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Clinical and Radiologic Outcomes of Patients With Lax Healing After Medial Meniscal Root Repair: Comparison With Subtotal Meniscectomy

Published:October 16, 2019DOI:https://doi.org/10.1016/j.arthro.2019.05.051

      Purpose

      To compare radiologic and clinical outcomes between patients who underwent medial meniscus posterior root tear (MMPRT) repair and were subsequently classified as having lax healing based on second-look arthroscopy and patients who underwent subtotal meniscectomy for an MMPRT.

      Methods

      The patients who received pullout repair or subtotal meniscectomy due to MMPRT between January 2011 and December 2014 were retrospectively reviewed. Among the patients who underwent MMPRT repair, those whose lax healing of the repair site was confirmed by second-look arthroscopy (repair/lax healing group) and among the patients who received subtotal meniscectomy, those who have varus deformity of <5° and a Kellgren–Lawrence grade of ≤2 (meniscectomy group) were included in the study population. Medial joint space width, Kellgren–Lawrence grade, International Knee Documentation Committee Subjective Knee Evaluation Form score, and Lysholm Knee score were used for radiologic and clinical assessment.

      Results

      The meniscectomy group included 24 patients (average follow-up, 37.2 months), and the repair/lax healing group included 21 patients (average follow-up, 39.2 months). The 2 groups showed improved patient-reported outcomes postoperatively (P < .001). However, medial joint space width (P < .001) became narrow and Kellgren–Lawrence grade (P = .002 and P = .005, respectively) worsened. Comparison of the radiologic outcomes between the 2 groups revealed that the repair/lax healing group had less Kellgren–Lawrence grade progression than the meniscectomy group (P = .014). The grade progressed by ≥2 grades in 4 patients (16.7%) and 0 patients in the meniscectomy and repair/lax healing groups, respectively (P < .001).

      Conclusions

      Although the repair/lax healing group showed improved functional outcomes on short-term follow-up, arthritic change progressed radiologically. Nevertheless, the repair/lax healing group showed better radiologic outcomes than the meniscectomy group, despite lax healing of the repair site. However, because of the small number of cases in this study, the results of this study could be associated with potential for type II or β errors.

      Level of Evidence

      Level III, retrospective comparative study.
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      Linked Article

      • Editorial Commentary: Failure With Continuity: Redefining Healing With Meniscal Root Repair
        ArthroscopyVol. 35Issue 11
        • Preview
          The importance of the medial meniscus posterior root for preserving knee joint kinematics, joint contact pressures, and articular cartilage integrity is well recognized. Medial meniscus root repair generally is associated with favorable clinical outcomes and radiographic changes compared with conservative treatment or subtotal meniscectomy; however, second-look arthroscopy often reveals some laxity at the repair site. Even in this latter situation of “failure with continuity” of the meniscus root repair, there may be benefit in delaying progression of radiographic degeneration changes.
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