Meniscal Root Tears: Take the time to fix them and which ones I - PowerPoint PPT Presentation

Meniscal Root Tears: Take the time to fix them and which ones I don’t. MARC LABBÉ, M.D. CHIEF OF SURGERY HOUSTON METHODIST THE WOODLANDS HOSPITAL

What is the big deal?! • Root tear disrupts meniscal “hoop” • Posterior • Root disruption = complete meniscectomy • Posteromedial repair restores “hoop” • Posterolateral repair is better than tear but not normal OSET 2017 2

When to expect them Older 40+ Younger >40 • Medial • Lateral • Minor trauma or degenerative • ACL tears • SPONK 80% • 8% with ACL tear • Associated chondromalacia • 0.8% without ACL tear • Popping with squatting • Posterior pain OSET 2017 3

56yo. with 3 mo. pain fails shot and PT OSET 2017 4

Radial root tear with Grade 2-3 changes chondromalacia OSET 2017 5

How to make a decision • Radial (Type 1) – Debride majority • Consider repair with age and tear extension into vascular zones • Complete Tear (Types 2-5) • Repair with age and chondromalacia • 40-45 yo. = relative cutoff OSET 2017 6

Outcomes Medial Lateral Feucht • Ahn • Lysholm 52 to 86 • 25 patients, 18 mo f/u • K-L Grade 84% no progression of OA • Good clinical and MRI resuls • Healed 62% • LaPrade • Partial healing 34% • 50 patients (15 lateral) • Failure to heal 3% • No lateral failures Chung • 6.7% reoperation (<50 yo. medial repairs) • Compare partial meniscectomy & repair • Outcomes improved regardless of M/L or • Both had incr. K-L but repair less age under/over 50 yo. • 35% conversion rate to TKA in meniscectomy group OSET 2017 7

Rehabilitation • Non-weight bearing 6 weeks than progress to full WB • 0-90 deg. Motion 0-2 weeks than full ROM • No closed-chain strength exercises in flexion > 70 deg. for 6 mo. • Full rehab. after 6 months and progress to sport OSET 2017 8

Resources Orthop Rev (Pavia) . 2015 Jun 3; 7(2): 5792. Meniscal Root Tear • Repair: Why, When and How? Davide Edoardo Bonasia, Pietro Pellegrino, Andrea D’Amelio,UmbertoCottino, and Roberto THANK YOU Rossi Bhatia S, LaPrade CM, Ellman MB, LaPrade RF. Meniscal root • tears: significance, diagnosis, and treatment. Am J Sport Med 2014. 42:3016-30. Acta Orthop . 2016 Oct; 87(5): 452–458. PMCID: PMC5016902 • Posterior meniscal root injuries A comprehensive review from anatomy to surgical treatment Gilbert Moatshe, Jorge Chahla, Erik Slette, Lars Engebretsen, and Robert F Laprade LaPrade CM, James EW, Cram TR, Feagin JA, Engebretsen L, • LaPrade RF. Meniscal Root Tears: A Classification System Based on Tear Morphology. American Journal of Sports Medicine . 2014: Vol 43 (2): 363-369. Hein CN, Deperio JG, Ehrensberger MT, Marzo JM. Effects of • medial meniscal posterior horn avulsion and repair on meniscal displacement. Knee 2011;18:189-92. Stärke C, Kopf S, Lippisch R, et al. Tensile forces on repaired • medial meniscal root tears. Arthroscopy 2013;29:205-12. Knee . 2009 Jan;16(1):77-80. Epub 2008 Oct 18. Arthroscopic all • inside repair of the lateral meniscus root tear. Ahn JH1, Lee YS, Chang JY, Chang MJ, Eun SS, Kim SM. Am J Sports Med . 2017 Mar;45(4):884-891. Epub 2016 Dec 5. • Posterior Meniscal Root Repairs: Outcomes of an Anatomic Transtibial Pull-Out Technique. LaPrade RF Matheny LM, Moulton SG, James EW, Dean CS. OSET 2017 9