical, radiologic, and arthroscopic findings with medial meniscectomy.Arthroscopy. 2011; 27: 346-354
- All-inside repair for a root tear of the medial meniscus using a suture anchor.Am J Sports Med. 2012; 40: 1406-1411
- Prognostic factors of arthroscopic pull-out repair for a posterior root tear of the medial meniscus.Am J Sports Med. 2012; 40: 1138-1143
- Arthroscopic suture anchor repair versus pullout suture repair in posterior root tear of the medial meniscus: A prospective comparison study.Arthroscopy. 2011; 27: 1644-1653
- Second-look arthroscopic findings after repairs of posterior root tears of the medial meniscus.Am J Sports Med. 2011; 39: 99-107
- Arthroscopic pullout suture repair of posterior root tear of the medial meniscus: Radiographic and clinical results with a 2-year follow-up.Arthroscopy. 2009; 25: 951-958
- Second-look arthroscopic findings after open-wedge high tibia osteotomy focusing on the posterior root tears of the medial meniscus.Arthroscopy. 2013; 29: 226-231
- Radial tears in the root of the posterior horn of the medial meniscus.Knee Surg Sports Traumatol Arthrosc. 2008; 16: 849-854
- Biomechanical consequences of a complete radial tear adjacent to the medial meniscus posterior root attachment site: In situ pull-out repair restores derangement of joint mechanics.Am J Sports Med. 2014; 42: 699-707
- Magnetic resonance imaging findings of surgically proven medial meniscus root tear: Tear configuration and associated knee abnormalities.J Comput Assist Tomogr. 2008; 32: 452-457
- The etiology of chondromalacia patellae.J Bone Joint Surg Br. 1961; 43: 752-757
- Digital radiographic evaluation of medial joint space narrowing after partial meniscectomy of bucket-handle medial meniscus tears in anterior cruciate ligament-intact knees.Am J Sports Med. 2006; 34: 1648-1655
- Radiological assessment of osteo-arthrosis.Ann Rheum Dis. 1957; 16: 494-502
- Effects of medial meniscus posterior horn avulsion and repair on tibiofemoral contact area and peak contact pressure with clinical implications.Am J Sports Med. 2009; 37: 124-129
- Meniscus root refixation technique using a modified Mason-Allen stitch.Knee Surg Sports Traumatol Arthrosc. 2013; 21: 654-657
- Microvasculature of the human meniscus.Am J Sports Med. 1982; 10: 90-95
- Collagenous fibril texture of the human knee joint menisci.Anat Embryol (Berl). 1998; 197: 317-324
- Meniscal root tears: From basic science to ultimate surgery.Br Med Bull. 2013; 106: 91-115
- Biomechanical evaluation of different suture techniques for arthroscopic transtibial pull-out repair of posterior medial meniscus root tears.Am J Sports Med. 2013; 41: 2784-2790
- The Chitranjan Ranawat award: Is neutral mechanical alignment normal for all patients? The concept of constitutional varus.Clin Orthop Relat Res. 2012; 470: 45-53
Article info
Publication history
Published online: June 18, 2015
Accepted:
March 19,
2015
Received:
September 10,
2014
Footnotes
The authors report that they have no conflicts of interest in the authorship and publication of this article.
Identification
Copyright
© 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
