Advertisement

International Orthopaedics

, Volume 43, Issue 5, pp 1239–1245 | Cite as

Arthroscopic scoring system of meniscal healing following medial meniscus posterior root repair

  • Takayuki FurumatsuEmail author
  • Shinichi Miyazawa
  • Masataka Fujii
  • Takaaki Tanaka
  • Yuya Kodama
  • Toshifumi Ozaki
Original Paper

Abstract

Purpose

Medial meniscus posterior root tear (MMPRT) leads to a rapid degradation of articular cartilage. In the treatment of MMPRT, transtibial pullout repair demonstrates a high clinical survival rate. However, there is no reliable method to evaluate the meniscal healing after surgery. We propose an arthroscopic scoring system for evaluating the meniscal healing status. The aim of this study was to investigate the correlations between second-look arthroscopic scores and clinical outcomes after transtibial pullout repair.

Methods

Twenty patients who had MMPRTs underwent transtibial pullout repairs. Clinical outcomes were assessed using the Japanese Knee Injury and Osteoarthritis Outcome Score (KOOS) and pain score evaluated by visual analogue scale at preoperatively and 1 year postoperatively. The healing status of repaired MM was assessed at one year post-operatively using a semi-quantitative arthroscopic scoring system (total, 10 points) composed of three evaluation criteria: (i) anteroposterior width of bridging tissues, (ii) stability of the MM posterior root, and (iii) synovial coverage of the sutures. Linear regression analysis was used to assess the correlation between second-look arthroscopic scores and clinical outcomes.

Results

Transtibial pullout repairs of MMPRTs significantly improved clinical evaluation scores at one year post-operatively. A median of second-look arthroscopic scores was 6.5 (5.75–8). A good correlation was observed between the arthroscopic score and KOOS quality of life (QOL) subscale. A moderate negative correlation between the arthroscopic score and pain score was observed.

Conclusions

This study demonstrated that our semi-quantitative scoring system of meniscal healing correlated with the KOOS QOL subscale following MMPRT transtibial pullout repair. Our results suggest that the second-look arthroscopic score using this system may be a useful scale to determine and compare the healing status of the MM posterior root.

Keywords

Arthroscopic scoring Meniscal healing Medial meniscus Posterior root tear Transtibial pullout repair 

Notes

Acknowledgments

The authors thank Drs. Hiroto Inoue, Tomohito Hino, Yusuke Kamatsuki, Yoshiki Okazaki, Shin Masuda, and Yuki Okazaki for their clinical supports.

Funding information

No funding sources were provided for this study.

Compliance with ethical standards

Informed consent

Informed consent was obtained from all patients for being included in this study.

Conflict of interest

The authors declare that they have no competing interests.

References

  1. 1.
    Bhatia S, LaPrade CM, Ellman MB, LaPrade RF (2014) Meniscal root tears: significance, diagnosis, and treatment. Am J Sports Med 42(12):3016–3030CrossRefGoogle Scholar
  2. 2.
    Yamagami R, Taketomi S, Inui H, Tahara K, Tanaka S (2017) The role of medial meniscus posterior root tear and proximal tibial morphology in the development of spontaneous osteonecrosis and osteoarthritis of the knee. Knee 24(2):390–395CrossRefGoogle Scholar
  3. 3.
    Furumatsu T, Kodama Y, Kamatsuki Y, Hino T, Okazaki Y, Ozaki T (2017) Meniscal extrusion progresses shortly after the medial meniscus posterior root tear. Knee Surg Relat Res 29(4):295–301CrossRefGoogle Scholar
  4. 4.
    Krych AJ, Reardon PJ, Johnson NR, Mohan R, Peter L, Levy BA, Stuart MJ (2017) Non-operative management of medial meniscus posterior horn root tears is associated with worsening arthritis and poor clinical outcome at 5-year follow-up. Knee Surg Sports Traumatol Arthrosc 25(2):383–389CrossRefGoogle Scholar
  5. 5.
    Han SB, Shetty GM, Lee DH, Chae DJ, Seo SS, Wang KH, Yoo SH, Nha KW (2010) Unfavorable results of partial meniscectomy for complete posterior medial meniscus root tear with early osteoarthritis: a 5- to 8-year follow-up study. Arthroscopy 26(10):1326–1332CrossRefGoogle Scholar
  6. 6.
    Krych AJ, Johnson NR, Mohan R, Dahm DL, Levy BA, Stuart MJ (2018) Partial meniscectomy provides no benefit for symptomatic degenerative medial meniscus posterior root tears. Knee Surg Sports Traumatol Arthrosc 26(4):1117–1122Google Scholar
  7. 7.
    Bonasia DE, Pellegrino P, D'Amelio A, Cottino U, Rossi R (2015) Meniscal root tear repair: why, when and how? Orthop Rev (Pavia) 7(2):5792Google Scholar
  8. 8.
    Kim JH, Chung JH, Lee DH, Lee YS, Kim JR, Ryu KJ (2011) Arthroscopic suture anchor repair versus pullout suture repair in posterior root tear of the medial meniscus: a prospective comparison study. Arthroscopy 27(12):1644–1653CrossRefGoogle Scholar
  9. 9.
    Chung KS, Ha JK, Ra HJ, Kim JG (2016) A meta-analysis of clinical and radiographic outcomes of posterior horn medial meniscus root repairs. Knee Surg Sports Traumatol Arthrosc 24(5):1455–1468CrossRefGoogle Scholar
  10. 10.
    Chung KS, Noh JM, Ha JK, Ra HJ, Park SB, Kim HK, Kim JG (2018) Survivorship analysis and clinical outcomes of transtibial pullout repair for medial meniscus posterior root tears: a 5- to 10-year follow-up study. Arthroscopy 34(2):530–535CrossRefGoogle Scholar
  11. 11.
    LaPrade CM, Foad A, Smith SD, Turnbull TL, Dornan GJ, Engebretsen L, Wijdicks CA, LaPrade RF (2015) Biomechanical consequences of a nonanatomic posterior medial meniscal root repair. Am J Sports Med 43(4):912–920CrossRefGoogle Scholar
  12. 12.
    Kaplan DJ, Alaia EF, Dold AP, Meislin RJ, Strauss EJ, Jazrawi LM, Alaia MJ (2017) Increased extrusion and ICRS grades at 2-year follow-up following transtibial medial meniscal root repair evaluated by MRI. Knee Surg Sports Traumatol Arthrosc.  https://doi.org/10.1007/s00167-017-4755-8
  13. 13.
    Seo HS, Lee SC, Jung KA (2011) Second-look arthroscopic findings after repairs of posterior root tears of the medial meniscus. Am J Sports Med 39(1):99–107CrossRefGoogle Scholar
  14. 14.
    Nha KW, Lee YS, Hwang DH, Kwon JH, Chae DJ, Park YJ, Kim JI (2013) Second-look arthroscopic findings after open-wedge high tibia osteotomy focusing on the posterior root tears of the medial meniscus. Arthroscopy 29(2):226–231CrossRefGoogle Scholar
  15. 15.
    Kodama Y, Furumatsu T, Fujii M, Tanaka T, Miyazawa S, Ozaki T (2016) Pullout repair of a medial meniscus posterior root tear using a FasT-fix all-inside suture technique. Orthop Traumatol Surg Res 102(7):951–954CrossRefGoogle Scholar
  16. 16.
    Furumatsu T, Kodama Y, Fujii M, Tanaka T, Hino T, Kamatsuki Y, Yamada K, Miyazawa S, Ozaki T (2017) A new aiming guide can create the tibial tunnel at favorable position in transtibial pullout repair for the medial meniscus posterior root tear. Orthop Traumatol Surg Res 103(3):367–371CrossRefGoogle Scholar
  17. 17.
    Fujii M, Furumatsu T, Kodama Y, Miyazawa S, Hino T, Kamatsuki Y, Yamada K, Ozaki T (2017) A novel suture technique using the FasT-fix combined with Ultrabraid for pullout repair of the medial meniscus posterior root tear. Eur J Orthop Surg Traumatol 27(4):559–562CrossRefGoogle Scholar
  18. 18.
    Choi SH, Bae S, Ji SK, Chang MJ (2012) The MRI findings of meniscal root tear of the medial meniscus: emphasis on coronal, sagittal and axial images. Knee Surg Sports Traumatol Arthrosc 20(10):2098–2103CrossRefGoogle Scholar
  19. 19.
    Furumatsu T, Fujii M, Kodama Y, Ozaki T (2017) A giraffe neck sign of the medial meniscus: a characteristic finding of the medial meniscus posterior root tear on magnetic resonance imaging. J Orthop Sci 22(4):731–736CrossRefGoogle Scholar
  20. 20.
    LaPrade CM, James EW, Cram TR, Feagin JA, Engebretsen L, LaPrade RF (2015) Meniscal root tears: a classification system based on tear morphology. Am J Sports Med 43(2):363–369CrossRefGoogle Scholar
  21. 21.
    Bae JH, Paik NH, Park GW, Yoon JR, Chae DJ, Kwon JH, Kim JI, Nha KW (2013) Predictive value of painful popping for a posterior root tear of the medial meniscus in middle-aged to older Asian patients. Arthroscopy 29(3):545–549CrossRefGoogle Scholar
  22. 22.
    Furumatsu T, Kamatsuki Y, Fujii M, Kodama Y, Okazaki Y, Masuda S, Ozaki T (2017) Medial meniscus extrusion correlates with disease duration of the sudden symptomatic medial meniscus posterior root tear. Orthop Traumatol Surg Res 103(8):1179–1182CrossRefGoogle Scholar
  23. 23.
    Yao J, Lancianese SL, Hovinga KR, Lee J, Lerner AL (2008) Magnetic resonance image analysis of meniscal translation and tibio-menisco-femoral contact in deep knee flexion. J Orthop Res 26(5):673–684CrossRefGoogle Scholar
  24. 24.
    Masuda S, Furumatsu T, Okazaki Y, Kodama Y, Hino T, Kamatsuki Y, Miyazawa S, Ozaki T (2018) Medial meniscus posterior root tear induces pathological posterior extrusion of the meniscus in the knee-flexed position: an open magnetic resonance imaging analysis. Orthop Traumatol Surg Res 104(4):485–489CrossRefGoogle Scholar
  25. 25.
    Markolf KL, Jackson SR, McAllister DR (2012) Force measurements in the medial meniscus posterior horn attachment: effects of anterior cruciate ligament removal. Am J Sports Med 40(2):332–338CrossRefGoogle Scholar

Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  • Takayuki Furumatsu
    • 1
    Email author
  • Shinichi Miyazawa
    • 1
  • Masataka Fujii
    • 1
  • Takaaki Tanaka
    • 1
  • Yuya Kodama
    • 1
  • Toshifumi Ozaki
    • 1
  1. 1.Department of Orthopaedic SurgeryOkayama University HospitalOkayamaJapan

Personalised recommendations