Non-operative management of medial meniscus posterior horn root tears is associated with worsening arthritis and poor clinical outcome at 5-year follow-up

Krych, Aaron J.; Reardon, Patrick J.; Johnson, Nick R.; Mohan, Rohith; Peter, Logan; Levy, Bruce A.; Stuart, Michael J.

doi:10.1007/s00167-016-4359-8

Cited by 205 publications

(230 citation statements)

References 36 publications

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“…Individuals with accelerated KOA have substantially greater pain and disability when compared to their peers without accelerated KOA, and this becomes evident prior to radiographic onset of the disease . Accelerated KOA may be a unique subset of KOA characterized by specific pathologic features (e.g., meniscal root tears ) that could differentiate it from typical KOA; however, this hypothesis has not been specifically examined. If specific pathologic profiles could be used to differentiate people at risk for accelerated KOA, it may help identify adults with early‐stage accelerated KOA or those at high risk for accelerated KOA, and thereby inspire novel prevention strategies.…”

Section: Introductionmentioning

confidence: 99%

Accelerated Knee Osteoarthritis Is Characterized by Destabilizing Meniscal Tears and Preradiographic Structural Disease Burden

Driban

Davis

Lü

et al. 2019

Arthritis & Rheumatology

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Objective. To determine whether accelerated knee osteoarthritis (KOA) is preceded by, and characterized over time by, destabilizing meniscal tears or other pathologic changes.Methods. We selected 3 sex-matched groups of subjects from the first 48 months of the Osteoarthritis Initiative, comprising adults who had a knee without KOA (Kellgren/Lawrence [K/L] radiographic grade <2) at baseline. Subjects in the accelerated KOA group developed KOA of K/L grade ≥3, those with typical KOA showed increased K/L radiographic scores, and those with no KOA had the same K/L grade over time. An index visit was the visit when the radiographic criteria for accelerated KOA and typical KOA were met (the no KOA group was matched to the accelerated KOA group). The observation period was up to 2 years before and after an index visit. Radiologists reviewed magnetic resonance (MR) images of the index knee and identified destabilizing meniscal tears (root tears, radial tears, complex tears), miscellaneous pathologic features (acute ligamentous or tendinous injuries, attrition, subchondral insufficiency fractures, other incidental findings), and meniscal damage in >2 of 6 regions (3 regions per meniscus: anterior horn, body, posterior horn). In addition, bone marrow lesions (BMLs) and cartilage damage on MR images were quantified. Linear mixed regression models were performed to analyze the results.Results. At 1 year before the index visit, >75% of adults with accelerated KOA had meniscal damage in ≥2 regions (odds ratio 3.19 [95% confidence interval 1.70-5.97] versus adults with typical KOA). By the index visit, meniscal damage in ≥2 regions was ubiquitous in adults with accelerated KOA, including 42% of subjects having evidence of a destabilizing meniscal tear (versus 14% of subjects with typical KOA). These changes corresponded to findings of larger BMLs and greater cartilage loss in the accelerated KOA group.Conclusion. Accelerated KOA is characterized by destabilizing meniscal tears in a knee compromised by meniscal damage in >2 regions, and also characterized by the presence of large BMLs and greater cartilage loss.

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Section: Introductionmentioning

confidence: 99%

Accelerated Knee Osteoarthritis Is Characterized by Destabilizing Meniscal Tears and Preradiographic Structural Disease Burden

Driban

Davis

Lü

et al. 2019

Arthritis & Rheumatology

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“…If left untreated, meniscal extrusion can occur rendering the meniscus nonfunctional resulting in degenerative arthritis of the knee. 3,4 Chung et al 5 compared the outcomes of 37 patients with meniscal root repairs with 20 patients who underwent partial meniscectomies. The repair group had superior subjective knee rating and knee function scores with less radiographic progression of arthritis.…”

mentioning

confidence: 99%

Medial Meniscus Posterior Root Repair Using a Transtibial Technique

Woodmass

Mohan

Stuart

et al. 2017

Arthroscopy Techniques

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The meniscal roots are critical in maintaining the normal shock absorbing function of the meniscus. If a meniscal root tear is left untreated, meniscal extrusion can occur rendering the meniscus nonfunctional resulting in degenerative arthritis. Two main repair techniques are described: (1) suture anchors (direct fixation) and (2) sutures pulled through a tibial tunnel (indirect fixation). Meniscal root repair using a suture anchor technique is technically challenging requiring a posterior portal and a curved suture passing device that can be difficult to manipulate within the knee. We present a technique for posterior medial meniscus root repair using 3 sutures (1 leader, 2 cinch), standard arthroscopy portals, and transtibial fixation. Overall, this technique simplifies a challenging procedure and allows for familiarity and efficiency.

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“…Along with the overall difference in arthritic changes, 35% of the patients who had undergone a meniscectomy to treat a meniscal root tear underwent conversion to total knee arthroplasty (TKA) by 5-year follow-up, whereas none of the patients who had undergone a meniscal root repair underwent conversion to TKA 38. To further support the importance of recognising and repairing meniscal root tears, Krych et al 39 reported poor clinical outcomes, worsening of OA and a 31% conversion to arthroplasty in 52 patients treated conservatively for posterior root tears at a mean follow-up of 5 years.…”

Section: Strategies and Evidencementioning

confidence: 99%

“…Moreover, studies have indicated that indirect costs associated with TKA can grow to as much as US$68 000 per patient, increasing the economic burden on the patient and the overall healthcare infrastructure. In this regard, Krych et al reported that the 16 patients (31%) with untreated meniscal root tears that underwent conversion to TKA by 5-year follow-up resulted in a US$1.1 million direct cost to society 39. Although TKA is a cost-effective treatment when compared with non-operative management for end-stage OA, treating medial meniscal root tears conservatively or with meniscectomy will likely accelerate the rise in the projected volume of TKA cases, putting further strain on the US healthcare system due to the increased costs.…”

Section: Strategies and Evidencementioning

confidence: 99%