J Korean Orthop Assoc.  2015 Oct;50(5):372-378. 10.4055/jkoa.2015.50.5.372.

High Tibia Osteotomy for a Posterior Root Tear of the Medial Meniscus

• Lee JS
• Chang YS
• Park HJ
• Yoon HH
• Ko HT
• Nha KW

• KMID: 2185099
• DOI: http://doi.org/10.4055/jkoa.2015.50.5.372

Abstract

Posterior root tear of the medial meniscus which is frequently unrecognized is a common injury of meniscus that often results in serious consequences in a knee joint. After medial meniscus posterior root tear (MMPR), there is a significant increase in tibio-femoral contact pressure concomitant with altered knee joint kinematics. This injury frequently leads to meniscal extrusion, and thus the transmission of circumferential hoop stresses would be impaired, which condition is biomechanically similar to that of total meniscectomy. For these reasons, several methods (conservative treatment, meniscectomy, repair, or unicompartmental knee arthroplasty) have been developed for treatment of MMPR, many of which have shown good clinical results. However, the methods of MMPR treatment are still debatable. This article presents a review of the current strategies for treatment of common injuries to these MMPR and clinical results of high tibia osteotomy for MMPR after failed conservative treatment.

Keyword

medial meniscus; posterior root; high tibia osteotomy

MeSH Terms

Biomechanical Phenomena
Knee
Knee Joint
Menisci, Tibial*
Osteotomy*
Tears*
Tibia*

Figure

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  Figure 1 (A) An 18-year-old man's traumatic radial rupture of the medial meniscus posterior root. (B) Two-year follow-up arthroscopic finding after pullout suture. It shows complete healing of the medial meniscus posterior root.

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  Figure 2 (A) Pullout suture for degenerative rupture of the medial meniscus posterior root (arrow). (B) Postoperative 2-year follow-up arthroscopic finding (arrow). It shows re-rupture of the medial meniscus posterior root.

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  Figure 3 (A) Arthroscopic finding of the ruptured medial meniscus posterior root. (B) Two-year follow-up arthroscopic finding after high tibia osteotomy. It shows natural healing of the medial meniscus posterior root.

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  Figure 4 Schematic diagram of posterior opening vertical suture. A complete posterior MM root tear (arrow). MM, medial meniscus; MTC, medial tibial condyle.

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  Figure 5 (A) Six-month follow-up arthroscopic finding after suture anchor. (B) It shows the re-ruptured medial meniscus posterior root. After high tibia osteotomy, this patient's symptom has disappeared.

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  Figure 6 Treatment of degenerative MM posterior root tear. MM, medial meniscus; HTO, high tibial osteotomy; OA, osteoarthritis.

Reference

1. Bin SI, Kim JM, Shin SJ. Radial tears of the posterior horn of the medial meniscus. Arthroscopy. 2004; 20:373–378.

2. Han SB, Shetty GM, Lee DH, et al. Unfavorable results of partial meniscectomy for complete posterior medial meniscus root tear with early osteoarthritis: a 5- to 8-year follow-up study. Arthroscopy. 2010; 26:1326–1332.

3. Jones AO, Houang MT, Low RS, Wood DG. Medial meniscus posterior root attachment injury and degeneration: MRI findings. Australas Radiol. 2006; 50:306–313.

4. Habata T, Uematsu K, Hattori K, Takakura Y, Fujisawa Y. Clinical features of the posterior horn tear in the medial meniscus. Arch Orthop Trauma Surg. 2004; 124:642–645.

5. Bae JH, Paik NH, Park GW, et al. Predictive value of painful popping for a posterior root tear of the medial meniscus in middle-aged to older Asian patients. Arthroscopy. 2013; 29:545–549.

6. Nha KW, Oh HK, Kim DH, Kim YH. MR findings of the radial tear of medial meniscus. J Korean Knee Soc. 2005; 17:147–152.

7. Magee T, Shapiro M, Williams D. MR accuracy and arthroscopic incidence of meniscal radial tears. Skeletal Radiol. 2002; 31:686–689.

8. Jones RS, Keene GC, Learmonth DJ, et al. Direct measurement of hoop strains in the intact and torn human medial meniscus. Clin Biomech (Bristol, Avon). 1996; 11:295–300.

9. Tuckman GA, Miller WJ, Remo JW, Fritts HM, Rozansky MI. Radial tears of the menisci: MR findings. AJR Am J Roentgenol. 1994; 163:395–400.

10. Marzo JM, Gurske-DePerio J. Effects of medial meniscus posterior horn avulsion and repair on tibiofemoral contact area and peak contact pressure with clinical implications. Am J Sports Med. 2009; 37:124–129.

11. Marzo JM, Kumar BA. Primary repair of medial meniscal avulsions: 2 case studies. Am J Sports Med. 2007; 35:1380–1383.

12. Wang KH, Hwang DH, Cho JH, Changale SD, Woo SJ, Nha KW. Arthroscopic direct repair for a complete radial tear of the posterior root of the medial meniscus. Clin Orthop Surg. 2011; 3:332–335.

13. Lee DW, Kim MK, Jang HS, Ha JK, Kim JG. Clinical and radiologic evaluation of arthroscopic medial meniscus root tear refixation: comparison of the modified Mason-Allen stitch and simple stitches. Arthroscopy. 2014; 30:1439–1446.

14. Seo HS, Lee SC, Jung KA. Second-look arthroscopic findings after repairs of posterior root tears of the medial meniscus. Am J Sports Med. 2011; 39:99–107.

15. Kim JH, Chung JH, Lee DH, Lee YS, Kim JR, Ryu KJ. Arthroscopic suture anchor repair versus pullout suture repair in posterior root tear of the medial meniscus: a prospective comparison study. Arthroscopy. 2011; 27:1644–1653.

16. Kim JH, Shin DE, Dan JM, Nam KS, Ahn TK, Lee DH. Arthroscopic suture anchor repair of posterior root attachment injury in medial meniscus: technical note. Arch Orthop Trauma Surg. 2009; 129:1085–1088.

17. Ahn JH, Wang JH, Yoo JC, Noh HK, Park JH. A pull out suture for transection of the posterior horn of the medial meniscus: using a posterior trans-septal portal. Knee Surg Sports Traumatol Arthrosc. 2007; 15:1510–1513.

18. Kim YM, Rhee KJ, Lee JK, Hwang DS, Yang JY, Kim SJ. Arthroscopic pullout repair of a complete radial tear of the tibial attachment site of the medial meniscus posterior horn. Arthroscopy. 2006; 22:795.

19. Seo JH, Li G, Shetty GM, et al. Effect of repair of radial tears at the root of the posterior horn of the medial meniscus with the pullout suture technique: a biomechanical study using porcine knees. Arthroscopy. 2009; 25:1281–1287.

20. Lim HC, Bae JH, Wang JH, Seok CW, Kim MK. Non-operative treatment of degenerative posterior root tear of the medial meniscus. Knee Surg Sports Traumatol Arthrosc. 2010; 18:535–539.

21. Harner CD, Mauro CS, Lesniak BP, Romanowski JR. Biomechanical consequences of a tear of the posterior root of the medial meniscus. Surgical technique. J Bone Joint Surg Am. 2009; 91:Suppl 2. 257–270.

22. Nha KW, Lee YS, Hwang DH, et al. Second-look arthroscopic findings after open-wedge high tibia osteotomy focusing on the posterior root tears of the medial meniscus. Arthroscopy. 2013; 29:226–231.

23. Kopf S, Colvin AC, Muriuki M, Zhang X, Harner CD. Meniscal root suturing techniques: implications for root fixation. Am J Sports Med. 2011; 39:2141–2146.

24. Nha KW, Wang KH, Shetty GM, Lee CS, Kim JI. Posterior reattachment of a radial tear in the posterior root of the medial meniscus. Orthopedics. 2011; 34:276–280.

25. Allaire R, Muriuki M, Gilbertson L, Harner CD. Biomechanical consequences of a tear of the posterior root of the medial meniscus. Similar to total meniscectomy. J Bone Joint Surg Am. 2008; 90:1922–1931.