Skip to main content
SpringerLink
Log in

Transtibial pullout repair of medial meniscus posterior root tears: effects on the meniscus healing score and ICRS grade among patients with mild osteoarthritis of the knee

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

Abstract

Purpose

To assess the effects of transtibial pullout repair for medial meniscus posterior root tears (MMPRTs) among patients with early osteoarthritis of the knee as measured by the meniscus healing score and to determine whether the meniscus healing score correlates with the International Cartilage Repair Society (ICRS) grade progression.

Methods

Forty-seven patients with mild osteoarthritic knees (Kellgren–Lawrence grade ≤ 2 and varus alignment < 5°) who underwent transtibial pullout repair less than 3 months after MMPRT onset were assessed. The association between meniscus healing scores at 1 year postoperatively and cartilage damage of the medial compartment (medial femoral condyle [MFC] and medial tibial plateau [MTP]) were evaluated. The MFC was divided into six zones (A to F) and the MTP into two zones (G and H). The mean ICRS grade for each zone was compared between the primary surgery and second-look arthroscopy. The correlation between cartilage damage and meniscus healing status at the time of second-look arthroscopy in each zone was analysed.

Results

The mean time interval from injury to surgery was 63 days, and all clinical scores showed significant improvement. There were no significant differences in the extent of cartilage damage in areas B, C, E, or F (n.s.) for MFC or in areas G and H (n.s.) for MTP. The meniscus healing score and cartilage damage were correlated in the loading areas (B, C, E, and H; − 0.53, − 0.45, − 0.33, and − 0.38, respectively; p < 0.05).

Conclusion

Transtibial pullout repair of MMPRTs among patients with mild osteoarthritic knees improved the clinical outcomes and showed a negative correlation between high meniscus healing scores and ICRS grades in the medial compartment loading area. This study suggests that early surgery should be undertaken for patients with mild osteoarthritic knee who develop MMPRTs.

Level of evidence

Level IV.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Code availability

Not applicable.

References

  1. Ahn JH, Jeong HJ, Lee YS, Park JH, Lee JW, Park J-H, Ko TS (2015) Comparison between conservative treatment and arthroscopic pull-out repair of the medial meniscus root tear and analysis of prognostic factors for the determination of repair indication. Arch Orthop Trauma Surg 135:1265–1276. https://doi.org/10.1007/s00402-015-2269-8

    Article  PubMed  Google Scholar 

  2. Alhalki MM, Howell SM, Hull ML (1999) How three methods for fixing a medial meniscal autograft affect tibial contact mechanics. Am J Sports Med 27:320–328. https://doi.org/10.1177/03635465990270030901

    Article  CAS  PubMed  Google Scholar 

  3. 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 

  4. Bhatia S, LaPrade CM, Ellman MB, LaPrade RF (2014) Meniscal root tears: significance, diagnosis, and treatment. Am J Sports Med 42:3016–3030. https://doi.org/10.1177/0363546514524162

    Article  PubMed  Google Scholar 

  5. Bonasia DE, Pellegrino P, D’Amelio A, Cottino U, Rossi R (2015) Meniscal root tear repair: why, when and how? Orthop Rev (Pavia) 7:5792. https://doi.org/10.1177/0363546514524162

    Article  Google Scholar 

  6. Cerminara AJ, LaPrade CM, Smith SD, Ellman MB, Wijdicks CA, LaPrade RF (2014) Biomechanical evaluation of a transtibial pull-out meniscal root repair: challenging the bungee effect. Am J Sports Med 42:2988–2995. https://doi.org/10.1177/0363546514524162

    Article  PubMed  Google Scholar 

  7. 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 20:2098–2103. https://doi.org/10.1007/s00167-011-1794-4

    Article  PubMed  Google Scholar 

  8. Chung KS, Ha JK, Ra HJ et al (2018) Pullout fixation for medial meniscus posterior root tears: clinical results were not age-dependent, but osteoarthritis progressed. Knee Surg Sports Traumatol Arthrosc 27:189–196. https://doi.org/10.1007/s00167-018-5024-1

    Article  PubMed  Google Scholar 

  9. Chung KS, Ha JK, Yeom CH et al (2015) Comparison of clinical and radiologic results between partial meniscectomy and refixation of medial meniscus posterior root tears: a minimum 5-year follow-up. Arthroscopy 31:1941–1950. https://doi.org/10.1007/s00167-018-5024-1

    Article  PubMed  Google Scholar 

  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 34:530–535. https://doi.org/10.1016/j.arthro.2017.08.266

    Article  PubMed  Google Scholar 

  11. 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 22:731–736. https://doi.org/10.1016/j.jos.2017.03.013

    Article  PubMed  Google Scholar 

  12. 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 103:1179–1182. https://doi.org/10.1016/j.otsr.2017.07.022

    Article  CAS  PubMed  Google Scholar 

  13. Furumatsu T, Kodama Y, Fujii M et al (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 103:367e71. https://doi.org/10.1016/j.rcot.2017.09.313

    Article  Google Scholar 

  14. 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 29:295–301. https://doi.org/10.5792/ksrr.17.027

    Article  PubMed  PubMed Central  Google Scholar 

  15. Furumatsu T, Miyazawa S, Fujii M, Tanaka T, Kodama Y, Ozaki T (2019) Arthroscopic scoring system of meniscal healing following medial meniscus posterior root repair. Int Orthop 43:1239–1245. https://doi.org/10.1007/s00264-018-4071-z

    Article  PubMed  Google Scholar 

  16. Han SB, Shetty GM, Lee DH et al (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 26:1326–1332. https://doi.org/10.1016/j.arthro.2010.01.032

    Article  PubMed  Google Scholar 

  17. Hino T, Furumatsu T, Miyazawa S et al (2019) A histological study of the medial meniscus posterior root tibial insertion. Connect Tissue Res 61(6):546–553

    Article  Google Scholar 

  18. 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 

  19. Jung YH, Choi NH, Oh JS, Victoroff BN (2012) All-inside repair for a root tear of the medial meniscus using a suture anchor. Am J Sports Med 40:1406–1411. https://doi.org/10.1177/0363546512439181

    Article  PubMed  Google Scholar 

  20. 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 27:1644–1653. https://doi.org/10.1016/j.arthro.2011.06.033

    Article  PubMed  Google Scholar 

  21. Kim JY, Bin SI, Kim JM, Lee BS, Oh SM, Park MH (2019) Tear gap and severity of osteoarthritis are associated with meniscal extrusion in degenerative medial meniscus posterior root tears. Orthop Traumatol Surg Res 105(7):1395–1399. https://doi.org/10.1016/j.otsr.2019.09.015

    Article  PubMed  Google Scholar 

  22. Kodama Y, Furumatsu T, Kamatsuki Y et al (2019) Preliminary diagnosis of medial meniscus posterior root tears using the Rosenberg radiographic view. Knee Surg Relat Res 31:1–8. https://doi.org/10.1186/s43019-019-0011-5

    Article  Google Scholar 

  23. Kodama Y, Furumatsu T, Masuda S et al (2019) 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. https://doi.org/10.1007/s00167-019-05810-x

    Article  PubMed  Google Scholar 

  24. 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 26:1117–1122. https://doi.org/10.1007/s00167-017-4454-5

    Article  PubMed  Google Scholar 

  25. 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 25:383–389. https://doi.org/10.1007/s00167-016-4359-8

    Article  PubMed  Google Scholar 

  26. Kwon OJ, Bin SI, Kim JM et al (2020) There is no difference in radiographic outcomes after average 9 years after arthroscopic partial medial meniscectomy for both posterior horn tears and posterior horn root tears. Arthroscopy 36:524–532. https://doi.org/10.1016/j.arthro.2019.08.039

    Article  PubMed  Google Scholar 

  27. LaPrade CM, LaPrade MD, Turnbull TL, Wijdicks CA, LaPrade RF (2015) Biomechanical evaluation of the transtibial pull-out technique for posterior medial meniscal root repairs using 1 and 2 transtibial bone tunnels. Am J Sports Med 43:899–904. https://doi.org/10.1177/0363546514563278

    Article  PubMed  Google Scholar 

  28. Lee JK, Jung M, Yang JH et al (2020) Repair versus nonrepair of medial meniscus posterior root tear: a systematic review of patients’ selection criteria, including clinical and radiographic outcomes. Medicine 99:e19499. https://doi.org/10.1097/md.0000000000019499

    Article  PubMed  PubMed Central  Google Scholar 

  29. Lim HC, Bae JH, Wang JH, Seok CW, Kim MK (2010) Non-operative treatment of degenerative posterior root tear of the medial meniscus. Knee Surg Sports Traumatol Arthrosc 18:535–539. https://doi.org/10.1007/s00167-009-0891-0

    Article  PubMed  Google Scholar 

  30. Neogi DS, Kumar A, Rijal L, Yadav CS, Jaiman A, Nag HL (2013) Role of nonoperative treatment in managing degenerative tears of the medial meniscus posterior root. J Orthop Traumatol 14:193–199. https://doi.org/10.1007/s10195-013-0234-2

    Article  PubMed  PubMed Central  Google Scholar 

  31. Okazaki Y, Furumatsu T, Kamatsuki Y et al (2020) Differences between the root and horn cells of the human medial meniscus from the osteoarthritic knee in cellular characteristics and responses to mechanical stress. J Orthop Sci. https://doi.org/10.1016/j.jos.2020.02.015

    Article  PubMed  Google Scholar 

  32. Okazaki Y, Furumatsu T, Kodama Y, Kamatsuki Y, Masuda S, Ozaki T (2019) Description of a surgical technique of medial meniscus root repair: a fixation technique with two simple stitches under an expected initial tension. Eur J Orthop Surg Traumatol 29:705–709. https://doi.org/10.1007/s00590-018-2347-z

    Article  PubMed  Google Scholar 

  33. Ozkoc G, Circi E, Gonc U, Irgit K, Pourbagher A, Tandogan RN (2008) Radial tears in the root of the posterior horn of the medial meniscus. Knee Surg Sports Traumatol Arthrosc 16:849–854. https://doi.org/10.1007/s00167-008-0569-z

    Article  PubMed  Google Scholar 

  34. Seo JH, LiG SGM et al (2009) Effect of repair of radial tears at the root of the posterior horn of the medial meniscus with the pullout suture technique: a biomechanical study using porcine knees. Arthroscopy 25:1281–1287. https://doi.org/10.1016/j.arthro.2009.05.014

    Article  PubMed  Google Scholar 

  35. Stärke C, Kopf S, Gröbel KH, Becker R (2010) The effect of a nonanatomic repair of the meniscal horn attachment on meniscal tension: a biomechanical study. Arthroscopy 26:358–365. https://doi.org/10.1016/j.arthro.2009.08.013

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

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

Funding

No funding was received for this study.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan

    Yuya Kodama, Takayuki Furumatsu, Yuki Okazaki, Shota Takihira, Takaaki Hiranaka, Shinichi Miyazawa, Yusuke Kamatsuki & Toshifumi Ozaki

  2. Department of Orthopaedic Surgery, Iwakuni Medical Center, 1-1-1 Atagomachi, Iwakuni, Yamaguchi, 740-8510, Japan

    Yuya Kodama

  3. Department of Orthopaedic Surgery, Kochi Health Sciences Center, 2125-1 Ike, Kochi, 781-8555, Japan

    Yusuke Kamatsuki

Authors
  1. Yuya Kodama
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Takayuki Furumatsu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yuki Okazaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shota Takihira
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Takaaki Hiranaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Shinichi Miyazawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yusuke Kamatsuki
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Toshifumi Ozaki
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Takayuki Furumatsu.

Ethics declarations

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 this study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kodama, Y., Furumatsu, T., Okazaki, Y. et al. Transtibial pullout repair of medial meniscus posterior root tears: effects on the meniscus healing score and ICRS grade among patients with mild osteoarthritis of the knee. Knee Surg Sports Traumatol Arthrosc 29, 3001–3009 (2021). https://doi.org/10.1007/s00167-020-06332-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-020-06332-7

Keywords

Search

Navigation