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Erschienen in: International Orthopaedics 5/2019

01.08.2018 | Original Paper

Arthroscopic scoring system of meniscal healing following medial meniscus posterior root repair

verfasst von: Takayuki Furumatsu, Shinichi Miyazawa, Masataka Fujii, Takaaki Tanaka, Yuya Kodama, Toshifumi Ozaki

Erschienen in: International Orthopaedics | Ausgabe 5/2019

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Abstract

Purpose

Medial meniscus posterior root tear (MMPRT) leads to a rapid degradation of articular cartilage. In the treatment of MMPRT, transtibial pullout repair demonstrates a high clinical survival rate. However, there is no reliable method to evaluate the meniscal healing after surgery. We propose an arthroscopic scoring system for evaluating the meniscal healing status. The aim of this study was to investigate the correlations between second-look arthroscopic scores and clinical outcomes after transtibial pullout repair.

Methods

Twenty patients who had MMPRTs underwent transtibial pullout repairs. Clinical outcomes were assessed using the Japanese Knee Injury and Osteoarthritis Outcome Score (KOOS) and pain score evaluated by visual analogue scale at preoperatively and 1 year postoperatively. The healing status of repaired MM was assessed at one year post-operatively using a semi-quantitative arthroscopic scoring system (total, 10 points) composed of three evaluation criteria: (i) anteroposterior width of bridging tissues, (ii) stability of the MM posterior root, and (iii) synovial coverage of the sutures. Linear regression analysis was used to assess the correlation between second-look arthroscopic scores and clinical outcomes.

Results

Transtibial pullout repairs of MMPRTs significantly improved clinical evaluation scores at one year post-operatively. A median of second-look arthroscopic scores was 6.5 (5.75–8). A good correlation was observed between the arthroscopic score and KOOS quality of life (QOL) subscale. A moderate negative correlation between the arthroscopic score and pain score was observed.

Conclusions

This study demonstrated that our semi-quantitative scoring system of meniscal healing correlated with the KOOS QOL subscale following MMPRT transtibial pullout repair. Our results suggest that the second-look arthroscopic score using this system may be a useful scale to determine and compare the healing status of the MM posterior root.
Literatur
1.
Zurück zum Zitat Bhatia S, LaPrade CM, Ellman MB, LaPrade RF (2014) Meniscal root tears: significance, diagnosis, and treatment. Am J Sports Med 42(12):3016–3030CrossRefPubMed Bhatia S, LaPrade CM, Ellman MB, LaPrade RF (2014) Meniscal root tears: significance, diagnosis, and treatment. Am J Sports Med 42(12):3016–3030CrossRefPubMed
2.
Zurück zum Zitat Yamagami R, Taketomi S, Inui H, Tahara K, Tanaka S (2017) The role of medial meniscus posterior root tear and proximal tibial morphology in the development of spontaneous osteonecrosis and osteoarthritis of the knee. Knee 24(2):390–395CrossRefPubMed Yamagami R, Taketomi S, Inui H, Tahara K, Tanaka S (2017) The role of medial meniscus posterior root tear and proximal tibial morphology in the development of spontaneous osteonecrosis and osteoarthritis of the knee. Knee 24(2):390–395CrossRefPubMed
3.
Zurück zum Zitat Furumatsu T, Kodama Y, Kamatsuki Y, Hino T, Okazaki Y, Ozaki T (2017) Meniscal extrusion progresses shortly after the medial meniscus posterior root tear. Knee Surg Relat Res 29(4):295–301CrossRefPubMedPubMedCentral Furumatsu T, Kodama Y, Kamatsuki Y, Hino T, Okazaki Y, Ozaki T (2017) Meniscal extrusion progresses shortly after the medial meniscus posterior root tear. Knee Surg Relat Res 29(4):295–301CrossRefPubMedPubMedCentral
4.
Zurück zum Zitat Krych AJ, Reardon PJ, Johnson NR, Mohan R, Peter L, Levy BA, Stuart MJ (2017) Non-operative management of medial meniscus posterior horn root tears is associated with worsening arthritis and poor clinical outcome at 5-year follow-up. Knee Surg Sports Traumatol Arthrosc 25(2):383–389CrossRefPubMed Krych AJ, Reardon PJ, Johnson NR, Mohan R, Peter L, Levy BA, Stuart MJ (2017) Non-operative management of medial meniscus posterior horn root tears is associated with worsening arthritis and poor clinical outcome at 5-year follow-up. Knee Surg Sports Traumatol Arthrosc 25(2):383–389CrossRefPubMed
5.
Zurück zum Zitat Han SB, Shetty GM, Lee DH, Chae DJ, Seo SS, Wang KH, Yoo SH, Nha KW (2010) Unfavorable results of partial meniscectomy for complete posterior medial meniscus root tear with early osteoarthritis: a 5- to 8-year follow-up study. Arthroscopy 26(10):1326–1332CrossRefPubMed Han SB, Shetty GM, Lee DH, Chae DJ, Seo SS, Wang KH, Yoo SH, Nha KW (2010) Unfavorable results of partial meniscectomy for complete posterior medial meniscus root tear with early osteoarthritis: a 5- to 8-year follow-up study. Arthroscopy 26(10):1326–1332CrossRefPubMed
6.
Zurück zum Zitat Krych AJ, Johnson NR, Mohan R, Dahm DL, Levy BA, Stuart MJ (2018) Partial meniscectomy provides no benefit for symptomatic degenerative medial meniscus posterior root tears. Knee Surg Sports Traumatol Arthrosc 26(4):1117–1122PubMed Krych AJ, Johnson NR, Mohan R, Dahm DL, Levy BA, Stuart MJ (2018) Partial meniscectomy provides no benefit for symptomatic degenerative medial meniscus posterior root tears. Knee Surg Sports Traumatol Arthrosc 26(4):1117–1122PubMed
7.
Zurück zum Zitat Bonasia DE, Pellegrino P, D'Amelio A, Cottino U, Rossi R (2015) Meniscal root tear repair: why, when and how? Orthop Rev (Pavia) 7(2):5792 Bonasia DE, Pellegrino P, D'Amelio A, Cottino U, Rossi R (2015) Meniscal root tear repair: why, when and how? Orthop Rev (Pavia) 7(2):5792
8.
Zurück zum Zitat Kim JH, Chung JH, Lee DH, Lee YS, Kim JR, Ryu KJ (2011) Arthroscopic suture anchor repair versus pullout suture repair in posterior root tear of the medial meniscus: a prospective comparison study. Arthroscopy 27(12):1644–1653CrossRefPubMed Kim JH, Chung JH, Lee DH, Lee YS, Kim JR, Ryu KJ (2011) Arthroscopic suture anchor repair versus pullout suture repair in posterior root tear of the medial meniscus: a prospective comparison study. Arthroscopy 27(12):1644–1653CrossRefPubMed
9.
Zurück zum Zitat Chung KS, Ha JK, Ra HJ, Kim JG (2016) A meta-analysis of clinical and radiographic outcomes of posterior horn medial meniscus root repairs. Knee Surg Sports Traumatol Arthrosc 24(5):1455–1468CrossRefPubMed Chung KS, Ha JK, Ra HJ, Kim JG (2016) A meta-analysis of clinical and radiographic outcomes of posterior horn medial meniscus root repairs. Knee Surg Sports Traumatol Arthrosc 24(5):1455–1468CrossRefPubMed
10.
Zurück zum Zitat Chung KS, Noh JM, Ha JK, Ra HJ, Park SB, Kim HK, Kim JG (2018) Survivorship analysis and clinical outcomes of transtibial pullout repair for medial meniscus posterior root tears: a 5- to 10-year follow-up study. Arthroscopy 34(2):530–535CrossRefPubMed Chung KS, Noh JM, Ha JK, Ra HJ, Park SB, Kim HK, Kim JG (2018) Survivorship analysis and clinical outcomes of transtibial pullout repair for medial meniscus posterior root tears: a 5- to 10-year follow-up study. Arthroscopy 34(2):530–535CrossRefPubMed
11.
Zurück zum Zitat LaPrade CM, Foad A, Smith SD, Turnbull TL, Dornan GJ, Engebretsen L, Wijdicks CA, LaPrade RF (2015) Biomechanical consequences of a nonanatomic posterior medial meniscal root repair. Am J Sports Med 43(4):912–920CrossRefPubMed LaPrade CM, Foad A, Smith SD, Turnbull TL, Dornan GJ, Engebretsen L, Wijdicks CA, LaPrade RF (2015) Biomechanical consequences of a nonanatomic posterior medial meniscal root repair. Am J Sports Med 43(4):912–920CrossRefPubMed
12.
Zurück zum Zitat Kaplan DJ, Alaia EF, Dold AP, Meislin RJ, Strauss EJ, Jazrawi LM, Alaia MJ (2017) Increased extrusion and ICRS grades at 2-year follow-up following transtibial medial meniscal root repair evaluated by MRI. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-017-4755-8 Kaplan DJ, Alaia EF, Dold AP, Meislin RJ, Strauss EJ, Jazrawi LM, Alaia MJ (2017) Increased extrusion and ICRS grades at 2-year follow-up following transtibial medial meniscal root repair evaluated by MRI. Knee Surg Sports Traumatol Arthrosc. https://​doi.​org/​10.​1007/​s00167-017-4755-8
13.
Zurück zum Zitat Seo HS, Lee SC, Jung KA (2011) Second-look arthroscopic findings after repairs of posterior root tears of the medial meniscus. Am J Sports Med 39(1):99–107CrossRefPubMed Seo HS, Lee SC, Jung KA (2011) Second-look arthroscopic findings after repairs of posterior root tears of the medial meniscus. Am J Sports Med 39(1):99–107CrossRefPubMed
14.
Zurück zum Zitat Nha KW, Lee YS, Hwang DH, Kwon JH, Chae DJ, Park YJ, Kim JI (2013) Second-look arthroscopic findings after open-wedge high tibia osteotomy focusing on the posterior root tears of the medial meniscus. Arthroscopy 29(2):226–231CrossRefPubMed Nha KW, Lee YS, Hwang DH, Kwon JH, Chae DJ, Park YJ, Kim JI (2013) Second-look arthroscopic findings after open-wedge high tibia osteotomy focusing on the posterior root tears of the medial meniscus. Arthroscopy 29(2):226–231CrossRefPubMed
15.
Zurück zum Zitat Kodama Y, Furumatsu T, Fujii M, Tanaka T, Miyazawa S, Ozaki T (2016) Pullout repair of a medial meniscus posterior root tear using a FasT-fix all-inside suture technique. Orthop Traumatol Surg Res 102(7):951–954CrossRefPubMed Kodama Y, Furumatsu T, Fujii M, Tanaka T, Miyazawa S, Ozaki T (2016) Pullout repair of a medial meniscus posterior root tear using a FasT-fix all-inside suture technique. Orthop Traumatol Surg Res 102(7):951–954CrossRefPubMed
16.
Zurück zum Zitat Furumatsu T, Kodama Y, Fujii M, Tanaka T, Hino T, Kamatsuki Y, Yamada K, Miyazawa S, Ozaki T (2017) A new aiming guide can create the tibial tunnel at favorable position in transtibial pullout repair for the medial meniscus posterior root tear. Orthop Traumatol Surg Res 103(3):367–371CrossRefPubMed Furumatsu T, Kodama Y, Fujii M, Tanaka T, Hino T, Kamatsuki Y, Yamada K, Miyazawa S, Ozaki T (2017) A new aiming guide can create the tibial tunnel at favorable position in transtibial pullout repair for the medial meniscus posterior root tear. Orthop Traumatol Surg Res 103(3):367–371CrossRefPubMed
17.
Zurück zum Zitat Fujii M, Furumatsu T, Kodama Y, Miyazawa S, Hino T, Kamatsuki Y, Yamada K, Ozaki T (2017) A novel suture technique using the FasT-fix combined with Ultrabraid for pullout repair of the medial meniscus posterior root tear. Eur J Orthop Surg Traumatol 27(4):559–562CrossRefPubMed Fujii M, Furumatsu T, Kodama Y, Miyazawa S, Hino T, Kamatsuki Y, Yamada K, Ozaki T (2017) A novel suture technique using the FasT-fix combined with Ultrabraid for pullout repair of the medial meniscus posterior root tear. Eur J Orthop Surg Traumatol 27(4):559–562CrossRefPubMed
18.
Zurück zum Zitat Choi SH, Bae S, Ji SK, Chang MJ (2012) The MRI findings of meniscal root tear of the medial meniscus: emphasis on coronal, sagittal and axial images. Knee Surg Sports Traumatol Arthrosc 20(10):2098–2103CrossRefPubMed Choi SH, Bae S, Ji SK, Chang MJ (2012) The MRI findings of meniscal root tear of the medial meniscus: emphasis on coronal, sagittal and axial images. Knee Surg Sports Traumatol Arthrosc 20(10):2098–2103CrossRefPubMed
19.
Zurück zum Zitat Furumatsu T, Fujii M, Kodama Y, Ozaki T (2017) A giraffe neck sign of the medial meniscus: a characteristic finding of the medial meniscus posterior root tear on magnetic resonance imaging. J Orthop Sci 22(4):731–736CrossRefPubMed Furumatsu T, Fujii M, Kodama Y, Ozaki T (2017) A giraffe neck sign of the medial meniscus: a characteristic finding of the medial meniscus posterior root tear on magnetic resonance imaging. J Orthop Sci 22(4):731–736CrossRefPubMed
20.
Zurück zum Zitat LaPrade CM, James EW, Cram TR, Feagin JA, Engebretsen L, LaPrade RF (2015) Meniscal root tears: a classification system based on tear morphology. Am J Sports Med 43(2):363–369CrossRefPubMed LaPrade CM, James EW, Cram TR, Feagin JA, Engebretsen L, LaPrade RF (2015) Meniscal root tears: a classification system based on tear morphology. Am J Sports Med 43(2):363–369CrossRefPubMed
21.
Zurück zum Zitat Bae JH, Paik NH, Park GW, Yoon JR, Chae DJ, Kwon JH, Kim JI, Nha KW (2013) Predictive value of painful popping for a posterior root tear of the medial meniscus in middle-aged to older Asian patients. Arthroscopy 29(3):545–549CrossRefPubMed Bae JH, Paik NH, Park GW, Yoon JR, Chae DJ, Kwon JH, Kim JI, Nha KW (2013) Predictive value of painful popping for a posterior root tear of the medial meniscus in middle-aged to older Asian patients. Arthroscopy 29(3):545–549CrossRefPubMed
22.
Zurück zum Zitat Furumatsu T, Kamatsuki Y, Fujii M, Kodama Y, Okazaki Y, Masuda S, Ozaki T (2017) Medial meniscus extrusion correlates with disease duration of the sudden symptomatic medial meniscus posterior root tear. Orthop Traumatol Surg Res 103(8):1179–1182CrossRefPubMed Furumatsu T, Kamatsuki Y, Fujii M, Kodama Y, Okazaki Y, Masuda S, Ozaki T (2017) Medial meniscus extrusion correlates with disease duration of the sudden symptomatic medial meniscus posterior root tear. Orthop Traumatol Surg Res 103(8):1179–1182CrossRefPubMed
23.
Zurück zum Zitat Yao J, Lancianese SL, Hovinga KR, Lee J, Lerner AL (2008) Magnetic resonance image analysis of meniscal translation and tibio-menisco-femoral contact in deep knee flexion. J Orthop Res 26(5):673–684CrossRefPubMed Yao J, Lancianese SL, Hovinga KR, Lee J, Lerner AL (2008) Magnetic resonance image analysis of meniscal translation and tibio-menisco-femoral contact in deep knee flexion. J Orthop Res 26(5):673–684CrossRefPubMed
24.
Zurück zum Zitat Masuda S, Furumatsu T, Okazaki Y, Kodama Y, Hino T, Kamatsuki Y, Miyazawa S, Ozaki T (2018) Medial meniscus posterior root tear induces pathological posterior extrusion of the meniscus in the knee-flexed position: an open magnetic resonance imaging analysis. Orthop Traumatol Surg Res 104(4):485–489CrossRefPubMed Masuda S, Furumatsu T, Okazaki Y, Kodama Y, Hino T, Kamatsuki Y, Miyazawa S, Ozaki T (2018) Medial meniscus posterior root tear induces pathological posterior extrusion of the meniscus in the knee-flexed position: an open magnetic resonance imaging analysis. Orthop Traumatol Surg Res 104(4):485–489CrossRefPubMed
25.
Zurück zum Zitat Markolf KL, Jackson SR, McAllister DR (2012) Force measurements in the medial meniscus posterior horn attachment: effects of anterior cruciate ligament removal. Am J Sports Med 40(2):332–338CrossRefPubMed Markolf KL, Jackson SR, McAllister DR (2012) Force measurements in the medial meniscus posterior horn attachment: effects of anterior cruciate ligament removal. Am J Sports Med 40(2):332–338CrossRefPubMed
Metadaten
Titel
Arthroscopic scoring system of meniscal healing following medial meniscus posterior root repair
verfasst von
Takayuki Furumatsu
Shinichi Miyazawa
Masataka Fujii
Takaaki Tanaka
Yuya Kodama
Toshifumi Ozaki
Publikationsdatum
01.08.2018
Verlag
Springer Berlin Heidelberg
Erschienen in
International Orthopaedics / Ausgabe 5/2019
Print ISSN: 0341-2695
Elektronische ISSN: 1432-5195
DOI
https://doi.org/10.1007/s00264-018-4071-z

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