Repair of meniscus root tears may reduce arthritis, arthroplasty risk in select patients
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NASHVILLE, Tenn. — Meniscus root tears should be recognized and diagnosed early to reduce the risk for arthritis and knee replacement, according to a presenter.
“If you do not recognize [a meniscus root tear] — and this can happen in a short period of time, within 6 to 12 months — literally a normal joint space can become bone-on-bone arthritis and we see this happen quite frequently,” Aaron J. Krych, MD, of Mayo Clinic Orthopedic Surgery and Sports Medicine, told Healio Orthopedics. “If you do not recognize it and treat it early then the natural history is for progression of arthritis, essentially.”
When it comes to repair of meniscus root tears, Krych noted in his presentation at the American Orthopaedic Society for Sports Medicine and Arthroscopy Association of North America Combined Meeting, that the transtibial pull-through technique has been shown to lead to significantly less osteoarthritis and arthroplasty compared with nonoperative management or partial meniscectomy.
“When we looked at our patients, specifically we found that when a patient had an acute event and less extrusion of the meniscus they did better from a repair,” Krych told Healio Orthopedics.
Young patients with lateral root tears in addition to a ligament injury, such as an ACL tear, have good outcomes with root repair, according to Krych. However, he noted patients aged 40 to 60 years who present with degenerative meniscus root tears on the medial side of the knee may not do as well with root repair depending on the amount of cartilage wear.
“There are patients who do not benefit from root repair. They just have too much arthritis at presentation,” Krych said. “So, whether that is looking at the X-rays if there is already joint space narrowing or at the knee through arthroscopy if there is already grade 3 chondromalacia, those patients probably do not benefit as much from surgical repair and a lot of those would be treated nonoperatively.”
He noted research is currently underway on the outcomes of centralizing the meniscus prior to root repair.
“We are in the middle of a multicenter trial looking at imaging and looking at patient outcomes and we will compare those with our standard root repair techniques to see if are we doing better. Are we able to extend indications a little bit more for these patients?” Krych said.
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Krych AJ. Meniscus root tear. Presented at: American Orthopaedic Society for Sports Medicine and Arthroscopy Association of North America Combined Meeting; July 7-11, 2021; Nashville, Tennessee.
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