Original Article
Predictive Value of Painful Popping for a Posterior Root Tear of the Medial Meniscus in Middle-Aged to Older Asian Patients

https://doi.org/10.1016/j.arthro.2012.10.026Get rights and content

Purpose

The purpose of this study was to determine the accuracy, sensitivity, specificity, and predictive values of a single event of painful popping in the presence of a posterior root tear of the medial meniscus in middle-aged to older Asian patients.

Methods

We conducted a retrospective review of medical records of 936 patients who underwent arthroscopic surgeries for an isolated medial meniscus tear between January 2000 and December 2010. There were 332 men and 604 women with a mean age of 41 years (range, 25 to 66 years). The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of a painful popping sensation for a posterior root tear of the medial meniscus were calculated.

Results

Arthroscopy confirmed the presence of posterior root tears of the medial menisci in 237 of 936 patients (25.3%). A single event of a painful popping sensation was present in 86 of these 936 patients (9.1%). Of these 86 patients with a painful popping sensation, 83 (96.5%) were categorized as having an isolated posterior root tear of the medial meniscus. The positive predictive value of a painful popping sensation in identifying a posterior root tear of the medial meniscus was 96.5%, the negative predictive value was 81.8%, the sensitivity was 35.0%, the specificity was 99.5%, and the diagnostic accuracy was 77.9%.

Conclusions

A single event of painful popping can be a highly predictive clinical sign of a posterior root tear of the medial meniscus in the middle-aged to older Asian population. However, it has low sensitivity for the detection of a posterior root tear of the medial meniscus.

Level of Evidence

Level IV, therapeutic case series.

Section snippets

Methods

After obtaining approval from our institutional review board, we conducted a retrospective review of medical records of patients who underwent arthroscopic sur-geries for medial meniscus tears at our institution between January 2000 and December 2010. The inclusion criteria were (1) an isolated medial meniscus tear with or without a cartilage lesion and (2) no significant sports injuries or traumatic events other than daily activities. All subjects had MRI preoperatively and were diagnosed with

Results

We identified 936 patients with an isolated medial meniscus tear who met the inclusion criteria. There were 332 men and 604 women with a mean age of 41 years (range, 25 to 66 years). Types of medial meniscus tears are shown in Table 1. Among all 936 patients, 237 (25.3%) were diagnosed with an isolated MMPRT (Fig 3). Acute onset with a single event of a painful popping sensation was present in 9.1% (86) of these 936 medial meniscus tears. Patients recalled a single event of a painful popping

Discussion

An MMPRT is not uncommon in the middle-aged to older Asian population, potentially because of lifestyle and activity level.4, 18 In our study the presence of a single event of a painful popping sensation was 9.1% (86 of 936 patients) for all kinds of medial meniscus tears. However, the positive predictive value of a single event of a painful popping sensation for an isolated MMPRT was very high (96.5%). When a middle-aged to older Asian patient presents with intense knee pain after a single

Conclusions

A single event of painful popping can be a highly predictive clinical sign of an MMPRT in the middle-aged to older Asian population. However, it has low sensitivity for the detection of an MMPRT.

References (19)

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    In addition, patients with semi-quantitative scores ≥8 points had better clinical outcomes than those <8 points, whereas no significant difference was found in complete healing and lax healing using qualitative arthroscopic evaluation. MMPRT is prone to occur when the patients are descending, exercising, or twisting the knee joint [14]. Severe knee varus is also a risk factor for MMPRT to increase the contact pressure on the medial compartment of the knee joint and accelerate the progression of OA, which is predictive for a clinical failure after MMPRT [15].

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    Patients with decreased meniscus extrusion at 1 year postoperatively had more favorable clinical scores and radiographic findings at midterm follow-up than did those with increased extrusion [10]. Therefore, prompt diagnosis of MMPRT on the basis of clinical signs [11] or a single painful popping event is necessary [12], and MMPRT repair is recommended to prevent subsequent cartilage degeneration or meniscus extrusion [13]. A robotic arm study reported that tibial external rotation is increased in association with MMPRT, and rotation is restored by posterior root repair [14].

  • Injury patterns of medial meniscus posterior root tears

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The authors report the following source of funding in relation to this article: Supported by a 2013 Inje University research grant.

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