A characteristic MRI finding to diagnose a partial tear of the medial meniscus posterior root: an ocarina sign

( Takayuki Furumatsu ),( Takaaki Hiranaka ),( Keisuke Kintaka ),( Yuki Okazaki ),( Naohiro Higashihara ),( Masanori Tamura ),( Toshifumi Ozaki ) 대한슬관절학회 2021 대한슬관절학회지 Vol.33 No.-

Background: Diagnosing partial tears of the medial meniscus (MM) posterior root is difficult. The aim of this study was to evaluate diagnostic values involved in conventional magnetic resonance imaging (MRI) features of MM posterior root tears (MMPRTs) and find other MRI-based findings in patients with partial MMPRTs. Methods: Eighteen patients who had arthroscopically confirmed partial MMPRTs were included. As a control, 18 patients who underwent partial meniscectomy for other types of MM tears were evaluated. Isolated partial MMPRTs were classified into the following three types: type A, accurate partial stable tear (cleavage < 1/2 of root width); type B, bridged unstable root tear (cleavage ≥ 1/2 of root width); type C, complex horn tear expanded to the root. Conventional MRI-based findings of MMPRTs were evaluated between two groups (n = 23). Posterior root irregularity, bone marrow spot, and ocarina-like appearance showing several condensed circles in triangular meniscal horn (ocarina sign) were also evaluated. Results: Posterior root irregularity and bone marrow spot were frequently observed in the partial MMPRTs (47.8%), compared with the other MM tears (P = 0.007 and 0.023, respectively). The ocarina sign was detected in 69.6% of patients with partial MMPRTs. A significant difference between two groups was observed in a positive ratio of ocarina sign (P < 0.001). Types A, B, and C of the partial tear/damage were observed in three, eight, and seven patients, respectively. The ocarina sign was the most common MRI finding in each type of partial MMPRT. Conclusions: This study demonstrated that a characteristic MRI finding, “ocarina sign,” was frequently observed in patients with partial tear/damage of the MM posterior root. The ocarina sign was the most common MRI finding in several types of partial MMPRTs. Our results suggest that the ocarina sign may be useful to diagnose unnoticed partial MMPRTs. Level of evidence: IV, retrospective comparative study.

Clinical evaluation of suture materials for transtibial pullout repair of medial meniscus posterior root tear

( Takaaki Hiranaka ),( Takayuki Furumatsu ),( Yuki Okazaki ),( Keisuke Kintaka ),( Yusuke Kamatsuki ),( Ximing Zhang ),( Haowei Xue ),( Masanori Hamada ),( Toshifumi Ozaki ) 대한슬관절학회 2022 대한슬관절학회지 Vol.34 No.-

Background: There are no recommendations for specific suture materials in transtibial pullout repair of medial meniscus posterior root tears. This study aimed to evaluate the clinical outcomes of transtibial pullout repair of medial meniscus posterior root tears using ultrahigh-molecular-weight polyethylene sutures and suture tape. Methods: We retrospectively reviewed the data of 36 patients (27 women and 9 men, mean age 64.1 years) who had undergone transtibial pullout repair of medial meniscus posterior root tears between November 2018 and December 2019. Two groups of 18 patients each received either two different cord-like sutures or suture tape. Clinical parameters were assessed preoperatively and on second-look arthroscopy (mean postoperative period 12 months). The meniscal healing status was assessed using a previously published scoring system (ranging from 0 to 10), and the incidence rate of suture cut-out was assessed on second-look arthroscopy. Results: All clinical scores significantly improved in both groups, with no significant between-group differences on second-look arthroscopy. The arthroscopic meniscal healing scores significantly differed between sutures (mean 6.7 points) and suture tape (mean 7.4 points; p = 0.044). No significant between-group difference in the suture cutout rate was observed. Conclusions: This study found no significant differences in the clinical outcomes between ultrahigh-molecularweight polyethylene sutures and suture tape. Favorable clinical outcomes were obtained using both types of suture; however, the usefulness of suture tape appears to be limited.

Second-Look Arthroscopic Assessment and Clinical Results of Modified Pull-Out Suture for Posterior Root Tear of the Medial Meniscus

( Jin Ho Cho ),( Jae Gwang Song ) 대한슬관절학회 2014 대한슬관절학회지 Vol.26 No.2

Purpose: To identify the structural integrity of the healing site after arthroscopic repair of a posterior root tear of the medial meniscus by second-look arthroscopy and to determine the clinical relevance of the findings. Materials and Methods: From January 2005 to December 2010, 20 consecutive patients underwent arthroscopic modified pull-out suture repair for a posterior root tear of the medial meniscus. Thirteen patients were available for second-look arthroscopic evaluation. The healing status of the medial meniscus was classified as complete healing, lax healing, scar tissue healing, and failed healing. We evaluated the correlation between the clinical symptoms and second-look arthroscopic findings. Clinical evaluation was based on the Lysholm knee scores and Hospital for Special Surgery (HSS) scores. Results: There were 4 cases of complete healing, 4 lax healing, 4 scar tissue healing, and 1 failed healing. The healing status of the repaired meniscus appeared to be related to the clinical symptoms. Patients who achieved complete tissue healing had no complaint. The healing status exhibited no relationship with age, mechanical axis, degree of subluxation, and symptom duration. The mean Lysholm score improved from 34.7 preoperatively to 75.6 at follow-up and the mean HSS score also significantly increased from 33.5 to 82.2. Conclusions: We achieved 4 complete and 8 partial healing (lax or scar) of the medial meniscus in this retrospective case series of posterior horn meniscus root repairs performed by 1 surgeon. Further research is needed to clarify why all patients showed clinical improvement despite findings of partial healing on second-look arthroscopy.

내측 반월상 연골판 후방 골 기시부 파열의 관절경적 봉합술 후 최소 1년 추시 결과

이철형 ( Chul Hyung Lee ),송인수 ( In Soo Song ),정현윤 ( Hyun Yoon Jeong ),이창수 ( Chang Soo Lee ),이봉주 ( Bong Ju Lee ) 대한스포츠의학회 2011 대한스포츠의학회지 Vol.29 No.1

This study is to evaluate clinical and arthroscopic second-look results of arthroscopic repairs of posterior root tears of medial meniscus which may cause loss of circumferential hoop tension and extrusion of meniscus. From October 2006 to May 2009, fifty-eight patients (59 knees) underwent arthroscopic pull-out repairs. Clinical results were evaluated using Hospital for Special Surgery (HSS) score and International Knee Documentation Committee (IKDC) score for 12-month follow-up. Second-look arthroscopy was done to evaluate meniscal healing in 21 cases. Magnetic resonance imaging (MRI) was performed to assess status of repaired meniscus and tibial tunnel position in 9 patients. Average preoperative HSS score and IKDC score of 59 cases were 69.5 and 36.0, respectively. Average postoperative HSS score and IKDC score of 59 cases had been changed into 90.3 (p<0.001) and 66.8 (p<0.001), respectively. Second-look arthroscopies revealed complete or incomplete healing except one case. Two patients showed increased one grade according to the Kellgren-Lawrence radiologic classification system and others showed no change. Of 9 patients who performed MRI, six patients showed complete healing. The average position of tibial tunnel was 4.8 mm anterior and 5.7 mm medial to center of posterior cruciate ligament. Arthroscopic pull-out repair technique using transtibial tunnel seems to be simple and effective procedure for posterior root tear of medial meniscus. Further evaluation of arthroscopic repair of posterior root tear of medial meniscus should be needed to prove the effectiveness on the prevention of osteoarthritis of knee.

Modified Pull-out Suture in Posterior Root Tear of the Medial Meniscus: Using a Posteromedial Portal

( Jin Ho Cho ) 대한슬관절학회 2012 대한슬관절학회지 Vol.24 No.2

In cases with root tear of the medial meniscus posterior horn, the meniscus usually can be repaired by a pull out suture technique. However, there is difficulty in manipulating a suture hook via the anteromedial portal and looking through the arthroscopic camera via anterolateral portal in the narrow medial joint space at the same time. This article describes a modified simple pull out suture technique for root tear of the medial meniscus posterior horn using a posteromedial portal that provides a safe and easy handling of the suture hook. Our indications of this technique used in patients with Outerbridge 1-2 arthritic change and minimal varus axis change. Benefits of this technique are simple, less invasive, and reduced operation time by simultaneous suture with a hook via posteromedial portal and pulling of a string with grasper. It may reduce the possibility of an additional chondral or meniscal injury.

Preliminary diagnosis of medial meniscus posterior root tears using the Rosenberg radiographic view

( Yuya Kodama ),( Takayuki Furumatsu ),( Yusuke Kamatsuki ),( Takaaki Hiranaka ),( Tomohiro Takahata ),( Masayuki Sadakane ),( Haruhiko Ikuta ),( Masaharu Yasumitsu ),( Toshifumi Ozaki ) 대한슬관절학회 2019 대한슬관절학회지 Vol.31 No.1

Purpose: To verify the effectiveness of detecting medial meniscus posterior root tears (MMPRTs) using weightbearing posterior-anterior (PA) radiographs. Materials and methods: Twenty-three patients were diagnosed with an MMPRT using magnetic resonance imaging (Group A), with 23 matched individuals forming the control group (Group B). The distance between medial tibial eminence and the lateral edge of the medial femoral condyle (MTE-MFC distance) and medial joint space (MJS) width were measured on weight-bearing PA radiographs, with the knee flexed at 45° (Rosenberg view). Absolute medial meniscus extrusion (MME) was measured on magnetic resonance images. Results: The MTE-MFC distance was greater and the MJS width was smaller in Group A than Group B (7.7 ± 1.7mm versus 6.0 ± 1.24mm and 3.2 ± 0.8mm versus 4.5 ± 0.7 mm, respectively; P < 0.05). The MTE-MFC distance and MJS width correlated with MME (r = 0.603 and 0.579, respectively; P < 0.05), and the extent of MME was greater in Group A than Group B (4.1 ± 1.1 mm versus 1.8 ± 1.5 mm, respectively; P < 0.05). Conclusions: MMPRTs increase the MTE-MFC distance and decrease the MJS width, with these measurements correlating to the MME. Therefore, measurement of the MTE-MFC distance and MJS width on the Rosenberg view could be a useful preliminary method for the diagnosis of an MMPRT. Level of evidence: IV

Second-Look Arthroscopic Assessment and Clinical Results of Modified Pull-Out Suture for Posterior Root Tear of the Medial Meniscus

조진호,송재광 대한슬관절학회 2014 대한슬관절학회지 Vol.26 No.2

Purpose: To identify the structural integrity of the healing site after arthroscopic repair of a posterior root tear of the medial meniscus by second-look arthroscopy and to determine the clinical relevance of the findings. Materials and Methods: From January 2005 to December 2010, 20 consecutive patients underwent arthroscopic modified pull-out suture repair for a posterior root tear of the medial meniscus. Thirteen patients were available for second-look arthroscopic evaluation. The healing status of the medial meniscus was classified as complete healing, lax healing, scar tissue healing, and failed healing. We evaluated the correlation between the clinical symptoms and second-look arthroscopic findings. Clinical evaluation was based on the Lysholm knee scores and Hospital for Special Surgery (HSS) scores. Results: There were 4 cases of complete healing, 4 lax healing, 4 scar tissue healing, and 1 failed healing. The healing status of the repaired meniscus appeared to be related to the clinical symptoms. Patients who achieved complete tissue healing had no complaint. The healing status exhibited no relationship with age, mechanical axis, degree of subluxation, and symptom duration. The mean Lysholm score improved from 34.7 preoperatively to 75.6 at follow-up and the mean HSS score also significantly increased from 33.5 to 82.2. Conclusions: We achieved 4 complete and 8 partial healing (lax or scar) of the medial meniscus in this retrospective case series of posterior horn meniscus root repairs performed by 1 surgeon. Further research is needed to clarify why all patients showed clinical improvement despite findings of partial healing on second-look arthroscopy.

Modified Pull-out Suture in Posterior Root Tear of the Medial Meniscus: Using a Posteromedial Portal

조진호 대한슬관절학회 2012 대한슬관절학회지 Vol.24 No.2

In cases with root tear of the medial meniscus posterior horn, the meniscus usually can be repaired by a pull out suture technique. However, there is difficulty in manipulating a suture hook via the anteromedial portal and looking through the arthroscopic camera via anterolateral portal in the narrow medial joint space at the same time. This article describes a modified simple pull out suture technique for root tear of the medial meniscus posterior horn using a posteromedial portal that provides a safe and easy handling of the suture hook. Our indications of this technique used in patients with Outerbridge 1-2 arthritic change and minimal varus axis change. Benefits of this technique are simple, less invasive, and reduced operation time by simultaneous suture with a hook via posteromedial portal and pulling of a string with grasper. It may reduce the possibility of an additional chondral or meniscal injury.

Meniscus extrusion is a predisposing factor for determining arthroscopic treatments in partial medial meniscus posterior root tears

( Takayuki Furumatsu ),( Keisuke Kintaka ),( Naohiro Higashihara ),( Masanori Tamura ),( Koki Kawada ),( Haowei Xue ),( Toshifumi Ozaki ) 대한슬관절학회 2023 대한슬관절학회지 Vol.35 No.-

Background Patients with partial medial meniscus posterior root tears (MMPRTs) sometimes require arthroscopic pullout repair because of their intolerable/repeated knee pains and continuous disturbance in gait during activities of daily living. However, the predisposing factors for future knee surgery in patients with partial MMPRTs remain unclear. We compared the findings of magnetic resonance imaging (MRI) between patients who underwent pullout repair and nonoperative management following partial MMPRTs. Methods Twenty-five patients who required arthroscopic repair for partial MMPRTs and 23 patients who were managed nonoperatively were evaluated during a mean follow-up period of 27.1 months. Sex, age, height, body weight, body mass index, duration from onset to initial MRI, MRI findings, and medial meniscus (MM) extrusion were compared between the two groups. Linear regression analysis was used to assess the correlation between MM extrusion and duration from onset to MRI examination. Results No significant differences were observed between the pullout repair and nonoperative management groups in terms of patient demographics and the positive ratio of MRI-based root tear signs. However, absolute MM extrusion in the pullout repair group (3.49 ± 0.82 mm) was larger than that in the nonoperative management group (2.48 ± 0.60 mm, P < 0.001). Extrusion of the MM ( > 3 mm) was detected more frequently in the pullout repair group than in the nonoperative management group (P < 0.001). The odds ratio in the pullout repair and MM extrusion > 3 mm cases was 9.662. Linear regression analysis revealed a fair correlation between the duration from onset to MRI and MM extrusion only in the pullout repair group (0.462 mm/month increase in MM extrusion). Conclusions This study demonstrated that more severe MM extrusions were observed in the pullout repair group than in the nonoperative management group. Major extrusion (> 3 mm) was also observed more in the pullout repair group than in the nonoperative group. Assessing MM extrusion and its severity can help determine a valid treatment for patients with partial MMPRTs. Level of evidence IV, Retrospective comparative study.

One-year clinical outcomes of pullout suture repair of medial meniscus posterior root tear using a knotless anchor and a modified Mason-Allen stitch

Young-­Jin Seo,Yon-Sik Yoo,Si Young Song,In Sung Kim,Chan Hyeok Kim,Yoon Sang Kim,Seong-Wook Jang 대한정형외과 스포츠의학회 2014 Arthroscopy and Orthopedic Sports Medicine Vol.1 No.1

Background: The purpose of the present study was to investigate clinical and radiological outcomes of pullout suture repair of medial meniscus posterior root (MMPR) tear using a knotless anchor and a modified Mason-Allen stitch in terms of physical assessment, functional score and radiological Kellgren-Lawrence grade. Methods: Eighteen consecutive patients were treated using an arthroscopic meniscal root repair technique. The average follow-up period was 15 ± 6.5 months (range, 13 to 32 months). There were 7 men and 11 women, and their mean age was 52.2 years (range, 43 to 60 years). Under the vision of the posterior trans-septal portal, the modified Mason-Allen stitch was applied to MMPR repair and the limbs of the two separate sutures were secured outside of the joint using knotless anchor. For postoperative clinical evaluation, joint line tenderness test, McMurray test, Lysholm knee scoring scale, Oxford knee score and visual analogue scale (VAS) were used. Radiological evaluation was performed using magnetic resonance imaging (MRI) and the Kellgren-Lawrence grading system. Results: The tenderness over the medial joint line and positive McMurray test demonstrated in all patients preoperatively were observed in 9 patients (50%) and 5 patients (28%) postoperatively (P = 0.023, P < 0.001, respectively). The average postoperative Lysholm score, Oxford score, VAS score were significantly increased compared to the preoperative values (P < 0.001). Postoperative Kellgren-Lawrence grades showed no significant difference from the preoperative values. Among eight patients in which postoperative MRI was performed, six patients exhibited complete healing and continuity at the previous tear site. Meanwhile, incomplete healing and some continuity within the posterior meniscal root lesion were found in two patients. Conclusion: Our study demonstrated that pullout repair of MMPR tears using a knotless anchor and a modified Mason-Allen stitch provides a wide field of vision for optimal tibial tunneling without the risk of iatrogenic cartilage damage, facilitates firm and effective fixation, and produces satisfying clinical outcomes.