Prospective Consecutive Clinical Outcomes After Transtibial Root Repair for Posterior Meniscal Root Tears: A Multicenter Study

Abstract

Background: Prospective evaluation of clinical outcomes after posterior meniscal root repair utilizing a transtibial pullout technique is limited, and factors that may contribute to outcomes are unclear. Hypothesis: It was hypothesized that there would be an overall significant improvement in outcomes after root repair and that differences in clinical outcomes would correlate with age, body mass index (BMI), sex, and meniscal extrusion. Study Design: Case-control study; Level of evidence, 3. Methods: Consecutive patients undergoing transtibial medial or lateral meniscal root repair were enrolled prospectively at 2 orthopaedic centers between March 2017 and January 2019. Pre- and postoperative magnetic resonance imaging (MRI) were obtained to assess for meniscal healing, quantification of extrusion, articular cartilage grade, and subchondral bone changes. Patient-reported outcomes including International Knee Documentation Committee (IKDC) scores, Tegner activity scale, and visual analog scale (VAS) for pain were collected preoperatively and 2 years postoperatively. Patients were then subdivided by clinical and demographic characteristics to determine factors associated with clinical outcomes. Results: Included were 45 patients (29 female, 16 male; mean age, 42.3 ± 12.9 years; mean BMI, 31.6 kg/m2) who underwent 47 meniscal root repairs (29 medial and 16 lateral; 2 had both). Significant improvements at 2-year follow-up were seen in IKDC score (41.1 vs 78.4; P < .001), Tegner activity level (3 vs 4; P < .001), and VAS pain (2.8 vs 0.7; P < .001). BMI, preoperative malalignment, cartilage status, and progressive meniscus extrusion (Δ = 0.7 mm) did not have a negative impact on IKDC and Tegner scores 2 years postoperatively. Age greater than or equal to 50 years and extrusion pre- and postoperatively were associated with decreased Tegner scores. Progressive meniscal extrusion was associated with a decreased overall improvement in Tegner scores. Conclusion: Transtibial root repair for medial and lateral posterior meniscal root tears demonstrated significantly improved clinical outcomes at 2 years postoperatively. Increased age, increased BMI, cartilage status, and meniscal extrusion did not have a negative impact on short-term functional outcomes (IKDC), but age greater than or equal to 50 years and extrusion negatively influenced patient activity level (Tegner). Registration: NCT03037242 ( ClinicalTrials.gov identifier).

Weight loss enhances meniscal healing following transtibial pullout repair for medial meniscus posterior root tears

“…Such an injury can be caused by trauma or degeneration, particularly in middleaged patients during activities of daily living, such as walking or descending stairs, and can lead to abnormal knee kinematics, increased contact pressure and cartilage damage [3]. Transtibial pullout repair is the most common method for re-establishing adequate root fixation, as it can restore normal knee function and reduce the risk of degenerative changes in the knee joint [4,5].…”

Intercondylar notch width and osteophyte width impact meniscal healing and clinical outcomes following transtibial pullout repair of medial meniscus posterior root tears

“…The MM posterior root (MMPR) plays a crucial role in maintaining the meniscus's normal function by controlling its movement. A tear in the MMPR (MMPRT) can cause abnormal loading and movement of the meniscus, leading to accelerated articular cartilage degeneration in the knee joint [1,2]. MMPRTs are a significant concern in orthopaedic practice as they are associated with a range of functional impairments and pain.…”

Younger patients, lower BMI, complete meniscus root healing, lower HKA degree and shorter preoperative symptom duration were the independent risk factors correlated with the good correction of MME in patients with repaired MMPRTs

“…Compared with partial meniscectomy, there is more evidence indicating that various repair surgical strategies, not only restore hoop tension of the medial meniscus but also prevent the progression of knee degenerative [11, 16, 33]. Arthroscopic transtibial pullout is the most widely used surgical method and has been reported associated with satisfactory outcomes [18, 31], however, results of MRI or second‐look arthroscopy studies evaluating the repaired meniscus have shown higher rates of incomplete healing or increased medial meniscal extrusion (MME) [27].…”