Repair of posterior meniscal root tears delayed time to knee arthroplasty
Click Here to Manage Email Alerts
Results of a matched cohort comparison of 45 patients with medial meniscal root tears who underwent either nonsurgical management, partial meniscectomy or repair showed significant differences among the groups for progression to knee arthroplasty, with the meniscus root repair group having significantly less arthritic progression based on changes in Kellgren-Lawrence grade.
Aaron J. Krych, MD, an orthopedic surgeon at Mayo Clinic in Rochester, Minnesota, and senior author of the study, and his colleagues hypothesized patients with a medial meniscus posterior root tear who were treated with transtibial pull-through repair would have lower rates of progression to arthroplasty than patients who underwent either partial meniscectomy or nonsurgical management.
In comments about the study, which was presented during the virtual American Academy of Orthopaedic Surgeons Annual Meeting, Krych told Healio Orthopedics, “In this matched comparison study of medial meniscus root tears, we found that restoration of meniscus function through transtibial root repair resulted in significantly less development of arthritis and progression to joint replacement than nonoperative management or meniscectomy. Therefore, we recommend consideration of root as the best treatment option in appropriately selected patients with meniscus root tears.”
The study involved a matched cohort of 15 patients in each group (nonsurgical, partial meniscectomy and root repair). Results showed there were significant differences regarding progression to arthroplasty at 74 months mean after treatment among the nonsurgical (four of 15 patients), partial meniscectomy (nine of 15 patients) and meniscus repair (zero of 15 patients) groups.
Researchers assessed patients’ arthritis progression based on their measured change in Kellgren-Lawrence grade from pretreatment to post-treatment. They found the changes for the nonsurgical, partial meniscectomy and meniscal repair groups were 1, 1.1 and 0.1, respectively.
“Meniscus root repair leads to significantly less arthritis progression and subsequent knee arthroplasty compared to nonsurgical management and partial meniscectomy in a demographically matched cohort,” Krych and colleagues wrote in the abstract. – by Susan M. Rapp
Reference:
Bernard C, et al. ePaper 637. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 24-28, 2020 (meeting canceled).
Disclosure: Krych reports he receives research support from Aesculap/B.Braun; receives IP royalties and research support from and is a paid consultant for Arthrex; receives research support from Arthritis Foundation, Ceterix and Histogenics; and is a paid consultant for JRF Ortho and Vericel.
Perspective
Back to Top
Andrew G. Geeslin, MD
As we reviewed in March 2017 Orthopedics Today, the optimal treatment for medial meniscal root tears is controversial. Mayo Clinic researchers compared matched cohorts of repair, partial meniscectomy and nonoperative treatment in their 2020 AAOS meeting abstract. Importantly, the repair group had less progression of Kellgren-Lawrence grade and none underwent arthroplasty. Without the full article, it is not clear which factors excluded patients from repair (eg, age, obesity, chondral status and tissue quality).
Due to the biomechanical consequences of neglected root tears, urgent evaluation with MRI is key. The combination of slice thickness and interslice gap, as well as volume averaging, particularly challenge the evaluation of this region of the meniscus; this necessitates close inspection on all three imaging planes. Findings cementing the diagnosis include a “ghost sign” and meniscal extrusion; development of osseous edema indicates compartmental overload. Prompt diagnosis supports early surgical treatment in appropriate candidates, which likely improves outcomes due to chondral protection.
Based on our experience and results of this study, medial meniscal root repair should be offered to appropriately indicated patients. Partially due to the relative rarity of root repair compared with partial meniscectomy in most communities, patient education is essential concerning treatment rationale and expectations. Even with advanced repair techniques, patient compliance with the required rehabilitation is critical, and may be an important consideration for many patients.
Ascension Borgess Orthopedics and Western Michigan University, Homer Stryker M.D. School of Medicine
Assistant professor, musculoskeletal radiology
Burlington, Vermont
Collapse
Bernard C, et al. ePaper 637. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 24-28, 2020 (meeting canceled).
Read more about
Click Here to Manage Email Alerts