Transtibial fixation for medial meniscus posterior root tear reduces posterior extrusion and physiological translation of the medial meniscus in middle-aged and elderly patients

  • Yuya Kodama
  • Takayuki FurumatsuEmail author
  • Shin Masuda
  • Yoshiki Okazaki
  • Yusuke Kamatsuki
  • Yuki Okazaki
  • Takaaki Hiranaka
  • Shinichi Miyazawa
  • Masaharu Yasumitsu
  • Toshifumi Ozaki



To investigate changes in meniscal extrusion during knee flexion before and after pullout fixation for medial meniscus posterior root tear (MMPRT) and determine whether these changes correlate with articular cartilage degeneration and short-term clinical outcomes.


Twenty-two patients (mean age 58.4 ± 8.2 years) diagnosed with type II MMPRT underwent open magnetic resonance imaging preoperatively, 3 months after transtibial fixation and at 12 months after surgery, when second-look arthroscopy was also performed. The medial meniscus medial extrusion (MMME) and the medial meniscus posterior extrusion (MMPE) were measured at knee 10° and 90° flexion at which medial meniscus (MM) posterior translation was also calculated. Articular cartilage degeneration was assessed using International Cartilage Research Society grade at primary surgery and second-look arthroscopy. Clinical evaluations included Knee Injury and Osteoarthritis Outcome Score, International Knee Documentation Committee subjective knee evaluation form, Lysholm score, Tegner activity level scale, and pain visual analogue scale.


MMPE at 10° knee flexion was higher 12 months postoperatively than preoperatively (4.8 ± 1.5 vs. 3.5 ± 1.2, p = 0.01). MMPE at 90° knee flexion and MM posterior translation were smaller 12 months postoperatively than preoperatively (3.5 ± 1.1 vs. 4.6 ± 1.3, 7.2 ± 1.7 vs. 8.9 ± 2.0, p < 0.01). Articular cartilage degeneration of medial femoral condyle correlated with MMME in knee extension (r = 0.5, p = 0.04). All clinical scores significantly improved 12 months postoperatively. However, correlations of all clinical scores against decreased MMPE and increased MMME were not detected.


MMPRT transtibial fixation suppressed the progression of MMPE and cartilage degeneration and progressed MMME minimally in knee flexion position at 1 year. However, in the knee extension position, MMME progressed and correlated with cartilage degeneration of medial femoral condyle. MMPRT transtibial fixation contributes to the dynamic stability of the MM in the knee flexion position.

Level of evidence



Medial meniscus Posterior root tear Transtibial fixation Meniscus extrusion Open magnetic resonance imaging 



Anterior cruciate ligament


Activities of daily living


Body mass index


Intra-class correlation coefficient


International Cartilage Research Society


International Knee Documentation Committee




Knee Injury and Osteoarthritis Outcome Score


Lateral femoral condyle


Lateral tibia plateau


Medial femoral condyle


Medial meniscus


Medial meniscus posterior root tear


Medial meniscus medial extrusion


Medial meniscus posterior extrusion


Magnetic resonance imaging


Medial tibia plateau


Quality of life


Visual analogue scale



We would like to thank Editage ( for English language editing.


No funding was received for this study.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional Review Board.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019

Authors and Affiliations

  • Yuya Kodama
    • 1
    • 2
  • Takayuki Furumatsu
    • 1
    Email author
  • Shin Masuda
    • 1
  • Yoshiki Okazaki
    • 1
  • Yusuke Kamatsuki
    • 1
  • Yuki Okazaki
    • 1
  • Takaaki Hiranaka
    • 1
  • Shinichi Miyazawa
    • 1
  • Masaharu Yasumitsu
    • 2
  • Toshifumi Ozaki
    • 1
  1. 1.Department of Orthopaedic SurgeryOkayama University HospitalOkayamaJapan
  2. 2.Department of Orthopaedic SurgeryIwakuni Clinical CenterIwakuniJapan

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