2015 ISAKOS Biennial Congress ePoster #1620

Meniscal Root Tears: A Classification System Based on Tear Morphology

Christopher M. LaPrade, BA, Milwaukee, WI UNITED STATES
Evan W. James, MD, New York, NY UNITED STATES
Tyler Cram, MA, ATC, OTC, Vail, CO UNITED STATES
John A. Feagin, MD, Vail, CO UNITED STATES
Lars Engebretsen, MD, PhD, Oslo/Lausanne NORWAY
Robert F. LaPrade, MD, PhD, Chanhassen, MN UNITED STATES

Steadman Philippon Research Institute, Vail, Colorado, USA

FDA Status Not Applicable

Summary: We recommend this meniscal root tear classification system be used to establish standardized definitions for various types of meniscus root tears to improve communication regarding meniscus root tears between practitioners and across centers.

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Abstract:

Background

Meniscal root tears present in many forms and can have profound consequences on the health of knee articular cartilage. While the biomechanics, natural history, and treatment of root tears have been increasingly investigated, the spectrum of meniscal root tear patterns observed during arthroscopic examination has yet to be defined and categorized.

Purpose

/ Hypothesis: The purpose of this study was to establish a classification system for meniscal root tears by reporting the morphology of meniscal root tears from a consecutive series of arthroscopic surgeries. It was hypothesized that meniscal root tears could be grouped into types by distinct tear patterns and that the recognition of tear pattern will affect treatment.

Materials And Methods

This study was IRB approved. All patients who underwent arthroscopic surgery from April 2010 to May 2014 by a single orthopaedic surgeon were included. After arthroscopic examination, data regarding the integrity of the meniscal roots were prospectively recorded in a data registry. Tear morphology and treatment received were subsequently extracted by two independent reviewers from operative notes and arthroscopic surgical photos.

Results

From April 2010 to May 2014, a total of 1556 knee arthroscopies were performed by a single orthopaedic surgeon. A total of 81 meniscal root tears were identified in 77 patients (48 male, 29 female) with a mean age of 33 years (range, 14 to 70 years). Of the 81 root tears, 10 root tears were excluded due to iatrogenic etiologies and revisions. After these exclusions, a total of 71 meniscal root tears in 67 patients, representing 4.3% of all arthroscopies during the study time period, were grouped into tear types with similar tear morphologies. Meniscal root tear patterns were categorized into partial stable root tears (Type I; n = 5), complete radial tears within 9 mm from the bony root attachment (Type II; n = 48), further subclassified into Types IIA, IIB, and IIC located 0-< 3 mm; 3-<6 mm; and 6-9 mm respectively from the root attachment, bucket handle tears with a complete root detachment (Type III; n = 4), complex oblique tears with complete root detachments extending into the root attachment (Type IV; n = 7), and bony avulsion fractures of the root attachments (Type V; n = 7).

Conclusions

We recommend this meniscal root tear classification system be used to establish standardized definitions for various types of meniscus root tears to improve communication regarding meniscus root tears between practitioners and across centers. In addition, this classification system may be used to correlate certain root tear types with a recommended treatment and may facilitate improved reporting of patient outcomes after treatment of meniscus root tears by reporting outcomes separately for each tear type.

Clinical Relevance: This classification system is recommended to (1) establish standardized definitions for various types of meniscus root tears, (2) improve communication regarding meniscus root tears between practitioners and across centers, (3) associate root tear types with treatments received, and (4) facilitate improved reporting of patient outcomes after treatment of meniscus root tears with various morphologies.