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. 2022 Feb 24;10(2):23259671221079794.
doi: 10.1177/23259671221079794. eCollection 2022 Feb.

Prospective Consecutive Clinical Outcomes After Transtibial Root Repair for Posterior Meniscal Root Tears: A Multicenter Study

Aaron J Krych  1 , Bryant M Song  1 , Richard F Nauert 3rd  1 , Corey S Cook  2 , Bruce A Levy  1 , Christopher L Camp  1 , Michael J Stuart  1 , Patrick A Smith  2   3
Affiliations

Prospective Consecutive Clinical Outcomes After Transtibial Root Repair for Posterior Meniscal Root Tears: A Multicenter Study

Aaron J Krych et al. Orthop J Sports Med. .

Abstract

Background: Prospective evaluation of clinical outcomes after posterior meniscal root repair utilizing a transtibial pullout technique is limited, and factors that may contribute to outcomes are unclear.

Hypothesis: It was hypothesized that there would be an overall significant improvement in outcomes after root repair and that differences in clinical outcomes would correlate with age, body mass index (BMI), sex, and meniscal extrusion.

Study design: Case-control study; Level of evidence, 3.

Methods: Consecutive patients undergoing transtibial medial or lateral meniscal root repair were enrolled prospectively at 2 orthopaedic centers between March 2017 and January 2019. Pre- and postoperative magnetic resonance imaging (MRI) were obtained to assess for meniscal healing, quantification of extrusion, articular cartilage grade, and subchondral bone changes. Patient-reported outcomes including International Knee Documentation Committee (IKDC) scores, Tegner activity scale, and visual analog scale (VAS) for pain were collected preoperatively and 2 years postoperatively. Patients were then subdivided by clinical and demographic characteristics to determine factors associated with clinical outcomes.

Results: Included were 45 patients (29 female, 16 male; mean age, 42.3 ± 12.9 years; mean BMI, 31.6 kg/m2) who underwent 47 meniscal root repairs (29 medial and 16 lateral; 2 had both). Significant improvements at 2-year follow-up were seen in IKDC score (41.1 vs 78.4; P < .001), Tegner activity level (3 vs 4; P < .001), and VAS pain (2.8 vs 0.7; P < .001). BMI, preoperative malalignment, cartilage status, and progressive meniscus extrusion (Δ = 0.7 mm) did not have a negative impact on IKDC and Tegner scores 2 years postoperatively. Age greater than or equal to 50 years and extrusion pre- and postoperatively were associated with decreased Tegner scores. Progressive meniscal extrusion was associated with a decreased overall improvement in Tegner scores.

Conclusion: Transtibial root repair for medial and lateral posterior meniscal root tears demonstrated significantly improved clinical outcomes at 2 years postoperatively. Increased age, increased BMI, cartilage status, and meniscal extrusion did not have a negative impact on short-term functional outcomes (IKDC), but age greater than or equal to 50 years and extrusion negatively influenced patient activity level (Tegner).

Registration: NCT03037242 (ClinicalTrials.gov identifier).

Keywords: meniscal extrusion; meniscal root; meniscal tear; meniscus; prospective cohort; transtibial pullout repair.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: This study was partially funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases for the Musculoskeletal Research Training Program (T32AR56950); its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. Support was also received from the Foderaro-Quattrone Musculoskeletal/Orthopaedic Surgery Research Innovation Fund. A.J.K. has received grant support from DJO; consulting fees from Arthrex, Joint Restoration Foundation, and Responsive Arthroscopy; speaking fees from Arthrex; honoraria from Vericel and Joint Restoration Foundation; royalties from Arthrex and Responsive Arthroscopy; and serves on the medical board of trustees for the Musculoskeletal Transplant Foundation. B.A.L. has received education payments from Linvatec, consulting fees from Arthrex, speaking fees from Arthrex and Smith & Nephew, and royalties from Arthrex. C.L.C. has received education payments and nonconsulting fees from Arthrex. M.J.S. has received consulting fees, speaking fees, and royalties from Arthrex. P.A.S. has received education payments from Elite Orthopedics; consulting fees from Arthrex; speaking fees from Alpha Orthopedic Systems, Arthrex, and Medical Device Business Services; and royalties from Arthrex. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

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