Clinical outcomes following medial meniscus posterior root repairs: A minimum of 5-year follow-up study

Abstract

Purpose: This study assessed the clinical outcomes of the FasT-Fix dependent modified Mason-Allen suture (F-MMA) and two simple stitches (TSS) on mid-term postoperative outcomes following medial meniscus (MM) posterior root repair.

Methods: Forty-three patients who underwent transtibial pullout repair for MM posterior root tear (PRT) between November 2016 and September 2018 were initially enrolled. Patients with a femorotibial angle ≤ 180°, Kellgren-Lawrence grade of 0-2, and modified Outerbridge grade I or II cartilage lesions were included. The Lysholm, Tegner activity, International Knee Documentation Committee score, pain visual analogue scale and Knee injury and Osteoarthritis Outcome scores were assessed as clinical outcomes. Conversion surgery to knee arthroplasty was considered as the endpoint. Surgeries other than second-look arthroscopy and plate or screw removal were also recorded.

Results: The mean follow-up period was 5.9 years. All evaluated 5-year postoperative clinical outcomes were significantly improved compared to the preoperative outcomes (p < 0.001). Both the F-MMA and TSS significantly improved all clinical scores at 5 years postoperatively in patients with MMPRT, whereas the F-MMA and TSS groups showed no significant differences in the pre- and postoperative clinical scores. None of the patients required ipsilateral knee arthroplasty during the follow-up, and the survival rate after pullout repair was 100%. However, the progression of osteoarthritis could not be completely suppressed, although there were no Kellgren-Lawrence grade 4 cases. The rate of subsequent knee-related surgical treatment was 11.6% in pullout-repaired knees, including arthroscopic debridement for arthrofibrosis with a limited range of motion, an additional all-inside suture repair and partial meniscectomy.

Conclusion: Both F-MMA and TSS pullout repairs yielded satisfactory clinical outcomes in patients with MMPRT with a mean follow-up of 5.9 years, and no conversion to knee arthroplasty was required. Further follow-up is warranted to assess long-term survival rates.

Level of evidence: Level III.

Keywords: clinical outcome; medial meniscus posterior root tear; mid‐term follow‐up; survival rate; transtibial pullout repair.

Figure 1

Flowchart of patient recruitment.

Figure 2

Arthroscopic findings of pullout repair for a medial meniscus posterior root tear (MMPRT) in the left knees. The repair included two simple stitches (TSS, a–c) and a FasT‐Fix dependent modified Mason‐Allen suture (F‐MMA, d–f). (a) MMPRT was confirmed. (b) A No. 2 Ultrabraid suture was passed through the meniscal tissue using a Knee Scorpion suture passer. (c) The TSS configuration was confirmed. (d) The first anchor of the FasT‐Fix was inserted into the meniscal tissue just lateral to the Ultrabraid. (e) The second anchor of the FasT‐Fix was inserted into the meniscal tissue, crossing the Ultrabraid. (f) The F‐MMA configuration was confirmed.

Figure 3

Comparison of preoperative and postoperative clinical scores. All scores significantly improved at final follow‐up period (Wilcoxon signed‐rank test). ADL, activities of daily living; IKDC, International Knee Documentation Committee subjective knee evaluation form; KOOS, Knee Injury and Osteoarthritis Outcome Score; QOL, quality of life; Sport/Rec, sport and recreation function; VAS, pain visual analogue scale *p < 0.001.