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Biconcave medial tibial plateaus linked with complex meniscus tears in knees undergoing arthroscopy
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According to recently published results, 27.4% of consecutive patients who underwent knee arthroscopy presented with biconcave medial tibial plateaus and investigators found complex medial meniscus tears often correlated with a biconcave medial tibial plateau.
“It is important to appreciate and understand the tibial plateau morphology and its impact on meniscal pathology,” Mark H. Getelman, MD, told Healio.com/Orthopedics. “As we study this concept more and better define the significance on the meniscus, I think it will ultimately influence our decision-making for treating meniscal tears and may better help us determine which tears are more amenable to repair.”
Getelman and colleagues identified 179 consecutive knees that underwent arthroscopy and retrospectively evaluated cases using preoperative MRIs, radiographs and intraoperative videos. Based on the findings from arthroscopy, 49 medial tibial plateaus were categorized as biconcave and 130 were categorized as controls. Investigators used MRI sagittal views to calculate the medial plateau slope and recorded demographics, BMI and arthroscopically confirmed knee pathology.
Results showed 103 complex medial meniscus tears. Investigators noted that although patients with a biconcave medial tibial plateau had lower BMI, they had more complex medial meniscus tears compared with patients who did not have a biconcave medial tibial plateau. Biconcavities that involved both cartilage and bone, bone only or were in an intermediate group showed no significant difference regarding the medial tibial plateau. – by Monica Jaramillo
Disclosures: Getelman reports he receives funding from Smith & Nephew and DePuy Mitek, receives grants from DJO and royalties from Wolters Kluwer. Please see the full study for a list of all other authors’ relevant financial disclosures.
Perspective
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Richard K. N. Ryu, MD
The stress riser phenomenon described in this well-written article may contribute to meniscal pathology. The biconcave tibial plateau, when identified, should alert the treating physician to the possibility of a more complex medial meniscal tear pattern. Furthermore, when contemplating a meniscal repair, a biconcave tibial plateau may be one of several factors to consider when making clinical decisions as a re-tear rate would seem more likely.
I am concerned that the “complex” tear was not clearly defined in the article, and there is always the possibility that chronology — that is how long the tear has been present — may be a more important factor than morphology, ie, a torn meniscus may become more “complex” as a function of continued stress from an active lifestyle, independent of tibial plateau shape. The authors should be commended for helping us recognize the biconcave tibial plateau as a meaningful first step in the meniscal pathology treatment algorithm.
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