scholarly journals ACL Injuries and Meniscal Lesion: Hand in Hand?

2021 ◽  
pp. 405-412
Author(s):  
U. Nivetha ◽  
. Vignesh ◽  
. Anvesh ◽  
. Munis ◽  
Navin Balasubramaniam
Keyword(s):  
Statistical Tests ◽  
Meniscal Tear ◽  
Lateral Meniscus ◽  
Meniscal Repair ◽  
Meniscus Tear ◽  
Age Group ◽  
Meniscal Tears ◽  
Meniscal Lesion ◽  
Acl Tear ◽  
Bucket Handle

Objective: To assess the incidence, nature and pattern of meniscal tear in ACL injury. Methodology: A retrospective study was conducted among the patients who were admitted and treated for ACL tear in Saveetha Medical And College And Hospital over a 2-year period from August 2019-August 2021. There were 52 patients admitted and treated for the same. The case records of each of the patients were reviewed to find the incidence of meniscal lesion in ACL tear and were then analyzed using appropriate statistical tests. Results: 52 patients with ACL tear were reviewed in this study. ACL tear was most commonly reported in younger age group of 20-29 (46.15%). Out of which, 19(36.54%) patients had meniscal tears. About 9(47.37%) patients had lateral meniscus tear, 6(31.58%) had medial meniscus tear and 4(21.05%) had bilateral meniscal tear. It was seen that bucket handle injury (n=12) was the most common meniscus tear overall. Radial tear was most specifically common in bilateral meniscus injury (N=4). Conclusion: Meniscal tears are the most common intra articular lesions associated with ACL tear. It was most commonly reported in the age group of 20-29. We found that the incidence of lateral meniscal tear was significantly higher in the patients rather than medial meniscal tear. Bucket handle injury was the most commonly reported tear in meniscal injury. Therefore, the surgeon needs to equip himself with the necessary meniscal repair instruments in his armamentarium

scholarly journals Which factors are associated with the prevalence of meniscal repair?

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Xiaoxiao Song ◽  
Dongyang Chen ◽  
Xinsheng Qi ◽  
Qing Jiang ◽  
Caiwei Xia
Keyword(s):  
Cruciate Ligament ◽  
Demographic Data ◽  
Meniscal Tear ◽  
Univariate Analysis ◽  
Lateral Meniscus ◽  
Meniscal Repair ◽  
Acl Injury ◽  
Partial Meniscectomy ◽  
Meniscus Tear ◽  
Confounding Factors

Abstract Purpose To investigate the potential factors associated with the prevalence of meniscal repair Methods Patients who received partial meniscectomy or meniscal repair in our institution from Jan 2015 to Dec 2019 were included in current study. The inclusion criteria were (1) meniscus tear treated using meniscectomy or repair, (2) with or without concomitant anterior cruciate ligament reconstruction, (3) not multiligamentous injury. Demographic data, including sex, age, body mass index (BMI), injury-to-surgery interval and intra-articular factors such as the location of injury, medial or lateral, ACL rupture or not and the option of procedure (partial meniscectomy or repair) were documented from medical records. Univariate analysis consisted of chi-square. Multivariate logistic regression was then performed to adjust for confounding factors. Results 592 patients including 399 males and 193 females with a mean age of 28.7 years (range from 10 to 75 years) were included in current study. In the univariate analysis, male (p = 0.002), patients aged 40 years or younger (p < 0.001), increased weight (p = 0.010), Posterior meniscus torn (0.011), concurrent ACL ruputure (p < 0.001), lateral meniscus (p = 0.039) and early surgery (p < 0.001) were all associated with the prevalence of meniscal repair. However, After adjusting for confounding factors, we found that age (OR, 0.35; 95% CI, 0.17 - 0.68, p = 0.002), ACL injury (OR, 3.76; 95% CI, 1.97 – 7.21, p < 0.001), side of menisci (OR, 3.29; 95% CI, 1.43 – 7.55, p = 0.005), site of tear (OR, 0.15; 95% CI, 0.07 – 0.32, p < 0.001), and duration of injury (OR, 0.46; 95% CI, 0.28 – 0.82, p = 0.008) were associated with the prevalence of meniscus repair. Conclusions Meniscal tear in aged patients especially those with concomitant ACL injury is likely to be repaired. Additionally, in order to increase the prevalence of repair and slow down progression of OA, the surgical procedure should be performed within two weeks after meniscus tear especially when the tear is located at lateral meniscal posterior. Study design Case-control study; level of evidence, 3.

scholarly journals Characterization of Synovial Cytokine Patterns in Bucket-Handle and Posterior Horn Meniscal Tears

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Marco Turati ◽  
Davide Maggioni ◽  
Nicolò Zanchi ◽  
Marta Gandolla ◽  
Massimo Gorla ◽  
...  
Keyword(s):  
Inflammatory Cytokines ◽  
Meniscal Tear ◽  
Meniscal Repair ◽  
Posterior Horn ◽  
Meniscal Tears ◽  
Tnf Α ◽  
Cytokine Levels ◽  
Tear Pattern ◽  
Cytokine Responsiveness ◽  
Bucket Handle

The specific etiology of meniscal tears, including the mechanism of lesion, location, and orientation, is considered for its contribution to subsequent joint cytokine responsiveness, healing outcomes, and by extension, appropriate lesion-specific surgical remediation. Meniscal repair is desirable to reduce the probability of development of posttraumatic osteoarthritis (PTOA) which is strongly influenced by the coordinate generation of pro- and anti-inflammatory cytokines by the injured cartilage. We now present biochemical data on variation in cytokine levels arising from two particular meniscal tears: bucket-handle (BH) and posterior horn (PH) isolated meniscal tears. We selected these two groups due to the different clinical presentations. We measured the concentrations of TNF-α, IL-1β, IL-6, IL-8, and IL-10 in knee synovial fluid of 45 patients with isolated meniscal lesions (BH tear, n = 12 ; PH tear, n = 33 ). TNF-α levels were significantly ( p < 0.05 ) greater in the BH group compared with the PH group, whereas IL-1β levels were significantly greater ( p < 0.05 ) in the PH group compared with the BH group. Both BH and PH groups were consistent in presenting a positive correlation between concentrations of IL-6 and IL-1β. A fundamental difference in IL-10 responsiveness between the two groups was noted; specifically, levels of IL-10 were positively correlated with IL-6 in the BH group, whereas in the PH group, levels of IL-10 were positively correlated with IL-1β. Collectively, our data suggest a possible influence of the meniscal tear pattern to the articular cytokine responsiveness. This differential expression of inflammatory cytokines may influence the risk of developing PTOA in the long term.

Correlation of Meniscal Tear with Timing of Anterior Cruciate Ligament Reconstruction in Patients without Initially Concurrent Meniscal Tear

2018 ◽  
Vol 32 (11) ◽  
pp. 1128-1132
Author(s):  
Kun-Hui Chen ◽  
En-Rung Chiang ◽  
Hsin-Yi Wang ◽  
Hsiao-Li Ma
Keyword(s):  
Medial Meniscus ◽  
Cruciate Ligament ◽  
Meniscal Tear ◽  
Lateral Meniscus ◽  
Acl Injury ◽  
Meniscus Tear ◽  
Meniscal Tears ◽  
Anterior Cruciate ◽  
Late Group ◽  
Acl Deficient

AbstractThe incidence of meniscal tear was reported to increase with the delay of anterior cruciate ligament reconstruction (ACLR). The tear may occur concurrently with the ACL injury or after the ACL injury. Few studies had focused on the patients whose meniscus is intact during ACL injury. We determined the correlation between timing of surgery and incidence of meniscal tears in ACL-deficient knees with initially intact meniscus. We retrospectively reviewed 387 patients who had undergone primary ACLR. Time of initial ACL injury, magnetic resonance imaging (MRI) examination, and surgery was recorded. The MRI was reviewed by experienced radiologic and orthopaedic doctors. Intraoperative arthroscopic images were also obtained and reviewed. The type of tear noted during surgery was classified according to the modification of International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine classification of meniscal tears. Patients were divided into early (surgery within 12 months from injury) and late surgery group (surgery at more than 12 months from injury). There were 216 patients with intact medial meniscus and 257 patients with intact lateral meniscus on the postinjury MRI study. The incidence of medial meniscus tear (MMT) was significantly higher than lateral meniscus tear (LMT) during the ACLR (33.8 vs. 19.8%, p < 0.001). The incidence of MMT is higher in late group than in early group (53.7 vs. 29.1%, p = 0.004, odds ratio= 2.815). The incidence of LMT is mildly higher in late group but without statistics significance (23.8 vs. 18.6%, p = 0.364). In both MMT and LMT, the most common injury pattern observed was a longitudinal tear. The incidence of each type is not different between early and late group. For patients without concurrent meniscal injuries with the ACL tear, the incidence of MMT significantly increased if ACLR was performed more than 12 months after injury. The medial meniscus was more prone to injury than the lateral meniscus in chronic ACL-deficient knee. ACLR should be performed earlier to reduce the risk of meniscal tears for patients without initially concurrent meniscal tear.

Comparative Outcomes of Radial and Bucket-Handle Meniscal Tear Repair: A Propensity-Matched Analysis

2018 ◽  
Vol 46 (11) ◽  
pp. 2653-2660 ◽  
Author(s):  
Isabella T. Wu ◽  
Mario Hevesi ◽  
Vishal S. Desai ◽  
Christopher L. Camp ◽  
Diane L. Dahm ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Cruciate Ligament ◽  
Meniscal Tear ◽  
Survival Rates ◽  
Meniscal Repair ◽  
Full Thickness ◽  
Meniscal Tears ◽  
Free Survival ◽  
Reoperation Rates ◽  
Bucket Handle

Background: Full-thickness radial meniscal tears render the meniscus nonfunctional and have historically been treated with partial meniscectomy. As preservative techniques evolve for radial repair, comparisons with other tear patterns are necessary to evaluate repair efficacy and prognosis. Purpose: To assess clinical outcomes and reoperation rates of radial meniscal repair and to compare them to bucket-handle meniscal repair. Study Design: Cohort study; Level of evidence, 3. Methods: Radial and bucket-handle meniscal tears without concurrent root injuries undergoing surgical repair at a single institution between 2007 and 2015 were analyzed, including both all-inside and inside-out suturing techniques. Propensity matching was performed on the basis of age at surgery, sex, meniscus laterality, body mass index (BMI), and concomitant anterior cruciate ligament reconstruction (ACLR) using a comparison pool of 70 bucket-handle repairs. Reoperation-free survival rates and Tegner, visual analog scale (VAS) for pain, and International Knee Documentation Committee (IKDC) scores were analyzed. Results: Twenty-four patients (18 male, 6 female; mean age, 22.8 ± 11.9 years) who underwent repair of a radial meniscal tear were followed for a mean of 3.5 years (range, 2.0-6.3 years). Significant postoperative improvements in VAS scores at rest and with use and IKDC scores were noted postoperatively ( P < .001). Five patients (20.8%) required a reoperation. Subsequently, 18 patients with radial tears (mean age, 19.1 ± 9.1 years; 12 male; mean BMI, 27.0 ± 6.2 kg/m2; 3 medial; 11 ACLR) were propensity matched to 18 patients with bucket-handle tears (mean age, 20.8 ± 5.1 years; 13 male; mean BMI, 25.0 ± 3.5 kg/m2; 3 medial; 11 ACLR). The matched radial and bucket-handle groups demonstrated similar ( P = .17) reoperation-free survival rates at 2 years (88.9% and 94.4%, respectively) and 5 years (77.8% and 87.7%, respectively). VAS and IKDC scores improved significantly after surgery ( P < .001), with no difference noted between the groups ( P ≥ .17). Patients with radial and bucket-handle meniscal repairs achieved mean postoperative Tegner scores (6.6 and 6.6, respectively) not significantly different from their preinjury levels (6.9 and 6.7, respectively) ( P ≥ .32). Conclusion: Satisfactory clinical outcomes are achievable for radial meniscal tear repair at short-term follow-up. In a robustly matched comparison, radial and bucket-handle meniscal tears demonstrate similar improvements in VAS and IKDC scores, restoration of preoperative Tegner scores, and acceptable reoperation rates. Full-thickness radial meniscal tears should be considered for repair.

scholarly journals An arthroscopic repair technique for meniscal tear using a needle and suture: outside-in transfer all-inside repair

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Zhiqiang Wang ◽  
Yan Xiong ◽  
Xin Tang ◽  
Qi Li ◽  
Zhong Zhang ◽  
...  
Keyword(s):  
Subcutaneous Tissue ◽  
Meniscal Tear ◽  
Lateral Meniscus ◽  
Meniscal Repair ◽  
Arthroscopic Repair ◽  
Normal Anatomy ◽  
Meniscal Tears ◽  
Repair Technique ◽  
Meniscus Tissue ◽  
Repair Techniques

Abstract Background At present, most repair techniques for meniscal tears fix the meniscus directly over the capsule. This changes the normal anatomy and biomechanics and limits the activity of the meniscus during motion. We introduce an arthroscopic repair technique by suturing the true meniscus tissue without the capsule and subcutaneous tissue. Methods After confirmation of a tear, a custom-designed meniscal repair needle first penetrates percutaneously, crossing the capsular portion and the torn meniscus, and exits from the femoral surface of one side of the torn meniscus. Then a No. 2 PDS suture is passed through the needle and retrieved through the arthroscopy portal. Next, the needle is withdrawn to the synovial margin of the meniscus and is reinserted, exiting the femoral surface of the other side of the torn meniscus. The suture is pulled out through the same portal with a grasper. Finally, arthroscopic knotting is performed. Results We had 149 cases of meniscal tears repaired with this outside-in transfer all-inside technique since July 2016. Conclusions It is a simple, minimally invasive, and economical procedure that is appropriate for most parts of the meniscus except the posterior horn of the lateral meniscus, and it can be used to fix torn meniscus tissue firmly while also preserving the inherent activity of the meniscus.

scholarly journals Development of OA Following ACL Reconstruction: Unexpected Finding in Medial Versus Lateral Meniscus Pathology

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0036
Author(s):  
Karen Briggs ◽  
Stephanie Petterson ◽  
Kevin Plancher
Keyword(s):  
Medial Meniscus ◽  
Meniscal Tear ◽  
Lateral Meniscus ◽  
Meniscal Repair ◽  
Meniscus Tear ◽  
Meniscus Tears ◽  
Medial Meniscal Tear ◽  
Lateral Meniscectomy ◽  
Meniscal Pathology

Objectives: Recent studies have described increased risk of OA following ACL reconstruction (ACLR). Systematic reviews have suggested that meniscal pathology, which occurs in up to 60% of patients with ACL injury, increases this risk. The literature reports a 50% incidence of OA following medial meniscectomy, two times the risk compared to lateral meniscectomy. The purpose of this study was to determine the influence of meniscal pathology on the incidence of OA following ACLR. Methods: All patients who underwent primary autograft or allograft BPTB transtibial ACLR by a single surgeon between 1999-2015 were identified. Revision ACLR, multi-ligamentous reconstructions, and patients with less than 2-year imaging follow-up were excluded. Meniscus pathology and treatment were recorded. OA was defined at follow-up as Kellgren-Lawrence grade III-IV on plain radiographs. Chi-square tests assessed differences in incidence rates (p<0.05). Results: A consecutive series of 103 patients (56 males, 47 females; age 36.1±11.4 years) with BPTB ACLR with an average follow-up of 8.81±4.96 (range 2-20 years) were included. The prevalence of medial meniscus tears at the time of ACL injury was 47.6% (49/103) and prevalence of lateral meniscus tears was 56.3% (58/103) (p=0.166). Medial compartment OA was seen in 9.7% (10/103) of patients. Prevalence of medial compartment OA was greater in patients with medial meniscus tear (14.3%; 7/49) compared to those without a medial meniscus tear (5.6%; 3/54); however, this was not significant (p=0.135). Of the 7 patients with medial meniscal tear and medial compartment OA, 5 underwent partial medial meniscectomy and 2 underwent repair. Lateral compartment OA was seen in 14.6% (15/103). The prevalence of lateral compartment OA was greater in patients with a lateral meniscus tear (22.4%; 13/58) compared to patients without lateral meniscus tears (4.4%; 2/45) (p=0.01). Patients with lateral meniscus tear were 5.04 [95%CI: 1.2 to 21.2] times more likely to develop OA. Thirteen of the 47 (28%) patients that underwent partial lateral meniscectomy developed lateral OA compared to 0% of patients (0/10) that underwent lateral meniscal repair (p=0.068). Conclusion: While studies with multiple surgeons and rehabilitation protocols have shown the development of OA following ACLR is increased with medial meniscal pathology, we found that the prevalence of medial OA was not significantly higher in these patients with medial meniscal tear at an average of 8.81 years follow-up. Whereas, lateral meniscal repair dramatically reduced the development of knee OA compared to partial meniscectomy in this cohort of patients with ACLR. These findings can inform clinical practice as despite prior literature indicating a relationship between medial meniscal tear and osteoarthritis, we did not see a greater prevalence of OA amongst patients undergoing ACLR with a medial meniscal tear. Further, a lateral meniscal repair offers superior protection against OA when compared to partial lateral meniscectomy in treating lateral meniscal tears and is essential in the treatment of these complex patients.

scholarly journals Comparative Outcomes of All-Inside Versus Inside-Out Repair of Bucket-Handle Meniscal Tears: A Propensity-Matched Analysis

2018 ◽  
Vol 6 (6) ◽  
pp. 232596711877904 ◽  
Author(s):  
Brian T. Samuelsen ◽  
Nicholas R. Johnson ◽  
Mario Hevesi ◽  
Bruce A. Levy ◽  
Diane L. Dahm ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Cruciate Ligament ◽  
Meniscal Tear ◽  
Meniscal Repair ◽  
Meniscal Tears ◽  
Level Of Evidence ◽  
Inside Out ◽  
Bucket Handle ◽  
Repair Techniques

Background: There are limited data comparing the outcomes of all-inside versus inside-out meniscal repair techniques. Purpose: To assess failure rates and clinical outcomes after the surgical repair of bucket-handle meniscal tears utilizing either an all-inside or inside-out technique. Study Design: Cohort study; Level of evidence, 3. Methods: Patients with bucket-handle meniscal tears undergoing all-inside or inside-out repair at a single institution between 2003 and 2013 were analyzed. A total of 28 mensici repaired utilizing second-generation all-inside suturing devices and 42 menisci repaired using an inside-out technique were eligible for inclusion. Rigorous propensity matching was performed on the basis of age, sex, tear laterality, rim width, and concomitant anterior cruciate ligament reconstruction (ACLR), resulting in a total of 40 patients equally distributed between the 2 repair techniques for comparison. Retear-free survival as well as preoperative and postoperative International Knee Documentation Committee (IKDC) and Tegner scores and physical examination findings were subsequently analyzed. Results: Twenty patients who underwent all-inside repair (14 male; mean age, 23.7 ± 6.7 years) were successfully propensity matched to 20 patients who underwent inside-out meniscal repair (15 male; mean age, 22.5 ± 7.6 years), with a mean retear-free follow-up of 4.4 years (range, 2.5-7.4 years). Four (20%) all-inside repairs and 4 (20%) inside-out repairs failed over the course of follow-up ( P > .999), with a mean time to failure of 2.7 years (range, 1.3-4.4 years) and 5.0 years (range, 0.8-7.5 years), respectively ( P = .25). Increasing patient age trended toward a decreased clinical retear rate, independent of the repair technique (hazard ratio, 0.86; P = .056). There were no significant differences in the Tegner scores, IKDC scores, or range of motion between the groups as a whole or when subcategorizing by age, sex, body mass index, tear complexity, rim width, isolated versus concomitant ACLR, or medial- versus lateral-sided repair. There were no complications in the all-inside group, while there was a 10% rate of minor complications in the inside-out group ( P = .49). Conclusion: Overall, satisfactory clinical outcomes are achievable at short-term to midterm follow-up with both inside-out and all-inside repair techniques of bucket-handle meniscal tears in rigorously matched patients with similar meniscal tear patterns.

Isolated Lateral Meniscal Tear in the Dog

1988 ◽  
Vol 01 (03/04) ◽  
pp. 152-154
Author(s):  
S. Johnson ◽  
D. Hulse
Keyword(s):  
External Rotation ◽  
Femoral Condyle ◽  
Meniscal Tear ◽  
Lateral Meniscus ◽  
Surgical Excision ◽  
Human Beings ◽  
Stifle Joint ◽  
Microscopic Pathology ◽  
Bucket Handle Tear ◽  
Bucket Handle

degenerative changes of the involved stifle joint associated with a “bucket handle” tear of the caudal body of the lateral meniscus. Surgical excision of the torn section of meniscus was beneficial in the first patient but this patient had persistant difficulty with the leg after exercise. Gross and microscopic pathology of the involved stifle in the second patient showed the meniscal lesion to be associated with severe cartilage fibrillation of the overlying lateral femoral condyle. As in human beings, the mechanism of injury may have been placement of the foot during vigorous external rotation of the femur with the stifle flexed. Extension of the limb from this position could have resulted in an isolated tear of the lateral meniscus.

scholarly journals DELAY TO ACL RECONSTRUCTION IN PEDIATRIC AND ADOLESCENT PATIENTS IS ASSOCIATED WITH A LINEAR INCREASE IN THE RISK OF MEDIAL MENISCAL TEARS

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0004
Author(s):  
David A. Kolin ◽  
Brody Dawkins ◽  
Joshua Park ◽  
Peter D. Fabricant ◽  
Allison Gilmore ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Meniscal Tear ◽  
Lateral Meniscus ◽  
Linear Increase ◽  
Meniscal Injury ◽  
Meniscal Tears ◽  
Increased Risk ◽  
Text Figure ◽  
Time From Injury

Background: Anterior cruciate ligament (ACL) tears are frequently associated with meniscal tears. Previous studies have shown that secondary meniscal tears—occurring after the initial ACL injury—are associated with greater delays from injury to ACL reconstruction (ACLR), but frequently use dichotomous categories of acute versus delayed ACLR. Purpose: As meniscal damage is likely accrued constantly over time, we investigated the variability of concurrent meniscal injuries as a function of time from injury to ACLR in a pediatric and adolescent population. Methods: We performed a retrospective review of all patients ≤18 years who underwent an ACLR between 2014 and 2018 at one of two tertiary academic hospitals. Outliers were excluded if time from injury to ACLR was greater than 78 weeks. Records were reviewed to assess patients’ dates of injury and surgery. The prevalence of concurrent medial and/or lateral meniscal injury was evaluated at the time of surgery for each patient. Adjusted relative risks (ARRs) of meniscal injury were calculated using Poisson regression models adjusted for age, sex, and body-mass index. Logistic regression was used to model the predicted probability of medial meniscal tears. Results: 546 patients met inclusion criteria. The mean age of participants was 15.3 years (S.D., 1.6), and 277 (50.7%) patients were male. Overall, 344 (63.0%) patients had a meniscal tear. 169 (49.1%) tears occurred at the medial meniscus, and 257 (74.7%) occurred at the lateral meniscus (Table 1). Compared to females, males had a greater risk of lateral meniscal injury (ARR, 1.46; 95% CI, 1.20-1.77) but not medial meniscal injury (ARR, 1.01; 95% CI, 0.77-1.31) (Figure 1). When considering all meniscal tears, time from injury to ACLR was not associated with increased risk of a tear (ARR, 1.01; 95% CI, 1.00-1.01). However, for medial meniscal tears, there was a significant association between time from injury to ACLR, in weeks, and meniscal tears (ARR, 1.02; 95% CI, 1.01-1.03, P = 0.003). A ten-week delay was associated with a 20% increased risk of medial meniscal injury (Figure 2). Conclusion: In pediatric and adolescent ACLR patients, the risk of any meniscal injury was not associated with delay from injury to surgery. However, the risk of medial meniscal injury increased by 2% each week from injury to surgery. [Table: see text][Figure: see text][Figure: see text]

scholarly journals Predicting Reparability of Meniscal Tears Pre-Operatively Using 3-Tesla MRI (111)

2021 ◽  
Vol 9 (10_suppl5) ◽  
pp. 2325967121S0026
Author(s):  
Thomas Kremen ◽  
Ignacio Garcia-Mansilla ◽  
Jason Strawbridge ◽  
Grant Schroeder ◽  
Kambiz Motamedi ◽  
...  
Keyword(s):  
Predictive Accuracy ◽  
Statistical Significance ◽  
Meniscal Tear ◽  
Meniscal Repair ◽  
Partial Meniscectomy ◽  
3 Tesla ◽  
Meniscus Tear ◽  
Predictive Values ◽  
3T Mri ◽  
Mri Characteristics

Objectives: The ability to predict meniscus tear reparability based on pre-operative MRI is desirable for pre-operative patient counseling. However, the accuracy of MRI-based predictive methods varies widely within the orthopedic and radiology literature. We hypothesized that modern higher resolution 3-Tesla (T) MRI improves the accuracy of predicting reparability compared to prior investigations using 1.5T MRI assessments. Methods: We identified 44 patients (age 16 to 40 years) who were known to have undergone arthroscopic meniscal repair at our institution between the dates of January 1, 2013 and June 1, 2019. The MRI characteristics of this meniscus repair group were then compared to 43 age- and sex-matched patients who underwent arthroscopic partial meniscectomy during the same time period. 3T MRI images from the repair (Figure 1A) and the partial meniscectomy (Figure 1B) groups were all obtained pre-operatively at the author’s institution. Images from all 87 patients were independently reviewed by two fellowship-trained musculoskeletal radiologists and one orthopedic surgery fellow specializing in sports medicine. Each examiner was blinded with regard to meniscus tear treatment (repair versus partial meniscectomy). Meniscal tear MRI characteristics were evaluated based on established arthroscopic criteria including tear length greater than 10 mm, tear location within 3 mm of the menisco-synovial junction, tear greater than 50% thickness, and the presence of an intact inner meniscal fragment. We then analyzed the predictive accuracy and interrater reliability of this method. Results: With regards to accurately predicting meniscal reparability using the established criteria, the three MRI examiners accurately predicted repair 58% (orthopedist), 60% (radiologist 1), and 63% (radiologist 2) of the time, with respective positive predictive values of 60%, 62%, and 70%. The three examiners agreed upon tear reparability (i.e., a score of 4 versus not 4) only 41% of the time (κ = 0.173, p = .005). For 2 of the examiners (orthopedist and radiologist), none of the individual criteria were significantly predictive of tear reparability. For the 3rd examiner (radiologist), tear location within 3mm of the meniscosynovial junction was the most predictive individual criterion and the only criteria that reached statistical significance (OR = 9.83, p = .04). Conclusions: Although 3T MRI is higher resolution than 1.5T MRI, 3T MR imaging assessments performed by experienced examiners demonstrated a poor ability to predict the reparability of meniscus tears based on the application of previously established arthroscopic criteria. In addition, inter-observer reliability in this setting was also poor. Arthroscopic inspection remains the gold standard for the determination of meniscus tear reparability.

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