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Short-term results and surgical technique of arthroscopic centralization as an augmentation for medial meniscus extrusion caused by medial meniscus posterior root tear

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Introduction

The purpose of this study was to perform medial meniscus (MM) centralization for medial meniscus extrusion (MME) associated with medial meniscus posterior root tear (MMPRT) and to examine the short-term results. The hypothesis is that arthroscopic centralization as an augmentation of MMPRT repair improves clinical outcomes and the extrusion distance of MM in short-term results.

Materials and methods

Twenty-six patients (mean age 62.1 ± 6.0 years) who underwent arthroscopic centralization as an augmentation of MMPRT repair were included. Clinical evaluation was performed before and 2 years after surgery using Lysholm score and knee injury and osteoarthritis outcome score (KOOS). Image evaluation used MRI and plain X-ray images. The extrusion distance and MME ratio were compared on MRI images before and 2 years after surgery. The degree of osteoarthritis (OA) was evaluated using Kellgren–Lawrence classification. The degree of OA and hip–knee–ankle (HKA) angle were compared by plane X-ray images before and 2 years after surgery.

Results

In clinical results, both Lysholm score and KOOS improved significantly after surgery. In image evaluation, the extrusion distance decreased significantly from 4.8 ± 0.7 mm before surgery to 2.7 ± 0.3 mm 2 years after surgery (p < 0.05). The MME ratio was significantly improved from 40.2 ± 7.0% before surgery to 22.6 ± 3.6% after surgery (p < 0.05). There was no significant difference in HKA angle at 2 years after surgery (p = 0.13).

Conclusions

The arthroscopic centralization for medial meniscal extrusion associated with MMPRT significantly improved clinical outcomes and the extrusion distance of MM. It is also one of the surgical techniques that can suppress medial meniscus extrusion.

Level of evidence

IV, therapeutic case series.

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References

  1. Rath E, Richmond JC (2000) The menisci: basic science and advances in treatment. Br J Sports Med 34:252–257. https://doi.org/10.1136/bjsm.34.4.252

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Aagaard H, Verdonk R (1999) Function of the normal meniscus and consequences of meniscal resection. Scand J Med Sci Sports 9:134–140. https://doi.org/10.1111/j.1600-0838.1999.tb00443.x

    Article  CAS  PubMed  Google Scholar 

  3. Lerer DB, Umans HR, Hu MX, Jones MH (2004) The role of meniscal root pathology and radial meniscal tear in medial meniscal extrusion. Skeletal Radiol 33:569–574. https://doi.org/10.1007/s00256-004-0761-2

    Article  CAS  PubMed  Google Scholar 

  4. Choi CJ, Choi YJ, Lee JJ, Choi CH (2010) Magnetic resonance imaging evidence of meniscal extrusion in medial meniscus posterior root tear. Arthroscopy 26:1602–1606. https://doi.org/10.1016/j.arthro.2010.05.004

    Article  PubMed  Google Scholar 

  5. Gale DR, Chaisson CE, Totterman SMS, Schwartz RK, Gale ME, Felson D (1999) Meniscal subluxation : association with osteoarthritis and joint space narrowing. Osteoarthr Cartil 7:526–532. https://doi.org/10.1053/joca.1999.0256

    Article  CAS  Google Scholar 

  6. Lee DH, Lee BS, Kim JM, Yang KS, Cha EJ, Park JH, Bin SI (2011) Predictors of degenerative medial meniscus extrusion: radial component and knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 19:222–229. https://doi.org/10.1007/s00167-010-1274-2

    Article  PubMed  Google Scholar 

  7. Puig L, Monllau JC, Corrales M, Pelfort X, MelendoCáceres EE (2006) Factors affecting meniscal extrusion: correlation with MRI, clinical, and arthroscopic findings. Knee Surg Sports Traumatol Arthrosc 14:394–398. https://doi.org/10.1007/s00167-005-0688-8

    Article  PubMed  Google Scholar 

  8. Costa CR, Morrison WB, Carrino JA (2004) Medial meniscus extrusion on knee MRI: is extent associated with severity of degeneration or type of tear? AJR Am J Roentgenol 183:17–23. https://doi.org/10.2214/ajr.183.1.1830017

    Article  PubMed  Google Scholar 

  9. Allaire R, Muriuki M, Gilbertson L, Harner CD (2008) Biomechanical consequences of a tear of the posterior root of the medial meniscus: similar to total meniscectomy. J Bone Joint Surg Am 90:1922–1931. https://doi.org/10.2106/JBJS.G.00748

    Article  PubMed  Google Scholar 

  10. Antony B, Driban JB, Price LL, Lo GH, Ward RJ, Nevitt M, Lynch J, Eaton CB, Ding C, McAlindon TE (2017) The relationship between meniscal pathology and osteoarthritis depends on the type of meniscal damage visible on magnetic resonance images: data from the osteoarthritis initiative. Osteoarthr Cartil 25:76–84. https://doi.org/10.1016/j.joca.2016.08.004

    Article  CAS  Google Scholar 

  11. Crema MD, Roemer FW, Felson DT, Englund M, Wang K, Jarraya M, Jarraya M, Nevitt MC, Marra MD, Torner JC, Lewis CE, Guermazi A (2012) Factors associated with meniscal extrusion in knees with or at risk for osteoarthritis: the multicenter osteoarthritis study. Radiology 264:494–503. https://doi.org/10.1148/radiol.12110986

    Article  PubMed  PubMed Central  Google Scholar 

  12. Teichtahl AJ, Cicuttini FM, Abram F, Wang Y, Pelletier JP, Dodin P, Martel-Pelletier J (2017) Meniscal extrusion and bone marrow lesions are associated with incident and progressive knee osteoarthritis. Osteoarthr Cartil 25:1076–1083. https://doi.org/10.1016/j.joca.2017.02.792

    Article  CAS  Google Scholar 

  13. Berthiaume MJ, Raynauld JP, Martel-Pelletier J, Labonté F, Beaudoin G, Bloch DA, Choquette D, Haraoui B, Altman RD, Hochberg M, Meyer JM, Cline GA, Pelletier JP (2015) Meniscal tear and extrusion are strongly associated with progression of symptomatic knee osteoarthritis as assessed by quantitative magnetic resonance imaging. Ann Rheum Dis 64:556–563. https://doi.org/10.1136/ard.2004.023796

    Article  Google Scholar 

  14. Rennie WJ, Finlay DB (2006) Meniscal extrusion in young athletes : associated knee joint abnormalities. AJR Am J Roentgenol 186:791–794. https://doi.org/10.2214/AJR.04.1181

    Article  PubMed  Google Scholar 

  15. Kwak YH, Lee S, Lee MC, Han HS (2018) Large meniscus extrusion ratio is a poor prognostic factor of conservative treatment for medial meniscus posterior root tear. Knee Surg Sports Traumatol Arthrosc 26:781–786. https://doi.org/10.1007/s00167-017-4441-x

    Article  PubMed  Google Scholar 

  16. Sharma L, Eckstein F, Song J, Guermazi A, Prasad P, Kapoor D, Cahue S, Marshall M, Hudelmaier M, Dunlop D (2008) Relationship of meniscal damage, meniscal extrusion, malalignment, and joint laxity to subsequent cartilage loss in osteoarthritic knees. Arthritis Rheum 58:1716–1726. https://doi.org/10.1002/art.23462

    Article  PubMed  Google Scholar 

  17. Ahn JH, Wang JH, Lim HC, Bae JH, Park JS, Yoo JC, Shyam AK (2009) Double transosseous pull out suture technique for transsection of posterior horn of medial meniscus. Arch Orthop Trauma Surg 129:387–392. https://doi.org/10.1007/s00402-008-0639-1

    Article  PubMed  Google Scholar 

  18. Chung KS, Ha JK, Ra HJ, Nam GW, Kim JG (2016) Pullout fixation of posterior medial meniscus root tears: correlation between meniscus extrusion and midterm clinical results. Am J Sports Med 45:42–49. https://doi.org/10.1177/0363546516662445

    Article  PubMed  Google Scholar 

  19. Feucht MJ, Kuhle J, Bode G, Mehl J, Schmal H, Südkamp NP, Niemeyer P (2015) Arthroscopic transtibial pullout repair for posterior medial meniscus root tears: a systematic review of clinical, radiographic, and second-look arthroscopic results. Arthroscopy 31:1808–1816. https://doi.org/10.1016/j.arthro.2015.03.022

    Article  PubMed  Google Scholar 

  20. Jones C, Reddy S, Ma CB (2010) Repair of the posterior root of the medial meniscus. Knee 17:77–80. https://doi.org/10.1016/j.knee.2009.06.010

    Article  PubMed  Google Scholar 

  21. Kim SB, Ha JK, Lee SW, Kim DW, Shim JC, Kim JG, Lee MY (2011) Medial meniscus root tear refixation: comparison of clinical, radiologic, and arthroscopic findings with medial meniscectomy. Arthroscopy 27:346–354. https://doi.org/10.1016/j.arthro.2010.08.005

    Article  PubMed  Google Scholar 

  22. Koenig JH, Ranawat AS, Umans HR, DiFelice GS (2009) Meniscal root tears: diagnosis and treatment. Arthroscopy 25:1025–1032. https://doi.org/10.1016/j.arthro.2009.03.015

    Article  PubMed  Google Scholar 

  23. 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 24:1455–1468. https://doi.org/10.1007/s00167-015-3832-0

    Article  PubMed  Google Scholar 

  24. Koga H, Watanabe T, Horie M, Katagiri H, Otabe K, Ohara T, Katakura M, Sekiya I, Muneta T (2017) Augmentation of the pullout repair of a medial meniscus posterior root tear by arthro-scopic centralization. Arthrosc Tech 6:e1335–e1339. https://doi.org/10.1016/j.eats.2017.05.014

    Article  PubMed  PubMed Central  Google Scholar 

  25. Hajek PC, Gylys-Morin VM, Baker LL, Sartoris DJ, Haghighi P, Resnick D (1987) The high signal intensity meniscus of the knee: magnetic resonance evaluation and in vivo correlation. Invest Radiol 22:883–890. https://doi.org/10.1097/00004424-198711000-00008

    Article  CAS  PubMed  Google Scholar 

  26. Krych AJ, Bernard CD, Leland DP, Camp CL, Johnson AC, Finnoff JT, Stuart MJ (2020) Isolated meniscus extrusion associated with meniscotibial ligament abnormality. Knee Surg Sports Traumatol Arthrosc 28(11):3599–3605. https://doi.org/10.1007/s00167-019-05612-1

    Article  PubMed  Google Scholar 

  27. Peltier A, Lording T, Maubisson L, Ballis R, Neyret P, Lustig S (2015) The role of the meniscotibial ligament in posteromedial rotational knee stability. Knee Surg Sports Traumatol Arthrosc 23(10):2967–2973. https://doi.org/10.1007/s00167-015-3751-0

    Article  CAS  PubMed  Google Scholar 

  28. Krych AJ, LaPrade MD, Hevesi M, Rhodes NG, Johnson AC, Camp CL, Stuart MJ (2020) Investigating the chronology of meniscus root tears: do medial meniscus posterior root tears cause extrusion or the other way around? Orthop J Sports Med 8(11):2325967120961368. https://doi.org/10.1177/2325967120961368

    Article  PubMed  PubMed Central  Google Scholar 

  29. 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):1644–1653. https://doi.org/10.1016/j.arthro.2011.06.033

    Article  PubMed  Google Scholar 

  30. Moon HK, Koh YG, Kim YC, Park YS, Jo SB, Kwon SK (2012) Prognostic factors of arthroscopic pull-out repair for a posterior root tear of the medial meniscus. Am J Sports Med 40(5):1138–1143. https://doi.org/10.1177/0363546511435622

    Article  PubMed  Google Scholar 

  31. Vedi V, Williams A, Tennant SJ, Spouse E, Hunt DM, Gedroyc WM (1999) Meniscal movement: an in-vivo study using dynamic MRI. J Bone Joint Surg Br 81:37–41. https://doi.org/10.1302/0301-620x.81b1.8928

    Article  CAS  PubMed  Google Scholar 

  32. Achtnich A, Petersen W, Willinger L, Sauter A, Rasper M, Wörtler K, Imhoff AB, Diermeier T (2018) Medial meniscus extrusion increases with age and BMI and is depending on different loading conditions. Knee Surg Sports Traumatol Arthrosc 26:2282–2288. https://doi.org/10.1007/s00167-018-4885-7

    Article  PubMed  Google Scholar 

  33. Zhang F, Bierma-Zeinstra SM, Oei EHG, Turkiewicz A, Englund M, Runhaar J (2017) Factors associated with meniscal body extrusion on knee MRI in overweight and obese women. Osteoarthr Cartil 25:694–699. https://doi.org/10.1016/j.joca.2016.12.001

    Article  CAS  Google Scholar 

  34. Goto N, Okazaki K, Akiyama T, Akasaki Y, Mizu-Uchi H, Hamai S, Nakamura S, Nakashima Y (2019) Alignment factors affecting the medial meniscus extrusion increases the risk of osteoarthritis development. Knee Surg Sports Traumatol Arthrosc 27:2617–2623. https://doi.org/10.1007/s00167-018-5286-7

    Article  PubMed  Google Scholar 

  35. Willinger L, Lang JJ, von Deimling C, Diermeier T, Petersen W, Imhoff AB, Burgkart R, Achtnich A et al (2020) Varus alignment increases medial meniscus extrusion and peak contact pressure: a biomechanical study. Knee Surg Sports Traumatol Arthrosc 28:1092–1098. https://doi.org/10.1007/s00167-019-05701-1

    Article  PubMed  Google Scholar 

  36. Navarro RA, Adams AL, Lin CC, Fleming J, Garcia IA, Lee J, Black MH (2020) Does knee arthroscopy for treatment of meniscal damage with osteoarthritis delay knee replacement compared to physical therapy alone? Clin Orthop Surg 12(3):304–311. https://doi.org/10.4055/cios19114

    Article  PubMed  PubMed Central  Google Scholar 

  37. Pihl K, Englund M, Lohmander LS, Jørgensen U, Nissen N, Schjerning J, Thorlund JB (2017) Signs of knee osteoarthritis common in 620 patients undergoing arthroscopic surgery for meniscal tear. Acta Orthop 88(1):90–95. https://doi.org/10.1080/17453674.2016.1253329

    Article  PubMed  Google Scholar 

  38. Persson F, Turkiewicz A, Bergkvist D, Neuman P, Englund M (2018) The risk of symptomatic knee osteoarthritis after arthroscopic meniscus repair vs partial meniscectomy vs the general population. Osteoarthr Cartil 26(2):195–201. https://doi.org/10.1016/j.joca.2017.08.020

    Article  CAS  Google Scholar 

  39. Bernard CD, Kennedy NI, Tagliero AJ, Camp CL, Saris DBF, Levy BA, Stuart MJ, Krych AJ (2020) Medial meniscus posterior root tear treatment: a matched cohort comparison of nonoperative management, partial meniscectomy, and repair. Am J Sports Med. 48(1):128–132. https://doi.org/10.1177/0363546519888212

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedics Surgery (Ohashi), School of Medicine, Toho University, 2-22-36 Ohashi, Meguro-ku, Tokyo, 153-8515, Japan

    Yuta Mochizuki, Keisuke Kawahara, Yuji Samejima, Takao Kaneko, Hiroyasu Ikegami & Yoshiro Musha

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  1. Yuta Mochizuki
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Correspondence to Yuta Mochizuki.

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Mochizuki, Y., Kawahara, K., Samejima, Y. et al. Short-term results and surgical technique of arthroscopic centralization as an augmentation for medial meniscus extrusion caused by medial meniscus posterior root tear. Eur J Orthop Surg Traumatol 31, 1235–1241 (2021). https://doi.org/10.1007/s00590-021-02874-9

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