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

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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

IV.

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Abbreviations

ACL:

Anterior cruciate ligament

ADL:

Activities of daily living

BMI:

Body mass index

ICC:

Intra-class correlation coefficient

ICRS:

International Cartilage Research Society

IKDC:

International Knee Documentation Committee

K–L:

Kellgren–Lawrence

KOOS:

Knee Injury and Osteoarthritis Outcome Score

LFC:

Lateral femoral condyle

LTP:

Lateral tibia plateau

MFC:

Medial femoral condyle

MM:

Medial meniscus

MMPRT:

Medial meniscus posterior root tear

MMME:

Medial meniscus medial extrusion

MMPE:

Medial meniscus posterior extrusion

MRI:

Magnetic resonance imaging

MTP:

Medial tibia plateau

QOL:

Quality of life

VAS:

Visual analogue scale

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Acknowledgements

We would like to thank Editage (https://www.editage.jp) for English language editing.

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No funding was received for this study.

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Correspondence to Takayuki Furumatsu.

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Kodama, Y., Furumatsu, T., Masuda, S. et al. Transtibial fixation for medial meniscus posterior root tear reduces posterior extrusion and physiological translation of the medial meniscus in middle-aged and elderly patients. Knee Surg Sports Traumatol Arthrosc 28, 3416–3425 (2020). https://doi.org/10.1007/s00167-019-05810-x

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Keywords

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