No dynamic extrusion in medial meniscus root lesions - an ultrasound study

Aims and Objectives: Extrusion of the medial meniscus in MRI is an indirect radiological sign for a meniscus root tear. However, a recent study has shown that ultrasound-detectable dynamic extrusion is considered physiological in healthy volunteers. The aim of our study was to analyze the dynamic meniscal extrusion in patients with proven root injury in ultrasound. Our hypothesis was that dynamic extrusion is reduced in patients with root injury of the medial meniscus compared to healthy volunteers. Materials and Methods: Inclusion criteria for this prospective study were MRI signs for a root lesion of the medial meniscus (ghost sign, extrusion > 3 mm). An age matched group of healthy volunteers served as control. Exclusion criterion was osteoarthritis > II° of the medial compartment according to Kellgren & Lawrence. The extrusion of the medial meniscus (MME) of the affected knee was measured by ultrasound (US) in supine position and under full weight bearing. Results: 25 patients with a medial root lesion were included in the study. The evaluation of the ultrasound results revealed a significant decreased dynamic medial displacement of the meniscus in patients with root injury. In the supine position, the mean medial meniscus extrusion was 3.60 mm (± 1.00 mm). In the standing position, the mean medial meniscus extrusion increased to 3.72 mm (± 0.96 mm). The mean delta-extrusion was 0.11 mm (± 0.17 mm). This difference was statistically not significant. In 14 patients, no dynamic extrusion was detectable at all. All patients belonging to the medial root tear group had a significant varus deformity (mechanical axis hits the tibial joint line more than 15 mm medially form the center). In the control group, the mean medial meniscus extrusion was 1.34 mm (± 0.37 mm) in supine position and 2.20 mm (± 0.34 mm) under full weight bearing. The mean delta-extrusion was 0.85 mm (± 0.30 mm). The difference in mean delta-extrusion between the root tear and control group was statistically significant. Conclusion: Ultrasonography is a diagnostic tool to detect the dynamic extrusion of the medial meniscus. Lack of dynamic extrusion (“dead meniscus sign”) may serve as an indicator for medial root injury.

Download Full-text

Correlation between meniscal extrusion and symptom duration, alignment, and arthritic changes in medial meniscus posterior root tear: research article

Knee Surgery and Related Research ◽

10.1186/s43019-019-0019-x ◽

2020 ◽

Vol 32 (1) ◽

Cited By ~ 1

Author(s):

Dong Hwi Kim ◽

Gwang Chul Lee ◽

Hyun Hak Kim ◽

Dong Hyuk Cha

Keyword(s):

Medial Meniscus ◽

Posterior Root ◽

Root Tear ◽

X Ray ◽

Posterior Root Tear ◽

Grade Ii ◽

The Mean ◽

Medial Meniscus Extrusion ◽

Meniscus Extrusion ◽

Grade Iii

Abstract Background Medial meniscus posterior root tear can result in medial meniscus extrusion. However, the severity of medial meniscus extrusion is different in each root tear patient. The purpose of this study was to identify the factors that contribute to the severity of medial meniscus extrusion with medial meniscus posterior root tear, such as duration of disease, the degree of arthritis—chondral wear, subchondral edema, osteophyte size, and Kellgren–Lawrence (K/L) grade—and mechanical alignment for appropriate treatment method. Methods From January 2009 to August 2014, we retrospectively analyzed magnetic resonance imaging (MRI) and simple x-ray of 99 patients with medial meniscus posterior root tear. The duration of the disease was identified through retrospective chart review. The severity of medial meniscus extrusion, the presence of subchondral edema, the degree of chondral wear, and the size of the osteophyte were measured on MRI. K/L grade was confirmed on simple x-ray, and the mechanical axis was measured on whole extremity radiographs. Statistical analysis was performed by using bivariate correlation analysis and one-way analysis of variance. Results The mean medial meniscus extrusion was 4.61 mm, and the mean duration of the disease was 15.52 months. The mean degree of chondral wear was 25.8%, and 63 out of 99 cases showed subchondral edema. The average alignment was 4.30 degrees, and the average size of the osteophyte was 1.48 mm. There were 40 cases (40.4%) with K/L grade I, 48 cases (48.5%) with grade II, 11 cases (11.1%) with grade III, and no cases with grade IV. In the group mean analysis between the K/L grade and the severity of medial meniscus extrusion, the average medial meniscus extrusions were 3.97 mm in grade I, 4.93 mm in grade II, and 5.59 mm in grade III. There was a statistical significance between the size of the osteophyte and the severity of medial meniscus extrusion (P = 0.000), K/L grade, and the severity of medial meniscus extrusion (P = 0.001). Conclusions The severity of medial meniscus extrusion with medial meniscus posterior horn root tear is associated with the size of the osteophyte and K/L grade.

Download Full-text

Greater Medial Meniscus Extrusion Seen on Ultrasonography Indicates the Risk of Posterior Root Tear in Non-radiographic Knee Osteoarthritis Population

10.21203/rs.3.rs-729085/v1 ◽

2021 ◽

Author(s):

Daisuke Chiba ◽

Tomoyuki Sasaki ◽

Yasuyuki Ishibashi

Keyword(s):

Odds Ratio ◽

Adjusted Odds Ratio ◽

Medial Meniscus ◽

Roc Curves ◽

Posterior Root ◽

Root Tear ◽

Cross Sectional ◽

Posterior Root Tear ◽

Medial Meniscus Extrusion ◽

Meniscus Extrusion

Abstract Purpose: To elucidate the association between medial meniscus extrusion measured on ultrasonography (MMEUS) and the prevalence of medial meniscus posterior root tear detected on magnetic resonance imaging (MMPRTMRI). Methods: We recruited 127 patients (135 knees) in this cross-sectional study. All participants had medial knee pain without a knee trauma or surgery history. Knee osteoarthritis (KOA) severity was evaluated using Kellgren-Lawrence grade (KLG) scores. Patients with KLG scores 0-1 and ≥2 were classified in non-radiographic (non-ROA) and radiographic KOA (ROA) groups, respectively. MMEUS was measured with patients in the supine position. Based on T2*-weighted images, MMPRTMRI was defined as the presence of “Ghost meniscus sign” and “Creft/truncation sign”, indicating an abnormal high signal intensity of a disrupted posterior root. MMEUS was compared between MMPRT+ and MMPRT– patients using a non-paired t-test. Receiver operating characteristic (ROC) curves were used to determine the optimal cut-off MMEUS to predict MMPRT+.Results: The prevalence of MMPRT+ was 31.3% (25/80 knees) and 29.1% (16/55 knees) in the non-ROA and ROA groups. The MMEUS of MMPRT+ patients were significantly greater than that of MMPRT– patients in both the non-ROA (5.9±1.4 mm vs. 4.4±1.0 mm, P<0.001) and ROA (7.8±1.3 mm vs. 6.3±1.3 mm, P<0.001) groups. ROC curves demonstrated that 5-mm and 7-mm MMEUS were the optimal cut-off values in non-ROA (adjusted odds ratio: 6.280; area under the curve [AUC]: 0.809; P<0.001) and ROA (adjusted odds ratio: 15.003; AUC: 0.797; P=0.001) groups.Conclusions: In early non-radiographic KOA stages, a greater MMEUS was associated with a higher MMPRTMRI prevalence.Level of evidence: III, Cross-sectional cohort study

Download Full-text

A repair technique using two simple stitches reduces the short-term postoperative medial meniscus extrusion after pullout repair for medial meniscus posterior root tear

European Journal of Orthopaedic Surgery & Traumatology ◽

10.1007/s00590-020-02647-w ◽

2020 ◽

Vol 30 (5) ◽

pp. 901-908 ◽

Cited By ~ 4

Author(s):

Takaaki Hiranaka ◽

Takayuki Furumatsu ◽

Shin Masuda ◽

Yoshiki Okazaki ◽

Yuki Okazaki ◽

...

Keyword(s):

Medial Meniscus ◽

Posterior Root ◽

Root Tear ◽

Short Term ◽

Posterior Root Tear ◽

Repair Technique ◽

Pullout Repair ◽

Medial Meniscus Extrusion ◽

Meniscus Extrusion

Download Full-text

Preoperative Meniscal Extrusion Predicts Unsatisfactory Clinical Outcomes and Progression of Osteoarthritis after Isolated Partial Medial Meniscectomy: A 5-Year Follow-Up Study

The Journal of Knee Surgery ◽

10.1055/s-0040-1715109 ◽

2020 ◽

Author(s):

João V. Novaretti ◽

Diego C. Astur ◽

Elton L.B. Cavalcante ◽

Camila C. Kaleka ◽

Joicemar T. Amaro ◽

...

Keyword(s):

Clinical Outcomes ◽

Medial Meniscus ◽

International Knee Documentation Committee ◽

Meniscal Extrusion ◽

Optimal Cutoff ◽

Medial Meniscectomy ◽

The Mean ◽

Medial Meniscus Extrusion ◽

Meniscus Extrusion

AbstractThe objective of this study was to examine the association between preoperative meniscal extrusion of patients undergoing partial medial meniscectomy with clinical outcomes and progression of osteoarthritis and to determine the extent of meniscal extrusion associated with unsatisfactory clinical outcomes and progression of osteoarthritis. Ninety-five patients who underwent partial medial meniscectomy with a minimum follow-up of 5 years were retrospectively reviewed. Preoperative meniscal extrusion was evaluated with magnetic resonance imaging. Patients were assessed preoperatively and postoperatively with Lysholm and International Knee Documentation Committee (IKDC) subjective scores for clinical outcomes and with IKDC radiographic scale for osteoarthritis. An ANOVA (Analysis of Variance) was used to analyze the variations in meniscal extrusion and the clinical and radiological outcomes. A regression analysis was performed to identify factors that affect preoperative medial meniscus extrusion and that influence results after partial meniscectomy. An optimal cutoff value for meniscal extrusion associated with unsatisfactory clinical outcomes and progression of osteoarthritis was established. Significance was set at p < 0.05. The mean ± SD preoperative and postoperative Lysholm scores were 59.6 ± 15.5 versus 83.8 ± 13.1 (p < 0.001) and the mean preoperative and postoperative IKDC subjective scores were 59.4 ± 16.8 versus 82.0 ± 15.8 (p < 0.001). Meniscal extrusion greater than 2.2 mm (sensitivity, 84%; specificity, 81%) and 2.8 mm (sensitivity, 73%; specificity, 85%) was associated with unsatisfactory (poor/fair) Lysholm and IKDC subjective scores, respectively. The progression of osteoarthritis, characterized as a change of at least one category on the IKDC radiographic scale, occurred when meniscal extrusion was greater than 2.2 mm (sensitivity, 63%; specificity, 75%). Patients with higher body mass index (BMI) had significantly greater meniscal extrusion that patients with normal BMI (p < 0.001). The medial meniscus was more extruded in patients with horizontal and root tears. In conclusion, patients with preoperative meniscal extrusion of 2.2 mm or greater had unsatisfactory clinical outcomes and progression of osteoarthritis after partial medial meniscectomy at a minimum of 5 years follow-up. Higher BMI and horizontal and root tears were associated with greater preoperative meniscal extrusion.

Download Full-text