Evaluation of Healing After Medial Meniscal Root Repair Using Second-Look Arthroscopy, Clinical, and Radiological Criteria

Lee, Sung-Sahn; Ahn, Jin Hwan; Kim, Jun Ho; Kyung, Bong Soo; Wang, Joon Ho

doi:10.1177/0363546518788064

Cited by 46 publications

(95 citation statements)

References 29 publications

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Section: Discussionmentioning

confidence: 99%

“…These findings are not novel, as they are consistent with previous studies that showed overall degenerative changes in the knee joint over time despite clinical improvement after arthroscopic transtibial pull-out repair of MMRT. 9,11,31 Accordingly, although the prevention of osteoarthritis progression has been shown to be difficult, several studies have been performed to find factors influencing surgical outcomes to delay or minimize the degenerative change of the knee as well as to improve surgical outcomes as much as possible. As a result, various factors such as patient age, varus alignment, the severity of cartilage lesion, healing status of repaired MMRT, and the change in MME after surgery have been found to be relevant factors and have been applied in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

“…As a result, various factors such as patient age, varus alignment, the severity of cartilage lesion, healing status of repaired MMRT, and the change in MME after surgery have been found to be relevant factors and have been applied in clinical practice. 10,11,31,34 Before the current study, prognostic factors including age, radiographic osteoarthritis grade, and the severity of cartilage lesions had been applied in the patient selection process to reduce the possibility of poor surgical outcomes. Furthermore, technical attempts were made to improve the surgical outcomes of the patients included in this study.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Early Surgical Repair of Medial Meniscus Posterior Root Tear Minimizes the Progression of Meniscal Extrusion: 2-Year Follow-up of Clinical and Radiographic Parameters After Arthroscopic Transtibial Pull-out Repair

et al. 2020

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Background: Conflicting results have been reported concerning the progression of medial meniscal extrusion (MME) after arthroscopic transtibial pull-out repair of medial meniscus posterior root tear (MMRT), and no study has evaluated the relevant factors affecting the progression of MME. Purpose: To (1) evaluate the subjective and objective surgical outcomes of arthroscopic transtibial pull-out repair of MMRT and (2) identify relevant factors affecting the progression of MME after surgery. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 63 patients who underwent isolated arthroscopic transtibial pull-out repair of MMRT between January 2010 and June 2017 were evaluated retrospectively. Clinical scores and various radiographic parameters were evaluated to assess the surgical outcomes. The patients were classified into 2 groups according to the change in medial meniscal extrusion ratio (MMER) at 1 year after surgery compared with before surgery (group 1 consisted of 21 patients with reduced or maintained MMER; group 2 consisted of 42 patients with increased MMER). Variables including baseline demographics, radiographic parameters, and arthroscopic findings were compared to identify relevant factors affecting the progression of MME after surgery. Results: In the overall cohort, clinical outcomes at postoperative 2 years improved significantly ( P < .001 for visual analog scale score, International Knee Documentation Committee subjective score, and Lysholm score), whereas radiographic parameters showed an overall deterioration compared with the preoperative level. In subgroup comparisons, a significant difference was seen in the time from the onset of symptoms until surgery ( P < .001), defined as preoperative symptom duration, which a subsequent logistic regression analysis revealed to be a relevant factor associated with the progression of MMER ( P = .015). Both groups showed progression of radiographic osteoarthritis, but the progression was significantly higher in group 2 compared with group 1 at postoperative 2 years ( P = .032). On receiver operating characteristic curve analysis, the cutoff point for preoperative symptom duration associated with the progression of MMER was 13 weeks (sensitivity, 52.4%; specificity, 76.2%; accuracy, 72.4%). Conclusion: The arthroscopic transtibial pull-out repair of MMRT showed clinical improvement but did not prevent the progression of knee osteoarthritis, MME, or MMER. Although the preservation of MMER was not capable of completely preventing the progression of knee degeneration, MMER still has a potential clinical value in delaying the rate of progression of knee degeneration. Early surgical repair of MMRT, within 13 weeks from the onset of symptoms, might be helpful to prevent the progression of MME.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Early Surgical Repair of Medial Meniscus Posterior Root Tear Minimizes the Progression of Meniscal Extrusion: 2-Year Follow-up of Clinical and Radiographic Parameters After Arthroscopic Transtibial Pull-out Repair

et al. 2020

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“…Lee et al 15 evaluated the healing of the meniscal root injury using second-look arthroscopy. Seventy percent of patients were stably healed and presented higher scores (Hospital for Special Surgery and International Knee Documentation Committee scores) than those with unstable healing.…”

Section: Discussionmentioning

confidence: 99%

Posterior Meniscal Root Repair Using a Meniscal Suture Device

Faria

Pavão

Pedrinha

et al. 2020

Arthroscopy Techniques

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A greater understanding of the deleterious consequences that a meniscal root tear brings to the knee joint and how its surgical repair can be advantageous over the previously used treatment strategies brings the need for the development of surgical techniques that make the procedure less complex and more reproducible. When meniscal root rupture occurs, a mechanical overload occurs in the affected compartment similar to a total meniscectomy. Several authors have concluded that meniscal root reinsertion significantly improves postoperative outcomes and patient satisfaction, regardless of age or laterality of the meniscal injury. The Meniscus 4 A-II device (Rio de Janeiro, Brazil) allows stitching at the root of the medial and lateral menisci. In this article, we describe the surgical repair technique for posteriormedial and-lateral meniscal root tears using this meniscal suture device. This technique is fast and effective.

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“…14 As an alternative to medial collateral ligament release, posterior portals increase accessibility to the posterior root area. 15 For the comparison between transtibial pullout repair and suture anchor repair, we compared the findings of the study by Chung et al 16 (transtibial pullout repair) with those of Feucht et al 8 (suture anchor). We concluded that currently, there is no consensus on the biomechanical superiority between the 2 techniques.…”

Section: See Related Article On Page 2189mentioning

confidence: 99%

Editorial Commentary: Save the Meniscal Root, Why Not?

Kim

2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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The repair of the meniscal root in medial meniscal posterior root tears is receiving increasing interest as more and more research highlights the positive effects of this procedure on the biomechanical restoration of the meniscus. As a testament to the findings of these studies, an international consensus statement recently acknowledged, with several supporting findings from both biomechanical and clinical studies, the effectiveness of meniscal root repairs. Various root repair techniques have been developed with the overarching goal of restoring the structure and function of the meniscus. Yet several challenges such as obtaining robust and long-term healing of degenerative tissue and minimizing meniscal extrusion remain to be overcome.

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Evaluation of Healing After Medial Meniscal Root Repair Using Second-Look Arthroscopy, Clinical, and Radiological Criteria

Abstract: Despite degenerative change progression, clinical outcomes were improved. The successful healing rate was 69.7% after repair of MMRTs. Compared with the unhealed group, the stable healed group showed better clinical outcomes and less degenerative change progression.

Cited by 46 publications

References 29 publications

Early Surgical Repair of Medial Meniscus Posterior Root Tear Minimizes the Progression of Meniscal Extrusion: 2-Year Follow-up of Clinical and Radiographic Parameters After Arthroscopic Transtibial Pull-out Repair

Early Surgical Repair of Medial Meniscus Posterior Root Tear Minimizes the Progression of Meniscal Extrusion: 2-Year Follow-up of Clinical and Radiographic Parameters After Arthroscopic Transtibial Pull-out Repair

Posterior Meniscal Root Repair Using a Meniscal Suture Device

Editorial Commentary: Save the Meniscal Root, Why Not?

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