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Researchers find it possible to categorize meniscal tears by tear morphology
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Until recently, no consistent patterns of meniscal root tears were documented or observed during arthroscopic examination, but researchers who conducted a case series found that individuals with meniscal root tears can be placed into distinct group based on the tear pattern. They contend this classification system may eventually result in specific treatments that are most effective for each type of tear.
Lars Engebretsen, MD, PhD, and colleagues found in the study that knowing the tear morphology of meniscal root tears can help physicians and surgeons accurately treat a patient with this injury.
Engebretsen told Orthopaedics Today Europe, “This study demonstrated it was possible to establish a concise classification system to group patients with meniscal root tears by tear morphology.”
Five types of tears
The study included 67 patients with 71 meniscal root tears. The patients underwent arthroscopic surgery between April 2010 and May 2014 performed by a single surgeon, Robert F. LaPrade, MD, PhD. Every patient had an arthroscopically confirmed meniscal root lesion.
Based on LaPrade’s arthroscopic findings, the meniscal root tears were divided by the researchers according to five types of types and several subtypes. Type 1 tears, of which there were five, were partially stable root tears. The 48 type 2 tears were complete radial meniscal tears, which had 9 mm of bony root attachment.
Subtypes of tears
The investigators further subtyped the type 2 tears into 27 type 2A tears, which were complete radial meniscal tears that occurred 0 mm to less than 3 mm from the center of the root attachment, and 12 type 2B tears that were radial meniscal tears that occurred 3 mm to less than 6 mm from the center of the root attachment. The nine type 2C tears were radial meniscal tears that occurred 6 mm to 9 mm from the center of the root attachment.
They further defined the four type 3 tears as bucket-handle tears with complete detachment that occurred within 9 mm of the center of the root attachment. They also defined the seven type 4 tears they identified as complex oblique meniscal tears leading to complete detachment within 9 mm of the center.
The researchers also identified seven type 5 tears and defined them as avulsion fractures of the meniscal root off the tibial plateau.
One tear variant
There was one variant of patients in the study: patients in whom the meniscofemoral ligaments were intact. These variants were not included in the final study because they were first observed during the final 18 months of the investigation.
“Prior to this paper, there has been no agreement on root tear classification,” Engebretsen said. “I think the new classification system, based on the drawings in the present paper, will improve the possibilities on research on the epidemiology, various treatment methods and description of new methods.”
Engebretsen and colleagues noted further information is needed to determine whether there is a specific treatment indicated for the different types of meniscal tears. – by Robert Linnehan
- Reference:
- LaPrade CM, et al. Am J Sports Med. 2015;doi:10.1177/0363546514559684.
- For more information:
- Lars Engebretsen, MD, PhD, can be reached at Orthopaedic Center, Ullevaal University Hospital and University of Oslo Medical School, PO Box 1078 Blindern, 0316 Oslo, Norway; email: lars.engebretsen@medisin.uio.no.
Disclosure: Engebretsen reports he is a consultant for Arthrex.