scholarly journals Meniscal Root Repair in Pediatric Patients: Minimum 2-Year Outcomes (196)

2021 ◽  
Vol 9 (10_suppl5) ◽  
pp. 2325967121S0030
Author(s):  
S. Clifton Willimon ◽  
Michael Busch ◽  
Asahi Murata ◽  
Crystal Perkins
Keyword(s):  
Patient Satisfaction ◽  
Pediatric Patients ◽  
Medial Meniscus ◽  
Lateral Meniscus ◽  
Injury Pattern ◽  
Posterior Root ◽  
Root Tear ◽  
Meniscus Root ◽  
Root Repair

Objectives: The medial and lateral menisci function to optimize force transmission across the knee by increasing contact area between the femur and tibia, absorbing shock, and transmitting loads. The anterior and posterior meniscus roots anchor the meniscus to bone. Injuries to the meniscus root attachments result in extrusion of the meniscus, impaired distribution of hoop stresses, and progressive degenerative articular wear. As a result of these deleterious effects, there has been increasing emphasis on repair of meniscus root injuries to restore structure and function. The purpose of this study is to describe meniscus root tears, associated injuries, and minimum 2-year treatment outcomes in a series of pediatric patients. Methods: A single-institution, IRB approved, retrospective review was performed of consecutive pediatric patients less than 19 years of age with a meniscus root tear treated with transosseous root repair over a 4-year period. All patients had minimum 24-month clinical follow-up. Partial root tears treated with partial meniscectomy or irreparable root tears were excluded. All meniscus root tears were classified arthroscopically based on the tear types described by LaPradeADDIN EN.CITE 9. The primary outcomes were revision meniscus surgery and patient reported outcome scores (PROs) (Lysholm, Patient Satisfaction, and Tegner activity). Results: Twenty-one patients, 11 males and 10 females with a mean age of 15 years (range 7 – 18 years), met inclusion criteria. There were 15 lateral meniscus root tears and 6 medial meniscus root tears. The tears occurred in the posterior root in 20 patients (95%). The most common injury pattern was a lateral meniscus posterior root tear (14 patients, 67%). 18 patients (86%) had an associated ligament tear: 13 ACL tears and 5 PCL tears. Two root tears occurred in isolation, and both were the posterior root of the medial meniscus. The majority of meniscus root tears (15 patients, 71%) were root avulsions (type 5). Mean follow-up was 42 months (range 25 – 71 months). Three patients had a second surgery on the affected knee. In two patients, one with revision ACL reconstruction and one treated with chondroplasty of the patella, the meniscus root repair was noted to be well healed. A third patient sustained a new injury to the knee 4 years following medial meniscus posterior root repair and underwent partial medial meniscectomy. At final follow-up, PROs were obtained for 17 patients (81%). Mean Lysholm score was 91 (range 51 – 100). Mean patient satisfaction score was 8.7 (range 5 – 10). Fourteen of 16 patients (88%) reported returning to the same or higher level of activity following surgery. Conclusions: Meniscus root tears occur in pediatric patients, most commonly as root avulsions of the posterior root of the lateral meniscus and in association with ACL tears. This is unique as compared to the adult population, in which the medial meniscus posterior root is often injured in isolation and radial tears adjacent the root are the most commonly described injury pattern. In our case series, transosseous root repair resulted in successful outcomes in the majority of patients with durable results at midterm follow-up.

scholarly journals MENISCUS ROOT TEARS IN CHILDREN AND ADOLESCENTS

2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0003
Author(s):  
S. Clifton Willimon ◽  
Melissa Christino ◽  
Michael Busch ◽  
Crystal Perkins
Keyword(s):  
Pediatric Patients ◽  
Medial Meniscus ◽  
Lateral Meniscus ◽  
Posterior Root ◽  
Associated Injuries ◽  
Inclusion Criteria ◽  
Root Tear ◽  
Meniscus Root ◽  
Meniscus Root Tear

Background: The medial and lateral menisci function to optimize force transmission across the knee by increasing contact area between the femur and tibia, absorbing shock, and transmitting loads. Injuries to the meniscus root attachments result in extrusion of the meniscus, impaired distribution of hoop stresses, and degenerative articular wear. The purpose of this study is to describe meniscus root tears, associated injuries, and treatment in a series of pediatric patients Methods: A single-institution retrospective review was performed of consecutive pediatric patients treated for meniscus root tears from 2013 – 2017. Inclusion criteria were patients less than 19 years of age, arthroscopic evidence of a meniscus root tear, and minimum 6 months clinical follow-up. The primary outcome was surgery for revision of the meniscus repair. Results: Twenty-seven patients were identified to fit inclusion criteria. There were 15 males and 12 females with a mean age of 15.2 years (range 7 – 18 years). Basketball, soccer, and football accounted for the majority (56%) of injuries. The lateral meniscus was involved in 21 patients (78%) and the medial meniscus in 6 patients (22%). The posterior meniscus root was torn in 25 patients (93%) and anterior meniscus root in 2 patients (7%). The most common injury pattern was a lateral meniscus posterior root tear (19 patients, 70%). Associated injuries included an ACL tear (19 patients, 70%), PCL tear (6 patients, 22%), and a tear of the opposite meniscus (7 patients, 26%). Two root tears occurred in isolation, and both were of the posterior root of the medial meniscus. All patients were treated surgically with an arthroscopic transosseous root repair in addition to simultaneous treatment for their associated injuries. Mean follow-up was 14 months (range 6 – 37 months). No patients required additional surgery for their meniscus root tear. Two patients had a second surgery on the affected knee: one for revision ACL reconstruction 2 years following the primary procedure and the other for chondroplasty of the patella 2.5 years following the primary procedure. Conclusions: Meniscus root tears occur in pediatric and adolescent patients, most commonly affecting the posterior root of the lateral meniscus and occurring in association with ACL tears. The adolescent meniscus root injury pattern is unique compared to the adult population in which the medial meniscus posterior root is often injured in isolation. Inspection of the meniscus root attachments with deliberate probing to assess the meniscus roots should be a routine part of every knee arthroscopy. In our case series, transosseous root repair resulted in successful outcomes in all patients without need for any additional meniscus treatment.

scholarly journals Does meniscectomy have any advantage over conservative treatment in middle-aged patients with degenerative medial meniscus posterior root tear?

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Nam-Hun Lee ◽  
Hyoung-Yeon Seo ◽  
Myung-Jin Sung ◽  
Bo-Ram Na ◽  
Eun-Kyoo Song ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Clinical Outcomes ◽  
Medial Meniscus ◽  
Joint Space ◽  
Posterior Root ◽  
Root Tear ◽  
Aged Patients ◽  
Posterior Root Tear ◽  
Arthroscopic Meniscectomy

Abstract Background The best treatment for degenerative medial meniscus posterior root tear (MMPRT) remains controversial. This study aimed to compare the clinical and radiological outcomes of arthroscopic meniscectomy and conservative treatment for degenerative MMPRT. Methods From January 2007 to December 2014, 146 patients (Meniscectomy group, 90; Conservative group, 56) were evaluated. Clinical outcomes were assessed using the Visual Analog Scale, International Knee Documentation Committee subjective scoring scale, Tegner activity scale, and Lysholm knee scoring scale at the final follow-up. Radiologic outcomes evaluated the progression of osteoarthritis (OA) according to the Kellgren-Lawrence (K-L) classification. We compared the hip-knee-ankle angle (HKAA), medial proximal tibial angle, tibial posterior slope angle, and width of medial joint space. After an average follow-up of 6.3 years, the survivorship was analyzed using the Kaplan–Meier method. Results All clinical outcomes were significantly improved in both groups after treatment, with no significant differences between the two groups at the final follow-up. The progression of OA according to the K-L classification, HKAA and width of medial joint space was significantly advanced in the meniscectomy group (p = 0.03, 0.04, 0.03, respectively). The 10-year survival rates in the meniscectomy and conservative groups were 87 and 88%, respectively. Conclusions This study demonstrated that both conservative treatment and meniscectomy provided symptomatic relief. However, it was confirmed that OA progression was more severe in the meniscectomy. We conclude that arthroscopic meniscectomy had no advantage over conservative treatment in terms of clinical outcomes and OA progression in middle-aged patients with MMPRT. Level of evidence Level III; retrospective comparative study.

scholarly journals Lateral Meniscal Posterior Root Repair With Anterior Cruciate Ligament Reconstruction Better Restores Knee Stability

2018 ◽  
Vol 47 (1) ◽  
pp. 59-65 ◽  
Author(s):  
Xin Tang ◽  
Brandon Marshall ◽  
Joon Ho Wang ◽  
Junjun Zhu ◽  
Jian Li ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Pivot Shift ◽  
Cruciate Ligament ◽  
Lateral Meniscus ◽  
Posterior Root ◽  
Knee Stability ◽  
Root Tear ◽  
Root Repair ◽  
Anterior Tibial ◽  
Reconstructed Knee

Background: The effect of lateral meniscal posterior root tear and repair—commonly seen in clinical practice in the setting of anterior cruciate ligament (ACL) reconstruction—is not known. Purpose/Hypothesis: This study evaluated the effect of tear and repair of the lateral meniscal posterior root on the biomechanics of the ACL-reconstructed knee. It was hypothesized that anterior tibial translation would increase under anterior loading and simulated pivot-shift loading with the root tear of the posterior lateral meniscus, while repair of the root tear would reduce it close to the noninjured state. Study Design: Controlled laboratory study. Methods: Thirteen fresh-frozen adult human knees were tested with a robotic testing system under 2 loading conditions: (1) an 89.0-N anterior tibial load applied at full extension and 15°, 30°, 60°, and 90° of knee flexion and (2) a combined 7.0-N·m valgus and 5.0-N·m internal tibial torque (simulated pivot-shift test) applied at full extension and 15° and 30° of knee flexion. The following knee states were tested: intact knee, ACL reconstruction and intact lateral meniscus, ACL reconstruction and lateral meniscal posterior root tear, and ACL reconstruction and lateral meniscal posterior root repair. Results: In the ACL-reconstructed knee, a tear of the lateral meniscal posterior root significantly increased knee laxity under anterior loading by as much as 1 mm. The transosseous pullout suture root repair improved knee stability under anterior tibial and simulated pivot-shift loading. Root repair improved the ACL graft force closer to that of the native ACL under anterior tibial loading. Conclusion: Lateral meniscal posterior root injury further destabilizes the ACL-reconstructed knee, and root repair improves knee stability. Clinical Relevance: This study suggests a rationale for surgical repair of the lateral meniscus, which can restore stability close to that of the premeniscal injury state.

scholarly journals Lateral meniscal posterior root tears experience acceptable healing status after transtibial repair technique

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Cathrine Aga ◽  
Ingerid Baksaas Aasen ◽  
Carsten Brocker ◽  
Nina Jullum Kise ◽  
Stig Heir
Keyword(s):  
Lateral Meniscus ◽  
Case Series ◽  
Rate Of Change ◽  
Posterior Root ◽  
Root Tear ◽  
Meniscal Extrusion ◽  
Posterior Root Tear ◽  
Meniscal Root ◽  
Global Rate

Abstract Purpose To evaluate patient MRI results, demography and clinical outcome following transtibial repair of lateral and medial meniscal posterior root tears. Methods Patients treated with transtibial repairs of posterior meniscal root tears from 2015 through 2018 performed pre- and postoperative MRI scans. Outcome measures were continuity/discontinuity of the meniscal root and change in meniscal extrusion on MRI. Other outcomes were KOOS, Lysholm score, Tegner activity scale and the Global Rate of Change (GRoC) score for function and pain at follow-up. Study design Retrospective case-series. Results Of 41 patients, 36 attended follow-up at mean 26 (12–38) months postoperatively. At follow-up, 11 out of 18 lateral meniscus posterior root tear (LMPRT) versus 5 out of 18 medial meniscus posterior root tear (MMPRT) repairs were classified as healed. Meniscal extrusion decreased in LMPRTs from of 2.3 ± 1.5 mm to 1.4 ± 1.09 mm (p = 0.080) and increased in MMPRTs from 3.1 ± 1.6 mm to 4.8 ± 1.9 mm (p = 0.005) at FU (between-group difference, p < 0.001). LMPRT repairs were associated with ACL injury and additional meniscal injury and were younger and with lower BMI. No between-group differences were found for KOOS, Lysholm or GRoC Function scores. Tegner scale was higher and GRoC Pain score lower in the LMPRT group compared to the MMPRTs. Conclusion Following transtibial repair for meniscal posterior root repairs, the LMPRTs had a higher frequency of healing, whereas most MMPRTs continued to extrude, despite surgical intervention. The study confirmed that LMPRTs and MMPRTs differ in demography and associated injuries.

Posterior Medial Meniscus Root Tears Potentiate the Effect of Increased Tibial Slope on Anterior Cruciate Ligament Graft Forces

2019 ◽  
Vol 48 (2) ◽  
pp. 334-340 ◽  
Author(s):  
Brian T. Samuelsen ◽  
Zachary S. Aman ◽  
Mitchell Iung Kennedy ◽  
Grant J. Dornan ◽  
Hunter W. Storaci ◽  
...  
Keyword(s):  
Knee Flexion ◽  
Medial Meniscus ◽  
Sagittal Plane ◽  
Cruciate Ligament ◽  
Tibial Slope ◽  
Tibial Osteotomy ◽  
Root Tear ◽  
Meniscus Root ◽  
Root Repair ◽  
Meniscus Root Tear

Background: Increased posterior tibial slope and posterior medial meniscus root tears increase the force experienced by the anterior cruciate ligament (ACL) and predispose patients to higher rates of primary ACL injury or ACL graft failure after an ACL reconstruction (ACLR). However, the interplay among sagittal plane tibial slope, medial meniscus root tears, and ACLR graft force remains inadequately defined. Purpose/Hypothesis: The purpose was to quantify the effect of sagittal plane tibial slope on ACLR graft force at varying knee flexion angles with an intact medial meniscus, a posterior medial meniscus root tear, and a medial meniscus root repair. Our null hypothesis was that changes in slope and meniscal state would have no effect on the forces experienced by the ACLR graft. Study Design: Controlled laboratory study. Methods: Ten male fresh-frozen cadaveric human knees underwent a posteriorly based high tibial osteotomy. A spanning external fixator and wedges of varying sizes were used to stabilize the osteotomy and allow for accurate slope adjustment. After ACLR, specimens were compressed with a 1000-N axial load at flexion angles of 0° and 30° for each of the 3 meniscal states and at tibial slopes of 0° to 15° at 3° increments. Graft loads were recorded through a force transducer clamped to the graft. Results: Increasing tibial slope led to a linear increase in ACLR graft force at 0° and 30° of knee flexion. Posterior medial meniscus root tear led to significant increases in ACLR graft forces over the intact state, while root repair restored the function of the medial meniscus as a secondary stabilizer. At 30° of knee flexion, the tibial slope effect on ACLR graft force was potentiated in the root tear state as compared with the intact and root repair states—test of interaction effect: t(139) = 2.67 ( P = .009). Conclusion: Increases in tibial slope lead to a linear increase in ACLR graft forces, and this effect is magnified in the setting of a posterior medial meniscus root tear. At slopes >12°, a slope-changing osteotomy could be considered in the setting of a revision ACLR with a concomitant medial meniscus root tear. Clinical Relevance: Defining the relationship between tibial slope and varying states of meniscal insufficiency can help determine when it may be necessary to perform a slope-decreasing proximal tibial osteotomy before ACLR and meniscal repair.

Outcomes of Arthroscopic All-Inside Repair Versus Observation in Older Patients With Meniscus Root Tears

2020 ◽  
Vol 48 (5) ◽  
pp. 1127-1133 ◽  
Author(s):  
Jason L. Dragoo ◽  
Jaclyn A. Konopka ◽  
Roberto A. Guzman ◽  
Nicole Segovia ◽  
Abdurrahman Kandil ◽  
...  
Keyword(s):  
Older Patients ◽  
Lateral Meniscus ◽  
Nonoperative Treatment ◽  
Contact Forces ◽  
Arthroscopic Repair ◽  
Meniscus Root ◽  
Root Repair ◽  
Conversion Rates ◽  
Meniscus Root Repair

Background: Meniscus root tears lead to de-tensioning of the meniscus, increased contact forces, and cartilage damage. Management of older patients with root tears is controversial and the efficacy of different treatment options is unclear. Purpose: To compare the clinical outcomes of patients with moderate knee osteoarthritis who underwent an all-inside meniscus root repair technique versus nonoperative management for either medial or lateral meniscus root tears. Study Design: Cohort study; Level of evidence, 2. Methods: Patients with a diagnosed posterior meniscus root tear who underwent arthroscopic repair (AR: 30 knees) or nonoperative treatment with observation (O: 18 knees) were followed for a minimum of 2 years (mean follow-up, 4.4 years). The arthroscopic repair included all-inside sutures to reduce the root back to its remnant (reduction sutures), thereby re-tensioning the meniscus, and 1 mattress suture to strengthen the repair by reapproximating the construct to the posterior capsule. The data collected included the Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm, Tegner, and Veterans RAND 12-Item Health Survey (VR-12) Physical Component Summary (PCS) and Mental Component Summary (MCS) scores and conversion to total knee arthroplasty (TKA). Results: Medial meniscus root tears comprised 80.0% of the AR group and 77.8% of the O group. The average Kellgren-Lawrence grade was 2 in both groups. The baseline scores for the KOOS Symptoms subscale were lower for AR (50.2 ± 19.3) than for O (66.5 ± 16.1) ( P = .003), as were the KOOS Knee-Related Quality of Life scores (AR, 26.7 ± 16.1; O, 39.6 ± 22.1) ( P = .046). No differences were found between groups for the absolute values at follow-up except that follow-up Tegner scores were lower in the O group than in the AR group ( P = .004). Significant improvements were seen in the AR group from baseline to ultimate follow-up in average KOOS subscale scores ( P < .001), Lysholm scores ( P < .001), Tegner scores ( P = .0002), and VR-12 PCS scores ( P < .001), whereas the O group had a significant improvement only in average KOOS Pain ( P = .003), KOOS Function in Daily Living ( P = .006), and VR-12 PCS ( P = .038) scores. Compared with the O group, the AR group had a significantly larger improvement from baseline to follow-up in average KOOS Pain ( P = .009), KOOS Symptoms ( P = .029), and Lysholm scores ( P = .016). During follow-up, 3.3% of the AR group underwent a TKA compared with 33.3% of the O group ( P = .008). The hazard ratio of TKA conversion was 93.2% lower for the AR group compared with the O group ( P = .013). Conclusion: All-inside medial or lateral meniscus root repair showed improved functional outcomes and decreased TKA conversion rates compared with nonoperative treatment and may be considered as a treatment option for the management of meniscus root tears in older patients with moderate osteoarthritis.

scholarly journals Medial Meniscus Posterior Root Tear Treatment: A matched cohort comparison of non-operative management, partial meniscectomy and repair

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0036
Author(s):  
Christopher Bernard ◽  
Adam Tagliero ◽  
Matthew LaPrade ◽  
Christopher Camp ◽  
Daniel Saris ◽  
...  
Keyword(s):  
Medial Meniscus ◽  
Operative Management ◽  
Partial Meniscectomy ◽  
Matched Cohort ◽  
Root Tear ◽  
Posterior Root Tear ◽  
Meniscus Root ◽  
Root Repair ◽  
Non Operative Management ◽  
Meniscus Root Repair

Objectives: Meniscal root disruption results in a loss of hoop strain resistance, increased articular cartilage contact pressure, and acceleration of degenerative changes. There is limited data comparing the outcomes of similarly matched patients with a medial meniscus posterior root tear treated with non-operative management, partial meniscectomy, or repair. The purpose of this study is to compare treatment failure, clinical outcome scores, and radiographic findings for a matched cohort of patients who underwent either non-operative management, partial meniscectomy, or transtibial pull-through repair for a medial meniscus posterior root tear (MMPRT). Our hypothesis is that patients who underwent meniscus root repair will have lower rates of progression to arthroplasty than patients who were treated with non-operative management or partial meniscectomy. Methods: Patients who underwent transtibial medial meniscus posterior horn root repair were matched by meniscus laterality, age, sex and K-L grades to patients treated non-operatively or with a partial meniscectomy. Progression to arthroplasty rates, IKDC and Tegner scores, and radiographic outcomes were analyzed between groups. Results: Forty-five patients were included in this study (15 non-operative, 15 partial meniscectomy, 15 root repair). Progression to arthroplasty demonstrated significant differences among treatment groups at a mean 74 months (non-operative 4/15, partial meniscectomy 9/15, meniscus repair 0/15, p=.0003). The meniscus root repair group had significantly less arthritic progression, as measured by change in K-L grade from pre-op to post-op (non-operative 1.0, partial mensicectomy 1.1, and meniscus repair 0.1, p=.001). Conclusion: Meniscus root repair leads to significantly less arthritis progression and subsequent knee arthroplasty compared to non-operative management and partial meniscectomy in a demographically matched cohort.

scholarly journals Quantifying the differential functional behavior between the medial and lateral meniscus after posterior meniscus root tears

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0259678
Author(s):  
Brian E. Walczak ◽  
Kyle Miller ◽  
Michael A. Behun ◽  
Lisa Sienkiewicz ◽  
Heather Hartwig Stokes ◽  
...  
Keyword(s):  
Axial Compression ◽  
Knee Flexion ◽  
Medial Meniscus ◽  
Lateral Meniscus ◽  
P Value ◽  
Posterior Root ◽  
Functional Responses ◽  
Meniscus Root ◽  
Functional Behavior ◽  
Meniscus Extrusion

Meniscus tears of the knee are among the most common orthopedic knee injury. Specifically, tears of the posterior root can result in abnormal meniscal extrusion leading to decreased function and progressive osteoarthritis. Despite contemporary surgical treatments of posterior meniscus root tears, there is a low rate of healing and an incidence of residual meniscus extrusion approaching 30%, illustrating an inability to recapitulate native meniscus function. Here, we characterized the differential functional behavior of the medial and lateral meniscus during axial compression load and dynamic knee motion using a cadaveric model. We hypothesized essential differences in extrusion between the medial and lateral meniscus in response to axial compression and knee range of motion. We found no differences in the amount of meniscus extrusion between the medial and lateral meniscus with a competent posterior root (0.338mm vs. 0.235mm; p-value = 0.181). However, posterior root detachment resulted in a consistently increased meniscus extrusion for the medial meniscus compared to the lateral meniscus (2.233mm vs. 0.4705mm; p-value < 0.0001). Moreover, detachment of the posterior root of the medial meniscus resulted in an increase in extrusion at all angles of knee flexion and was most pronounced (4.00mm ± 1.26mm) at 30-degrees of knee flexion. In contrast, the maximum mean extrusion of the lateral meniscus was 1.65mm ± 0.97mm, occurring in full extension. Furthermore, only the medial meniscus extruded during dynamic knee flexion after posterior root detachment. Given the differential functional behaviors between the medial and lateral meniscus, these findings suggest that posterior root repair requires reducing overall meniscus extrusion and recapitulating the native functional responses specific to each meniscus.

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