J Korean Orthop Assoc.  2014 Aug;49(4):255-262. 10.4055/jkoa.2014.49.4.255.

Second-Look Arthroscopic Results after Repair of Medial Meniscus Root Tears

• Kim SW
• Sung MK
• Choi JY

• KMID: 2185180
• DOI: http://doi.org/10.4055/jkoa.2014.49.4.255

Abstract

PURPOSE
The purpose of this study is to evaluate the healing rate of medial meniscus root repair according to the duration of symptom and to determine the association between healing status and the clinical result after medial meniscus root repair.
MATERIALS AND METHODS
Eighty-four patients who underwent arthroscopic meniscal root repair and second-look arthroscopy were included. Second-look arthroscopy evaluation of meniscal healing status was performed by dividing medial meniscal posterior root into the anterior half and posterior half and classifying by contact degree on the surface of the tibia and continuity. Clinical results were analyzed according to International Knee Documentation Committee (IKDC) subjective scores and Lysholm scores. In addition, after dividing cases according to acute group and chronic group by six-month symptomatic period, differences were evaluated.
RESULTS
Significant differences in post-operative clinical results were observed between the acute group and chronic group. A significant difference in meniscal healing status was observed between the two groups (p<0.001). A higher postoperative IKDC score and Lysholm score was observed for the completely healed group, as confirmed by second-look arthroscopy, than for the other groups.
CONCLUSION
In the aspect of improving the clinical result, arthroscopic medial meniscal posterior root repair is a good treatment modality. Early repair of medial meniscal posterior root may lead to improvements in the clinical result such as meniscal healing status.

Keyword

medial meniscus; posterior root tear; meniscal healing status

MeSH Terms

Arthroscopy
Humans
Knee
Menisci, Tibial*
Tibia

Figure

• 

  Figure 1 Arthroscopic findings were classified as grading of meniscal healing. (A) Completely healed. (B) Partially healed. (C) Failure.

• 

  Figure 2 Comparison of clinical results by meniscal healing state. *Significant at p<0.05. IKDC, International Knee Documentation Committee; Group C, completely healed group; Group P, partially healed group; Group F, failure group.

Reference

1. 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.

2. Shino K, Hamada M, Mitsuoka T, Kinoshita H, Toritsuka Y. Arthroscopic repair for a flap tear of the posterior horn of the lateral meniscus adjacent to its tibial insertion. Arthroscopy. 1995; 11:495–498.

3. Ozkoc G, Circi E, Gonc U, Irgit K, Pourbagher A, Tandogan RN. Radial tears in the root of the posterior horn of the medial meniscus. Knee Surg Sports Traumatol Arthrosc. 2008; 16:849–854.

4. Shepard MF, Hunter DM, Davies MR, Shapiro MS, Seeger LL. The clinical significance of anterior horn meniscal tears diagnosed on magnetic resonance images. Am J Sports Med. 2002; 30:189–192.

5. Vedi V, Williams A, Tennant SJ, Spouse E, Hunt DM, Gedroyc WM. Meniscal movement. An in-vivo study using dynamic MRI. J Bone Joint Surg Br. 1999; 81:37–41.

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

7. Ahn JH, Wang JH, Lim HC, et al. Double transosseous pull out suture technique for transection of posterior horn of medial meniscus. Arch Orthop Trauma Surg. 2009; 129:387–392.

8. Choi NH, Son KM, Victoroff BN. Arthroscopic all-inside repair for a tear of posterior root of the medial meniscus: a technical note. Knee Surg Sports Traumatol Arthrosc. 2008; 16:891–893.

9. Engelsohn E, Umans H, Difelice GS. Marginal fractures of the medial tibial plateau: possible association with medial meniscal root tear. Skeletal Radiol. 2007; 36:73–76.

10. Griffith CJ, LaPrade RF, Fritts HM, Morgan PM. Posterior root avulsion fracture of the medial meniscus in an adolescent female patient with surgical reattachment. Am J Sports Med. 2008; 36:789–792.

11. 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.e1–795.e4.

12. 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.

13. Petersen W, Tillmann B. Collagenous fibril texture of the human knee joint menisci. Anat Embryol (Berl). 1998; 197:317–324.

14. Petersen W, Tillmann B. Age-related blood and lymph supply of the knee menisci. A cadaver study. Acta Orthop Scand. 1995; 66:308–312.

15. Bräuer D. Comparison of independent samples: the Kruskal-Wallis test and the Conover multiple median value comparison. Z Arztl Fortbild (Jena). 1988; 82:883–884.

16. 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.

17. Bessette GC. The meniscus. Orthopedics. 1992; 15:35–42.

18. Gale DR, Chaisson CE, Totterman SM, Schwartz RK, Gale ME, Felson D. Meniscal subluxation: association with osteoarthritis and joint space narrowing. Osteoarthr Cartil. 1999; 7:526–532.

19. Lozano J, Ma CB, Cannon WD. All-inside meniscus repair: a systematic review. Clin Orthop Relat Res. 2007; 455:134–141.

20. Ponce de León JC, Sierra Suárez L, Almazán Díaz A, et al. Meniscal repair in patients with chronic lesions. Acta Ortop Mex. 2008; 22:12–18.

21. Pujol N, Panarella L, Selmi TA, Neyret P, Fithian D, Beaufils P. Meniscal healing after meniscal repair: a CT arthrography assessment. Am J Sports Med. 2008; 36:1489–1495.