Indentifying and Repairing Meniscus Root Tears Thomas Carter, MD - PowerPoint PPT Presentation

Indentifying and Repairing Meniscus Root Tears Thomas Carter, MD Phoenix, AZ

Meniscal Root Tears (MRT) • tear within 1cm (typically radial) or avulsion of the meniscus insertion • loss of circumferential hoop stress and significant decrease in function

Effects of medial meniscus posterior horn avulsion and repair on tibiofemoral contact area and peak contact pressure with clinical implications Marzo and Gurske-DePeno Am J Sports Med 2009;37:124-129 • cadaveric study of medial MRT • increase of medial compartment peak pressure 24.4% • decrease in contact area 20.2% • repair returned to normal

Root tear typical findings • young > 40 yrs old • significant trauma • minor or no trauma • large effusion • small effusion • often associated • 1/3 have joint space with ligament injury narrowing

Mechanism of injury • medial -specific mechanism in young patients -insidious in most older patients • lateral -typically associated with ACL tears

Extrusion measured on MRI  3mm or 25% abnormal medial graft lateral graft Courtesy of R. Verdonk

The role of meniscal root pathology and radial meniscal tear in medial meniscal extrusion Lerer et al. Skeletal Radiol 2004;33:569-574 • 205 consecutive MR scans/extrusion >3mm strong association with DJD >3mm but no DJD: 62 % had root tears

MRI Evidence of Meniscal Extrusion-MMRT Choi et al. Arthroscopy 2010;26:1602-1606 • 248 MR reviews with medial meniscus tears and confirmed at arthroscopy • 53.5 years of age (15-81 years) • 76% with root tears had extrusion • 39% with extrusion had root tears

Treatment options • meniscectomy -DJD -chronic -rehab an issue

Rehab • partial wgt bearing 4 weeks (not full because of outward stress) • running 12 weeks • “ full activities ” 16 weeks

Repair methods Primary • sufficient tissue at attachment is rare • N/V concern Transosseous (typical method)

Suture only fixation technique leads to a higher degree of extrusion than bony fixation in meniscal allograft transplantation Abat et al. Am J Sports Med 2012;40:1591-6 • 88 meniscal allograft 33 sutures only 55 bone plugs • minimum follow-up 3 years (range 36-48 mths)

Abat et al . • extrusion > 3 mm -suture 72.2% -bone 30.9% • repair retears -suture 21.4% -bone 7.3%

Transosseous repair

Technical tips • make contralateral portal 1 st • hug patella tendon • use spinal needle before making working portal to assure it is in line with root attachments • “ notchplasty ” if can’t see entire attachment

Medial meniscus root tear refixation Kim et al. Arthroscopy 2011;27:346-354 • 30 medial root repairs • 28 meniscectomy • 48.5 mth follow-up repair • 46.1 mth follow-up meniscectomy • better Lysholm & IKDC • less joint narrowing • 2(6.7%) retear

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