2015 ISAKOS Biennial Congress ePoster #1605

Arthroscopic Meniscus Posterior Root Repair – Clinicoradiological Results

Dinshaw Pardiwala, MS(Orth), DNB(Orth), FCPS, Mumbai, Maharashtra INDIA
Yathiraju Thimmappa, Mysore, Karnataka INDIA

Kokilaben Dhirubhai Ambani Hospital, Mumbai, INDIA

FDA Status Cleared

Summary: Arthroscopic pull-out suture repair for posterior root avulsions and complete radial tears of the posterior horns of the menisci demonstrate significant clinical, functional, and radiological improvement with anatomical healing and reversal of meniscal extrusion noted on MRI in 86% of cases.

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Abstract:

Background

& AIMS : Posterior root avulsions and radial tears of the posterior horns of the menisci cause complete disruption of the circumferential fibres, resulting in increased contact pressures in the knee, and rapid secondary cartilage degeneration. Pull-out suture repairs for such tears reverse the biomechanical consequences of such tears, however, there is insufficient evidence that these tears heal and result in improved clinical results in the long-term. This retrospective study was designed to determine whether arthroscopic pull-out suture repairs for posterior root / horn tears of the medial and lateral menisci demonstrate healing on MRI and improvement on clinical outcome scores.

STUDY DESIGN: Retrospective case series; level of evidence = 4.

PATIENTS & METHODS : 50 patients (age, 23-64 years) who underwent arthroscopic posterior root/horn pull-out suture repair and had a minimum two year follow-up were retrospectively analysed. There were 41 patients with degenerative medial meniscus root/horn tears. The inclusion criteria for these patients were persistent knee pain following trivial trauma of less than 1 year duration with a preoperative MRI diagnosis of posterior root avulsion or complete radial tear of the posterior horn of the medial or lateral meniscus confirmed on arthroscopy. Only patients less than 65 years of age with Kellgren-Lawrence osteoarthritis grade 3 or less on preoperative weight-bearing radiographs were offered surgical repair. The exclusion criteria were incomplete radial/root tears, presence of varus > 50, and obesity (BMI>30). We also included 9 patients with ACL tears and concomitant lateral meniscus root avulsions. All patients underwent an identical surgical procedure of footprint root repair. This consisted of a two suture cinch knots 5 mm apart on the posterior meniscus horn pulled through a single 4.5 mm transtibial tunnel and fixed on the anteromedial proximal tibia over an endobutton. The mean follow-up duration was 29.4 months (range, 24 to 53 months). All patients underwent preoperative and postoperative assessment of clinical criteria (effusions, locking, joint line tenderness, pain on full flexion, range of motion, McMurray’s test), functional scores (IKDC criteria, and Lysholm score), Kellgren-Lawrence osteoarthritis grading on radiographs, and MRI (postoperative presence of structural healing, measurement of meniscal extrusion, gap distance, progression of cartilage degeneration).

Results

On clinical evaluation, all parameters showed significant improvement at the last follow-up compared with preoperative (P<0.5). 22% had presence of persistent postoperative joint line tenderness attributed to medial compartment degenerative joint disease. On functional scores, significant improvement was noted at the last follow-up compared with preoperatively (P<0.5). Only 2 patients (both with follow-up durations beyond 4 years) showed radiographic increase in osteoarthritis by one grade on Kellgren-Lawrence grading. On MRI, presence of structural healing of the meniscus and significant reversal of meniscal extrusion was noted in 86%. Gap distance at the torn meniscal root was significantly decreased. Progression of cartilage degeneration on MRI was noted not only in the 14% in whom there was incomplete meniscal healing, but also in another 12%. Of these 6 patients with progression of chondral degeneration despite meniscus root healing, 5 had preoperative symptoms of over 6 months prior to surgical repair.

Discussion

Arthroscopic pull-out suture repairs for posterior root avulsions and complete radial tears of the posterior horns of the medial and lateral menisci demonstrate significant clinical, functional, and radiological improvement. Anatomical healing and restoration of meniscal function (reversal of meniscal extrusion) on MRI is noted in 86% of cases. Rapid progression of cartilage degeneration on MRI can be halted, however early surgery is recommended for this to be effective.