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. 2024 Aug 19;12(8):23259671241263648.
doi: 10.1177/23259671241263648. eCollection 2024 Aug.

Prognostic Factors on Preoperative MRI for Patient-Reported Outcomes After Posterior Medial Meniscus Root Repair

Sergio E Flores  1 , Rawee Manatrakul  2   3 , Christopher Anigwe  1 , Chotigar Ngarmsrikam  2 , Brian T Feeley  1 , C Benjamin Ma  1 , Thomas M Link  2 , Drew A Lansdown  1
Affiliations

Prognostic Factors on Preoperative MRI for Patient-Reported Outcomes After Posterior Medial Meniscus Root Repair

Sergio E Flores et al. Orthop J Sports Med. .

Abstract

Background: Repair of posterior medial meniscus root (PMMR) tears has demonstrated favorable outcomes and may prevent rapid progression of knee osteoarthritis; however, there is a paucity of data regarding prognostic factors affecting postoperative outcomes.

Purpose/hypothesis: The purpose of this study was to identify factors on preoperative magnetic resonance imaging (MRI) that predict postoperative outcomes after PMMR repair. It was hypothesized that patients with increasing levels of degenerative changes as evaluated through semiquantitative preoperative MRI scans would have worse postoperative patient-reported outcome (PRO) scores.

Study design: Cohort study; Level of evidence, 3.

Methods: Patients who underwent PMMR repair between 2012 and 2020 and had minimum 2-year follow-up data were enrolled. Pre- and postoperative visual analog scale pain scores and postoperative PRO surveys including the Patient-Reported Outcomes Measurement Information System-Physical Function, Lysholm knee score, and Knee injury and Osteoarthritis Outcome Score (KOOS) were collected. Patients who achieved the Patient Acceptable Symptom State (PASS) on the KOOS subscales were reported. Two fellowship-trained musculoskeletal radiologists reviewed preoperative MRIs and calculated the Whole-Organ Magnetic Resonance Imaging Score for meniscus, cartilage, bone marrow edema-like lesions (BMELL), and meniscal extrusion. Statistical analysis was performed using the 2-sample t test, Mann-Whitney test, and Fisher exact test for categorical variables.

Results: A total of 29 knees in 29 patients were evaluated (22 female, 7 male; mean age at surgery, 52.3 ± 9.9 years; body mass index, 27.6 ± 5.6 kg/m2; mean follow-up, 59.6 ± 26.5 months). Visual analog scale for pain scores decreased significantly from preoperatively (4.9 ± 2.0) to final follow-up (1.6 ± 1.9) (P < .001), and the percentage of patients meeting the PASS ranged from 44.8% for KOOS Sport and Recreation to 72.4% for KOOS Pain and KOOS Quality of Life. Patients with medial tibial BMELL (MT-BMELL) had significantly lower KOOS Symptoms scores (76.1 ± 17.3 vs 88.4 ± 9.7 without MT-BMELL; P = .032). Cartilage quality and presence of meniscal extrusion were not associated with outcomes.

Conclusion: Patients with MT-BMELL on their preoperative MRI in the setting of PMMR tear were found to have worse KOOS Symptoms scores after PMMR repair.

Keywords: knee articular cartilage; knee meniscus; magnetic resonance imaging; patient-reported outcomes.

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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: B.T.F. has received education payments from Evolution Surgical. T.M.L. has received consulting fees from Pfizer. D.A.L. has received education payments from Evolution Surgical and consulting fees from Vericel. 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. Ethical approval for this study was obtained from University of California, San Francisco (ref No. 21-34760).

Figures

Figure 1.
Figure 1.
T2-weighted magnetic resonance imaging scans. (A) Coronal and (B) sagittal images showing a medial tibial bone marrow edema–like lesion. (C) Coronal image demonstrating a posterior medial meniscus root tear.
Figure 2.
Figure 2.
Postoperative mean patient-reported outcome scores between patients with and without MT-BMELL on preoperative magnetic resonance imaging. Error bars represent standard deviation. *Statistically significant difference between MT-BMELL and no MT-BMELL (P < .05). MT-BELL, medial tibial bone marrow edema–like lesions; ADL, Activities of Daily Living; KOOS, Knee injury and Osteoarthritis Outcome Score; PROMIS, Patient–Reported Outcomes Measurement Information System; QoL, Quality of Life; Sport, Sport and Recreation.
See this image and copyright information in PMC

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