Summary

Transtibial pullout repair of medial meniscus posterior root tears showed improved clinical outcomes in middle-aged patients with decreased progression of knee osteoarthritis compared with partial meniscectomy

Abstract

Background

There are limited data regarding the prognostic factors and clinical outcomes of medial meniscus posterior root tear in middle-aged patients with moderate knee osteoarthritis.

Objectives
This study aims at (1) comparing clinical and radiological outcomes, rate of conversion to knee arthroplasty in middle-aged patients undergoing transtibial pullout technique versus partial meniscectomy, (2) at establishing correlations between preoperative radiological findings as prognostic factors and postoperative clinical outcome. The hypothesis of this study was that the transtibial pullout technique would provide better functional outcomes overall, with lower conversion to knee arthroplasty compared to partial meniscectomy and one or more prognostic factors for poor clinical outcome could be identified among the study variables used.


Study Design & Methods

A comparative case-control analysis was conducted. 65 patients between 40 and 70 years of age were included into two groups: 30 patients who underwent transtibial pullout technique (group 1) and 35 patients who underwent partial meniscectomy (group 2). Mean follow-up was set at 27.2 months.
Primary clinical outcomes included Knee injury and Osteoarthritis Outcome Score and Lysholm Knee Questionnare. Preoperative MRI and intraoperative arthroscopic findings were recorded. The correlation between these findings and patient-reported subjective outcome were assessed.

Results

The transtibial pullout group exhibited significantly greater improvement in clinical outcomes. A univariate model revealed that the presence of preoperative meniscal extrusion, body mass index (>30), osteochondral defect, and female gender were predictors of poor clinical outcome. Multivariate regression analysis showed meniscal extrusion and osteochondral defect as significant prognostic factors for both study groups.

Conclusions

Medial meniscus root repair leads to significantly improved clinical outcomes compared to partial meniscectomy and may be considered a valid option in middle-aged patients with moderate osteoarthritis. Presence of meniscal extrusion, osteochondral defect, BMI >30, and female gender were predictors of poor patient-reported outcome.