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

Abstract

PurposeThis study investigated the impact of weight change on the success of transtibial pullout repair for medial meniscus (MM) posterior root tears (MMPRTs).MethodsThe study included 129 patients diagnosed with MMPRTs who had undergone transtibial pullout repair. The patients were screened between July 2018 and November 2021. Patient‐reported outcomes were assessed preoperatively and at 12 months postoperatively using the Knee injury and Osteoarthritis Outcome Score (KOOS). MM extrusion (MME) and ΔMME (postoperative MME – preoperative MME) were calculated preoperatively and at 12 months postoperatively using magnetic resonance imaging.ResultsPatients were divided into weight loss (body mass index [BMI] decrease of at least 0.5 kg/m2 after primary repair; n = 63) and weight gain (BMI increase of at least 0.5 kg/m2; n = 66) groups. Both groups had similar demographic variables and preoperative clinical scores; patient‐reported outcomes significantly improved postoperatively. The weight loss group had significantly greater improvement in KOOS–quality of life (weight loss, 29.4 ± 23.7; weight gain, 23.9 ± 27.6; p = 0.034), lower postoperative MME (weight loss, 3.9 ± 1.7 mm; weight gain, 4.2 ± 1.2 mm; p = 0.043) and lower ΔMME (weight loss, 0.8 ± 0.8 mm; weight gain, 1.2 ± 0.9 mm; p = 0.002) than the weight gain group. Total arthroscopic healing scores (weight loss, 7.6 ± 1.0; weight gain, 7.2 ± 1.5; p = 0.048) and associated subscales, including anteroposterior bridging tissue width (weight loss, 4.0 ± 0.0; weight gain, 3.8 ± 0.7; p = 0.004) and MM posterior root stability (weight loss, 2.6 ± 0.7; weight gain, 2.4 ± 0.7; p = 0.041), significantly differed between the groups.ConclusionsWeight loss was associated with better meniscal healing and less MME progression after MMPRT repair, highlighting the significance of weight management in individuals undergoing meniscal surgery. These findings provide valuable insights into the clinical significance of weight loss in the success of transtibial pullout repair for MMPRTs.Level of EvidenceLevel III.

Meniscal extrusion consensus statement: A collaborative survey within the Meniscus International Network (MenIN) Study Group

“…Based on the responses of surgeons in this study, various elements, such as patients' characteristics (e.g., age and BMI), specific tear attributes (laterality and anatomical location) and aetiology, should be considered when devising a comprehensive classification system. Specifically, weight loss and a low BMI have previously been reported to positively affect meniscal extrusion and meniscal healing following posterior medial meniscus root repair, highlighting the importance of BMI for both classification and prognosis [13]. Considering the implications of a meniscal extrusion classification system, respondents in the current study advocated for a classification addressing OA progression, treatment approaches, a grading system, clinical outcomes/prognosis, stability or progression of meniscal extrusion, dynamic factors, centralization procedures and reducibility [23].…”

Accurate tibial tunnel position in transtibial pullout repair for medial meniscus posterior root tears delays the progression of medial joint space narrowing

“…While many similar studies have reported on postoperative MM extrusion (MME) progression [19,23,29], a previous study reported that MMPR repair slowed the progression of osteoarthritis compared with conservative treatment or meniscectomy in a rabbit model [3]. Factors such as age, weight, quadriceps muscle strength, healing status of the repaired posterior roots and time from symptom onset to surgery have been reported to influence the progression of MJS, MME and osteoarthritis in the postoperative period after MMPR repair [7,11,24]. However, recent studies have shown significant progression of MJS narrowing and MME in the first postoperative year but tapering off in the second postoperative year [13,15].…”