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. 2023 Oct;47(10):2401-2407.
doi: 10.1007/s00264-023-05701-4. Epub 2023 Jan 30.

Medial joint space narrowing progresses after pullout repair of medial meniscus posterior root tear

Koki Kawada  1 , Takayuki Furumatsu  2   3 , Masanori Tamura  1 , Haowei Xue  1 , Naohiro Higashihara  1 , Keisuke Kintaka  1 , Yusuke Yokoyama  1 , Toshifumi Ozaki  1
Affiliations

Medial joint space narrowing progresses after pullout repair of medial meniscus posterior root tear

Koki Kawada et al. Int Orthop. 2023 Oct.

Abstract

Purpose: The extent to which arthropathic changes progress after medial meniscus posterior root tear (MMPRT) repair remains controversial. This retrospective study assessed medial joint space (MJS) narrowing progression after pullout repair for MMPRT and identified the correlating factors.

Methods: We included 56 patients who underwent pullout repair for MMPRT. The MJS of the bilateral knees was assessed with radiography using the fixed-flexion view. A second-look arthroscopy was performed one year post-operatively for all patients. The baseline characteristics, clinical scores, Kellgren-Lawrence (KL) grade, and medial meniscus extrusion (MME) were identified. Statistical comparisons and correlation analyses were conducted.

Results: The MJS narrowing width was significantly larger in MMPRT knees than in contralateral knees (0.51 ± 0.85 mm vs. 0.09 ± 0.49 mm, p < 0.001). KL grade progression was observed in 23.2% (13/56) of patients. There was a significant difference between pre- and post-operative MME values, indicating MME progression (p < 0.001). Each clinical score showed significant improvement one year post-operatively (p < 0.001). Positive correlations were found between MJS narrowing and pre-operative MJS (coefficient = 0.510, p < 0.001), rate of change in MJS (coefficient = 0.929, p < 0.001), and increase in MME (ΔMME) (coefficient = 0.506, p < 0.001).

Conclusion: Knees that underwent pullout repair for MMPRT showed progression of MJS narrowing by 0.51 mm at one year post-operatively, although clinical scores markedly improved. Correlating factors for MJS narrowing were pre-operative MJS, rate of change in MJS, and ΔMME. Preventing MME progression is essential for preventing arthropathic changes.

Keywords: Fixed-flexion view; Medial joint space; Medial meniscus extrusion; Meniscus; Posterior root tear; Pullout repair.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Study protocol flowchart. MMPRT, medial meniscus posterior root tear; FFV, fixed-flexion view
Fig. 2
Fig. 2
FFV methods. (a) The custom-made limb positioning plate. (b) The patient standing on the custom-made plate while keeping the toes and the front of the thighs in contact with the film cassette. A posteroanterior image is acquired with the X-ray beam angled caudally at 10°. FFV, fixed-flexion view
Fig. 3
Fig. 3
Measurement of the MJS width using the midpoint technique (left knee). The MJS (white line) is measured between the femoral and tibial surfaces at the midpoints of the medial tibial eminence and the medial point of the tibial plateau (yellow circles), parallel to the long axis of the tibia (black dotted line). MJS, medial joint space
Fig. 4
Fig. 4
Measurement of MME using the bony landmark method (left knee). The MME is determined by measuring the horizontal distance (red arrow) between the medial point of the tibial plateau and the medial point of the meniscus in the slice where the highest medial tibial eminence (yellow arrowhead) is visible. MME, medial meniscus extrusion
Fig. 5
Fig. 5
Scatter plot of the correlation between MJS narrowing and preoperative MJS (a), rate of change in MJS (b), and ΔMME (c). MJS, medial joint space; rate of change in MJS, medial joint space narrowing divided by preoperative medial joint space; ΔMME, the increase in medial meniscus extrusion
See this image and copyright information in PMC

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