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Functional Outcome Following Concurrent Medial Meniscus Posterior Horn Root Repair during High Tibial Osteotomy in Early Medial Compartment Osteoarthritis

Vol. 10 | Issue 1 | January-February 2022 | Page: 09-14 | Kumar Amerendra Singh, Hitesh Shah

DOI:10.13107/jkoa.2022.v10i01.045


Authors: Anoop Pilar [1], Madan Mohan M [1], Sunil L K [1], Surendra Babu S [1], Padmanabhan Sekaran [2], Rajkumar S. Amaravathi [1]

[1] Department of Orthopaedics, St Johns Medical College and Hospital, Bangalore, Karnataka, India.
[2] Department of Physiotherapy and Rehabilitation, Sparsh Hospital, Bangalore, Karnataka, India.

Address of Correspondence

Dr. Rajkumar S. Amaravathi,
Department of Orthopaedics, St Johns Medical College and Hospital, Bangalore, Karnataka, India.
E-mail: rajkumar_as@yahoo.co.in


Abstract


Background: Meniscal root tears cause biomechanical changes comparable to a total meniscectomy. The resultant compromise in hoop stress, leads to decreased tibiofemoral contact area and increased contact pressure. This will lead to early arthritis. The meniscus root tear causes more detrimental changes in people with varus alignment of the lower limb. This increases the chances of progression to arthritis, causing joint pain and functional limitation, eventually necessitating early replacement surgery. Surgical management with repair of the meniscus, with corrective osteotomy restoring the normal anatomy, has been reported to improve clinical and functional outcomes and delay the replacement surgery. This study aimed to evaluate the functional outcome following concurrent Medial meniscus posterior horn root (MMPHRTs) repair during open medial wedge high tibial osteotomy (HTO) with medial osteoarthritis.
Methods: We performed posterior horn root repair with open medial wedge HTO in 9 patients, between 2016 and 2021. The mean follow-up of patients was 2 years. The mean Lysholm and IKDC scores showed significant improvement (7 had excellent and 2 had satisfactory scores). Patients returned to their expected activity of daily living.
Conclusion: Concurrent MMPHRT repair along with medial open wedge HTO for medial compartmental osteoarthritis with varus alignment gives good results and has shown good clinical and radiological outcome on short term follow-up.
Keywords: Meniscal root tear, Medial open wedge HTO, Preoperative planning, Outcome.


References


1. Fithian, D.C.; Kelly, M.A.; Mow, V.C. Material properties and structure-function relationships in the menisci. Clin. Orthop. Relat.Res. 1990, 252, 19–31.
2. Koenig, J.H.; Ranawat, A.S.; Umans, H.R.; Difelice, G.S. Meniscal root tears: Diagnosis and treatment. Arthrosc. J. Arthrosc. Relat.Surg. 2009, 25, 1025–1032.
3. Kan, A.; Oshida, M.; Oshida, S.; Imada, M.; Nakagawa, T.; Okinaga, S. Anatomical significance of a posterior horn of medial meniscus: The relationship between its radial tear and cartilage degradation of joint surface. Sports Med. Arthrosc. Rehabil.Ther. Technol. 2010, 2, 1.
4. Allaire R, Muriuki M, Gilbertson L, Harner CD. Biomechanical consequences of a tear of the posterior root of the medial meniscus. Similar to total meniscectomy. J Bone Joint Surg Am. 2008;90(9):1922–31.
5. Marzo JM, Gurske-DePerio J. Efects of medial meniscus posterior horn avulsion and repair on tibiofemoral contact area and peak contact pressure with clinical implications. Am J Sports Med. 2009;37(1):124–9.
6. Padalecki JR, Jansson KS, Smith SD, Dornan GJ, Pierce CM, Wijdicks CA, et al. Biomechanical consequences of a complete radial tear adjacent to the medial meniscus posterior root attachment site: in situ pull-out repair restores derangement of joint mechanics. Am J Sports Med. 2014;42(3):699–707.
7. Jiang EX, Abouljoud MM, Everhart JS, DiBartola AC, Kaeding CC, Magnus sen RA, et al. Clinical factors associated with successful meniscal root repairs: a systematic review. Knee. 2019;26(2):285–91.
8. Kim JH, Chung JH, Lee DH, Lee YS, Kim JR, Ryu KJ. Arthroscopic suture anchor repair versus pullout suture repair in posterior root tear of the medial meniscus: a prospective comparison study. Arthroscopy. 2011;27(12):1644–53.
9. Kim SB, Ha JK, Lee SW, Kim DW, Shim JC, Kim JG, et al. Medial meniscus root tear refixation: comparison of clinical, radiologic, and arthroscopic fndings with medial meniscectomy. Arthroscopy. 2011;27(3):346–54.
10. Moon HK, Koh YG, Kim YC, Park YS, Jo SB, Kwon SK. Prognostic factors of arthroscopic pull-out repair for a posterior root tear of the medial meniscus. Am J Sports Med. 2012;40(5):1138–43.
11. Moon HS, Choi CH, Jung M, Lee DY, Hong SP, Kim SH. Early surgical repair of medial meniscus posterior root tear minimizes the progres sion of meniscal extrusion: 2-year follow-up of clinical and radiographic parameters after arthroscopic transtibial pull-out repair. Am J Sports Med. 2020;48(11):2692–702.
12. Chung KS, Ha JK, Ra HJ, Kim JG. Preoperative varus alignment and post-operative meniscus extrusion are the main long-term predictive factors of clinical failure of meniscal root repair. Knee Surg Sports Traumatol Arthrosc. 2021.
13. Chung KS, Ha JK, Ra HJ. Kim JG (2016) Prognostic factors in the midterm results of pullout fxation for posterior root tears of the medial meniscus. Arthroscopy. 2016;32(7):1319–27.
14. Bonasia DE, Dettoni F, Sito G, Blonna D, Marmotti A, Bruzzone M, et al. Medial opening wedge high tibial osteotomy for medial compartment overload/arthritis in the varus knee: prognostic factors. Am J Sports Med. 2014;42(3):69–78.
15. Floerkemeier S, Staubli AE, Schroeter S, Goldhahn S, Lobenhofer P. Out come after high tibial open-wedge osteotomy: a retrospective evaluation of 533 patients. Knee Surg Sports Traumatol Arthrosc. 2013;21(1):170–80.
16. Ferruzzi A, Buda R, Cavallo M, Timoncini A, Natali S, Giannini S. Cartilage repair procedures associated with high tibial osteotomy in varus knees: clinical results at 11 years’ follow-up. Knee. 2014;21(2):445–50.
17. Birmingham TB, Moyer R, Leitch K, Chesworth B, Bryant D, Willits K, et al. Changes in biomechanical risk factors for knee osteoarthritis and their association with 5-year clinically important improvement after limb realignment surgery. Osteoarthritis Cartilage. 2017;25(12):1999–2006.
18. Bin SI, Kim JM, Shin SJ. Radial tears of the posterior horn of the medial meniscus. Arthroscopy 2004;20(04):373–378
19. Robertson DD, Armfield DR, Towers JD, Irrgang JJ, Maloney WJ, Harner CD. Meniscal root injury and spontaneous osteonecrosis of the knee: an observation. J Bone Joint Surg Br 2009;91(02): 190–195
20. Jung WH, Takeuchi R, Chun CW, Lee JS, Ha JH, Kim JH, et al. Second-look arthroscopic assessment of cartilage regeneration after medial openingwedge high tibial osteotomy. Arthroscopy. 2014;30(1):72–9.
21. Sterett WI, Steadman JR, Huang MJ, Matheny LM, Briggs KK. Chondral resurfacing and high tibial osteotomy in the varus knee: survivorship analysis. Am J Sports Med. 2010;38(7):1420–4.
22. Kim KI, Seo MC, Song SJ, Bae DK, Kim DH, Lee SH. Change of chondral lesions and predictive factors after medial open-wedge high tibial oste otomy with a locked plate system. Am J Sports Med. 2017;45(7):1615–21.
23. Jung WH, Takeuchi R, Chun CW, Lee JS, Jeong JH. Comparison of results of medial opening-wedge high tibial osteotomy with and without sub chondral drilling. Arthroscopy. 2015;31(4):673–9.
24. Wakabayashi S, Akizuki S, Takizawa T, Yasukawa Y. A comparison of the healing potential of fbrillated cartilage versus eburnated bone in osteo arthritic knees after high tibial osteotomy: an arthroscopic study with 1-year follow-up. Arthroscopy. 2002;18(3):272–8.
25. LaPrade RF, Ho CP, James E, Crespo B, LaPrade CM, Matheny LM. Diagnostic accuracy of 3.0 T magnetic resonance imaging for the detection of meniscus posterior root pathology. Knee Surg Sports Traumatol Arthrosc 2015;23(01):152–157
26. Lee DW, Kim MK, Jang HS, Ha JK, Kim JG. Clinical and radiologic evaluation of arthroscopic medial meniscus root tear refixation: comparison of the modified Mason-Allen stitch and simple stitches. Arthroscopy 2014;30(11):1439–1446
27. Krych AJ, Reardon PJ, Johnson NR, et al. Non-operative manage ment 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 2017;25(02): 383–389
28. Chung KS, Ha JK, Yeom CH, et al. Comparison of clinical and radiologic results between partial meniscectomy and refixation of medial meniscus posterior root tears: a minimum 5-year follow-up. Arthroscopy 2015;31(10):1941–1950
29. Han SB, Shetty GM, Lee DH, et al. Unfavorable results of partial meniscectomy for complete posterior medial meniscus root tear with early osteoarthritis: a 5- to 8-year follow-up study. Arthro scopy 2010;26(10):1326–133
30. Okazaki Y, Furumatsu T, Masuda S, Miyazawa S, Kodama Y, Kamatsuki Y, et al. Pullout repair of the medial meniscus posterior root tear reduces proton density-weighted imaging signal intensity of the medial menis cus. Acta Med Okayama. 2018;72(5):493–8.
31. LaPrade CM, Foad A, Smith SD, Turnbull TL, Dornan GJ, Engebretsen L, et al. Biomechanical consequences of a nonanatomic posterior medial meniscal root repair. Am J Sports Med. 2015;3(4):912–20.
32. Kim YM, Joo BY, Lee WY, Kim YK. Remodifed Mason-Allen suture technique concomitant with high tibial osteotomy for medial meniscus posterior root tears improved the healing of the repaired root and suppressed osteoarthritis progression. Knee Surg Sports Traumatol Arthrosc. 2020.
33. Lee DW, Lee SH, Kim JG. Outcomes of medial meniscal posterior root repair during proximal tibial osteotomy. Is root repair benefcial? Arthroscopy. 2020.
34 Kodama Y, Furumatsu T, Fujii M, Tanaka T, Miyazawa S, Ozaki T. Pullout repair of a medial meniscus posterior root tear using a FasT-Fix all-inside suture technique. Orthop Traumatol Surg Res 2016;102(07):951–954
35 Chung KS, Ha JK, Ra HJ, Nam GW, Kim JG. Pullout fixation of posterior medial meniscus root tears: correlation between meniscus extrusion and midterm clinical results. Am J Sports Med 2017;45(01):42–49


How to Cite this article:  Pilar A, Madan MM, Sunil LK, Babu SS, Sekaran P, Amaravathi RS | Functional Outcome Following Concurrent Medial Meniscus Posterior Horn Root Repair during High Tibial Osteotomy in Early Medial Compartment Osteoarthritis | Journal of Karnataka Orthopaedic Association | January-February 2022; 10(1): 09-14.

 


 


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