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Increased extrusion and ICRS grades at 2-year follow-up following transtibial medial meniscal root repair evaluated by MRI

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of the current study was to evaluate the short-term results of meniscal root repair surgery, assessing clinical and radiographic outcomes, utilizing MRI to assess root healing and extent of post-operative extrusion.

Methods

This was a single-center, retrospective study evaluating patients who had undergone a medial meniscus posterior root repair using a transtibial pullout technique with two locking cinch sutures. Demographic data were collected from patient charts. Clinical outcomes were assessed with pre- and post-operative IKDC and Lysholm scores. Pre-op scores were taken at the patients’ initial clinical visit, mean 1.55 months prior to surgery (± 1.8 months, min 0.3, max 7.3). Radiographic outcomes were assessed with MRI evaluation of root healing, meniscal extrusion, and cartilage degeneration using ICRS criteria. Tunnel placement was evaluated and compared to the anatomic footprint.

Results

Eighteen patients (47.2 years ± 11.9) were evaluated at mean follow-up of 24.9 months (± 7.2, min 18.4, max 35.6). The IKDC score significantly increased from 45.9 (± 12.6) pre-operatively to 76.8 (± 14.7) post-operatively (p < 0.001). Lysholm scores also increased from 50.9 (± 7.11) to 87.1 (± 9.8) (p < 0.001). Mean tunnel placement was 5.3 mm (± 3.5, range 0–11.8) away from the anatomic footprint. Mean extrusion increased from 4.74 mm (± 1.7) pre-operatively to 5.98 (± 2.8) post-operatively (p < 0.02). No patients with > 3 mm of extrusion on pre-operative MRI had < 3 mm of extrusion on post-operative MRI. Both medial femoral condyle and medial tibial plateau ICRS grades worsened significantly (p < 0.02 and p < 0.01, respectively). On MRI, one root appeared completely healed, 16 partially healed, and one not healed.

Conclusion

Patients treated with the transtibial suture pull-out technique with two locking cinch sutures had improved clinical outcomes, but only partial healing in the majority of cases, increased extrusion, and progression of medial compartment cartilage defect grade on follow-up MRI. Patients should be counseled that although clinical outcomes in the short term may be optimistic, long-term outcomes regarding progression to degenerative arthritis may not be as predictable.

Clinical level of evidence

III.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Sports Medicine Division, NYU Langone Orthopedic Hospital, New York, NY, USA

    Daniel J. Kaplan, Andrew P. Dold, Robert J. Meislin, Eric J. Strauss, Laith M. Jazrawi & Michael J. Alaia

  2. Department of Radiology, Musculoskeletal Division, NYU Langone Medical Center, New York, NY, USA

    Erin F. Alaia

Authors
  1. Daniel J. Kaplan
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  2. Erin F. Alaia
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  3. Andrew P. Dold
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  7. Michael J. Alaia
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Correspondence to Daniel J. Kaplan.

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Conflict of interest

No authors have any relevant financial dislosures of conflicts of interest related to the topics covered in this article.

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There is no funding source.

Ethical approval

All aspects of this study were approved by the NYU internal review board, and no unethical treatment of patients or patient information occured.

Informed consent

Informed consent was received from all individual participants in the study.

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Kaplan, D.J., Alaia, E.F., Dold, A.P. et al. Increased extrusion and ICRS grades at 2-year follow-up following transtibial medial meniscal root repair evaluated by MRI. Knee Surg Sports Traumatol Arthrosc 26, 2826–2834 (2018). https://doi.org/10.1007/s00167-017-4755-8

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  • DOI: https://doi.org/10.1007/s00167-017-4755-8

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