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Degenerative Medial Meniscus Tear With a Displaced Flap Into the Meniscotibial Recess and Tibial Peripheral Reactive Bone Edema Presents Good Results With Arthroscopic Surgical Treatment

      Purpose

      To report the arthroscopic treatment results of a degenerative medial meniscus tear with a displaced flap into the meniscotibial recess, tibial peripheral reactive bone edema, and focal knee medial pain. As a secondary objective, we propose to identify possible factors associated with a good or poor prognosis of the surgical treatment of this lesion.

      Methods

      From 2012 to 2018, patients who had this specific meniscus pathology and underwent arthroscopic surgical treatment were retrospectively evaluated. Patients with Kellgren-Lawrence (KL) classification greater than 2 were excluded. KL classification, the presence of an Outerbridge grade III/V chondral lesion of the medial compartment, limb alignment, body mass index, and smoking were evaluated. The subjective outcomes included the International Knee Documentation Committee score, improvement in the pain reported by patients, and the Global Perceived Effect (GPE) scale score.

      Results

      A total of 69 patients were evaluated. The mean age was 58.6 ± 7.1 years. The follow-up time was 48.7 ± 20.8 months. Fifty-five (79.7%) patients reported pain improvement. The postoperative International Knee Documentation Committee was 62.6 ± 15.4, and the mean GPE was 2.3 ± 2.6. Fourteen patients (20.3%) showed no improvement in pain, and 7 patients (10.2%) presented complications. Groups that improved (GPE > 0) and did not improve (GPE < 0) did not present differences regarding age, sex, follow-up time, chondral lesions, or body mass index. Patients without improvement had a greater incidence of smoking (P = .001), varus alignment (P = .008), and more advanced KL classification (P < .001). In the multivariate analysis based on the GPE score, KL classification (P = .038) and smoking (P = .003) were significant.

      Conclusions

      Arthroscopic surgical treatment of degenerative medial meniscal tears with a meniscal flap displaced into the meniscotibial recess and adjacent focal bone edema in the tibia shows good results in approximately 80% of cases. Smoking and KL grade 2 were factors associated with poor prognosis of surgical treatment.

      Level of Evidence

      Level IV (case series).
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      References

        • Hohmann E.
        • Glatt V.
        • Tetsworth K.
        • Cote M.
        Arthroscopic partial meniscectomy versus physical therapy for degenerative meniscus lesions: how robust is the current evidence? A critical systematic review and qualitative synthesis.
        Arthroscopy. 2018; 34: 2699-2708
        • Sihvonen R.
        • Paavola M.
        • Malmivaara A.
        • et al.
        Arthroscopic partial meniscectomy versus placebo surgery for a degenerative meniscus tear: A 2-year follow-up of the randomised controlled trial.
        Ann Rheum Dis. 2018; 77: 188-195
        • Lizaur-Utrilla A.
        • Miralles-Muñoz F.A.
        • Gonzalez-Parreño S.
        • Lopez-Prats F.A.
        Outcomes and patient satisfaction with arthroscopic partial meniscectomy for degenerative and traumatic tears in middle-aged patients with no or mild osteoarthritis.
        Am J Sports Med. 2019; 47: 2412-2419
        • Karpinski K.
        • Müller-Rath R.
        • Niemeyer P.
        • Angele P.
        • Petersen W.
        Subgroups of patients with osteoarthritis and medial meniscus tear or crystal arthropathy benefit from arthroscopic treatment.
        Knee Surg Sports Traumatol Arthrosc. 2019; 27: 782-796
        • Hohmann E.
        • Angelo R.
        • Arciero R.
        • et al.
        Degenerative meniscus lesions: An expert consensus statement using the modified Delphi technique.
        Arthroscopy. 2020; 36: 501-512
        • Essilfie A.
        • Kang H.P.
        • Mayer E.N.
        • Trasolini N.A.
        • Alluri R.K.
        • Weber A.E.
        Are orthopaedic surgeons performing fewer arthroscopic partial meniscectomies in patients greater than 50 years old? A national database study.
        Arthroscopy. 2019; 35: 1152-1159.e1
        • Bernard C.D.
        • Kennedy N.I.
        • Tagliero A.J.
        • et al.
        Medial meniscus posterior root tear treatment: A matched cohort comparison of nonoperative management, partial meniscectomy, and repair.
        Am J Sports Med. 2020; 48: 128-132
        • 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
        • Helito C.P.
        • Melo L. da P.
        • Guimarães T.M.
        • et al.
        Alternative techniques for lateral and medial posterior root meniscus repair without special instruments.
        Arthrosc Tech. 2020; 9: e1017-e1025
        • Lecouvet F.
        • Van Haver T.
        Acid S, et al. Magnetic resonance imaging (MRI) of the knee: Identification of difficult-to-diagnose meniscal lesions.
        Diagn Interv Imaging. 2018; 99: 55-64
        • Herschmiller T.A.
        • Anderson J.A.
        • Garrett W.E.
        • Taylor D.C.
        The trapped medial meniscus tear: An examination maneuver helps predict arthroscopic findings.
        Orthop J Sports Med. 2015; 3 (2325967115583954)
        • Jung M.
        • Lee D.H.
        • Kim S.-J.
        • et al.
        Preoperative diagnosis and treatment outcomes of incarcerated inferiorly displaced flap tear of the medial meniscus: Comparison between flap tears with and without incarcerated fragment.
        Biomed Res Int. 2018; 2018: 5941057
        • Bassett A.J.
        • Hadley C.J.
        • Tjoumakaris F.
        • Freedman K.B.
        The meniscal grammar signs: Comma and apostrophe signs for characterization of a displaced fragment in the meniscal recess.
        Arthrosc Tech. 2019; 8: e727-e732
        • Krych A.J.
        • Wu I.T.
        • Desai V.S.
        • et al.
        Osteomeniscal impact edema (OMIE): Description of a distinct MRI finding in displaced flap tears of the medial meniscus, with comparison to posterior root tears.
        J Knee Surg. 2020; 33: 659-665
        • Chang E.Y.
        • Chen K.C.
        • Chung C.B.
        The shiny corner of the knee: A sign of meniscal osteochondral unit dysfunction.
        Skeletal Radiol. 2014; 43: 1403-1409
        • Marcillaud G.
        • Cistac C.
        • Moisan J.
        • Heizmann J.
        Conflit ostéoméniscal: Intérêt de sa sémiologie IRM dans l’identification d’une lésion méniscale instable. À propos de 13 cas.
        Rev Chir Orthop Traumatol. 2013; 99: S60-S66
        • Salem H.S.
        • Carter A.H.
        • Shi W.J.
        • et al.
        The meniscal comma sign: Characterization and treatment of a displaced fragment in the meniscotibial recess.
        Orthopedics. 2018; 41: e442-e444
        • Lecas L.K.
        • Helms C.A.
        • Kosarek F.J.
        • Garret W.E.
        Inferiorly displaced flap tears of the medial meniscus: MR appearance and clinical significance.
        AJR Am J Roentgenol. 2000; 174: 161-164
        • Kamper S.J.
        • Ostelo R.W.J.G.
        • Knol D.L.
        • Maher C.G.
        • de Vet H.C.W.
        • Hancock M.J.
        Global Perceived Effect scales provided reliable assessments of health transition in people with musculoskeletal disorders, but ratings are strongly influenced by current status.
        J Clin Epidemiol. 2010; 63: 760-766.e1
        • Sihvonen R.
        • Paavola M.
        • Malmivaara A.
        • et al.
        Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear.
        N Engl J Med. 2013; 369: 2515-2524
        • Katz J.N.
        Editorial Commentary: Degenerative meniscal tear: Sojourn to the oracle.
        Arthroscopy. 2020; 36: 513-515
        • Kartus J.-T.
        Editorial commentary: Fresh evidence that there is still no reliable evidence on how to best treat knee degenerative meniscus tears.
        Arthroscopy. 2018; 34: 2711-2712
        • Cole B.J.
        • Chahla J.
        Editorial commentary: Meniscal tears or meniscal aging—that is the question.
        Arthroscopy. 2019; 35: 1160-1162
        • Lubowitz J.H.
        • Brand J.C.
        • Rossi M.J.
        Nonoperative management of degenerative meniscus tears is worth a try.
        Arthroscopy. 2020; 36: 327-328
        • Bonadio M.B.
        • Filho A.G.O.
        • Helito C.P.
        • Stump X.M.
        • Demange M.K.
        Bone marrow lesion: Image, clinical presentation, and treatment.
        Magn Reson Insights. 2017; 10 (1178623X17703382)
        • Khan I.
        • Ashraf T.
        • Saifuddin A.
        Magnetic resonance imaging of impingement and friction syndromes around the knee.
        Skeletal Radiol. 2020; 49: 823-836
        • Kon E.
        • Ronga M.
        • Filardo G.
        • et al.
        Bone marrow lesions and subchondral bone pathology of the knee.
        Knee Surg Sports Traumatol Arthrosc. 2016; 24: 1797-1814
        • Moran T.E.
        • Demers A.
        • Awowale J.T.
        • Werner B.C.
        • Miller M.D.
        The outside-in, percutaneous release of the medial collateral ligament for knee arthroscopy.
        Arthrosc Tech. 2020; 9: e393-e397
        • Heyer J.H.
        • Perim D.A.
        • Amdur R.L.
        • Pandarinath R.
        Impact of smoking on outcomes following knee and shoulder arthroscopy.
        Eur J Orthop Surg Traumatol. 2020; 30: 329-336
        • Johnson D.J.
        • Castle J.P.
        • Hartwell M.H.
        • et al.
        Smoking as a risk factor for readmission in arthroscopic surgery: A propensity matched analysis.
        J Surg Orthop Adv. 2019; 28: 272-276
        • Basques B.A.
        • Gardner E.C.
        • Varthi A.G.
        • et al.
        Risk factors for short-term adverse events and readmission after arthroscopic meniscectomy: Does age matter?.
        Am J Sports Med. 2015; 43: 169-175