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

Published:October 16, 2019DOI:


      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.


      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.


      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).


      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.
      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 access
      One-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 to Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Allaire R.
        • Muriuki M.
        • Gilbertson L.
        • Harner C.D.
        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
        • Bhatia S.
        • LaPrade C.M.
        • Ellman M.B.
        • LaPrade R.F.
        Meniscal root tears: Significance, diagnosis, and treatment.
        Am J Sports Med. 2014; 42: 3016-3030
        • Lee D.W.
        • Ha J.K.
        • Kim J.G.
        Medial meniscus posterior root tear: A comprehensive review.
        Knee Surg Relat Res. 2014; 26: 125-134
        • LaPrade C.M.
        • Jansson K.S.
        • Dornan G.
        • Smith S.D.
        • Wijdicks C.A.
        • LaPrade R.F.
        Altered tibiofemoral contact mechanics due to lateral meniscus posterior horn root avulsions and radial tears can be restored with in situ pull-out suture repairs.
        J Bone Joint Surg Am. 2014; 96: 471-479
        • LaPrade R.F.
        • LaPrade C.M.
        • James E.W.
        Recent advances in posterior meniscal root repair techniques.
        J Am Acad Orthop Surg. 2015; 23: 71-76
        • Chung K.S.
        • Ha J.K.
        • Yeom C.H.
        • et al.
        Comparison of clinical and radiologic results between partial meniscectomy and refixation of medial meniscus posterior root tears: A minimum 5-year follow-up.
        Arthroscopy. 2015; 31: 1941-1950
        • Jung Y.H.
        • Choi N.H.
        • Oh J.S.
        • Victoroff B.N.
        All-inside repair for a root tear of the medial meniscus using a suture anchor.
        Am J Sports Med. 2012; 40: 1406-1411
        • Kim J.H.
        • Chung J.H.
        • Lee D.H.
        • Lee Y.S.
        • Kim J.R.
        • Ryu K.J.
        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
        • Lee J.H.
        • Lim Y.J.
        • Kim K.B.
        • Kim K.H.
        • Song J.H.
        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
        • Cho J.H.
        • Song J.G.
        Second-look arthroscopic assessment and clinical results of modified pull-out suture for posterior root tear of the medial meniscus.
        Knee Surg Relat Res. 2014; 26: 106-113
        • Kim S.B.
        • Ha J.K.
        • Lee S.W.
        • et al.
        Medial meniscus root tear refixation: Comparison of clinical, radiologic, and arthroscopic findings with medial meniscectomy.
        Arthroscopy. 2011; 27: 346-354
        • Seo H.S.
        • Lee S.C.
        • Jung K.A.
        Second-look arthroscopic findings after repairs of posterior root tears of the medial meniscus.
        Am J Sports Med. 2011; 39: 99-107
        • Lee S.S.
        • Ahn J.H.
        • Kim J.H.
        • Kyung B.S.
        • Wang J.H.
        Evaluation of healing after medial meniscal root repair using second-look arthroscopy, clinical, and radiological criteria.
        Am J Sports Med. 2018; 46: 2661-2668
        • Okazaki Y.
        • Furumatsu T.
        • Shimamura Y.
        • et al.
        Time-dependent increase in medial meniscus extrusion after medial meniscus posterior root tear analyzed by using magnetic resonance imaging.
        Knee Surg Relat Res. 2019; 31: 120-125
        • Papalia R.
        • Vasta S.
        • Franceschi F.
        • D'Adamio S.
        • Maffulli N.
        • Denaro V.
        Meniscal root tears: from basic science to ultimate surgery.
        Br Med Bull. 2013; 106: 91-115
        • Lee Y.G.
        • Shim J.C.
        • Choi Y.S.
        • Kim J.G.
        • Lee G.J.
        • Kim H.K.
        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
        • Kellgren J.H.
        • Lawrence J.S.
        Radiological assessment of osteo-arthrosis.
        Ann Rheum Dis. 1957; 16: 494-502
        • Krych A.J.
        • Johnson N.R.
        • Mohan R.
        • Dahm D.L.
        • Levy B.A.
        • Stuart M.J.
        Partial meniscectomy provides no benefit for symptomatic degenerative medial meniscus posterior root tears.
        Knee Surg Sports Traumatol Arthrosc. 2018; 26: 1117-1122
        • Feucht M.J.
        • Grande E.
        • Brunhuber J.
        • Burgkart R.
        • Imhoff A.B.
        • Braun S.
        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
        • Shelbourne K.D.
        • Dickens J.F.
        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
        • Furumatsu T.
        • Kodama Y.
        • Kamatsuki Y.
        • Hino T.
        • Okazaki Y.
        • Ozaki T.
        Meniscal extrusion progresses shortly after the medial meniscus posterior root tear.
        Knee Surg Relat Res. 2017; 29: 295-301
        • Lee D.H.
        • Lee B.S.
        • Kim J.M.
        • et al.
        Predictors of degenerative medial meniscus extrusion: radial component and knee osteoarthritis.
        Knee Surg Sports Traumatol Arthrosc. 2011; 19: 222-229
        • Irrgang J.J.
        • Anderson A.F.
        • Boland A.L.
        • et al.
        Development and validation of the International Knee Documentation Committee Subjective Knee Form.
        Am J Sports Med. 2001; 29: 600-613
        • Lysholm J.
        • Gillquist J.
        Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale.
        Am J Sports Med. 1982; 10: 150-154

      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.
        • Full-Text
        • PDF