Prognostic Factors on Preoperative MRI for Patient-Reported Outcomes After Posterior Medial Meniscus Root Repair

Overview

Journal Orthop J Sports Med

Specialty Orthopedics

Date 2024 Aug 21

PMID 39165327

Authors

Sergio E Flores

Rawee Manatrakul

Christopher Anigwe

Chotigar Ngarmsrikam

Brian T Feeley

C Benjamin Ma

Thomas M Link

Drew A Lansdown

Affiliations

Soon will be listed here.

Abstract

Background: Repair of posterior medial meniscus root (PMMR) tears has demonstrated favorable outcomes and may prevent rapid progression of knee osteoarthritis; however, there is a paucity of data regarding prognostic factors affecting postoperative outcomes.

Purpose/hypothesis: The purpose of this study was to identify factors on preoperative magnetic resonance imaging (MRI) that predict postoperative outcomes after PMMR repair. It was hypothesized that patients with increasing levels of degenerative changes as evaluated through semiquantitative preoperative MRI scans would have worse postoperative patient-reported outcome (PRO) scores.

Study Design: Cohort study; Level of evidence, 3.

Methods: Patients who underwent PMMR repair between 2012 and 2020 and had minimum 2-year follow-up data were enrolled. Pre- and postoperative visual analog scale pain scores and postoperative PRO surveys including the Patient-Reported Outcomes Measurement Information System-Physical Function, Lysholm knee score, and Knee injury and Osteoarthritis Outcome Score (KOOS) were collected. Patients who achieved the Patient Acceptable Symptom State (PASS) on the KOOS subscales were reported. Two fellowship-trained musculoskeletal radiologists reviewed preoperative MRIs and calculated the Whole-Organ Magnetic Resonance Imaging Score for meniscus, cartilage, bone marrow edema-like lesions (BMELL), and meniscal extrusion. Statistical analysis was performed using the 2-sample test, Mann-Whitney test, and Fisher exact test for categorical variables.

Results: A total of 29 knees in 29 patients were evaluated (22 female, 7 male; mean age at surgery, 52.3 ± 9.9 years; body mass index, 27.6 ± 5.6 kg/m; mean follow-up, 59.6 ± 26.5 months). Visual analog scale for pain scores decreased significantly from preoperatively (4.9 ± 2.0) to final follow-up (1.6 ± 1.9) ( < .001), and the percentage of patients meeting the PASS ranged from 44.8% for KOOS Sport and Recreation to 72.4% for KOOS Pain and KOOS Quality of Life. Patients with medial tibial BMELL (MT-BMELL) had significantly lower KOOS Symptoms scores (76.1 ± 17.3 vs 88.4 ± 9.7 without MT-BMELL; = .032). Cartilage quality and presence of meniscal extrusion were not associated with outcomes.

Conclusion: Patients with MT-BMELL on their preoperative MRI in the setting of PMMR tear were found to have worse KOOS Symptoms scores after PMMR repair.

References

Maheshwer B, Wong S, Polce E, Paul K, Forsythe B, Bush-Joseph C . Establishing the Minimal Clinically Important Difference and Patient-Acceptable Symptomatic State After Arthroscopic Meniscal Repair and Associated Variables for Achievement. Arthroscopy. 2021; 37(12):3479-3486. DOI: 10.1016/j.arthro.2021.04.058. View

Rauscher I, Stahl R, Cheng J, Li X, Huber M, Luke A . Meniscal measurements of T1rho and T2 at MR imaging in healthy subjects and patients with osteoarthritis. Radiology. 2008; 249(2):591-600. PMC: 2657859. DOI: 10.1148/radiol.2492071870. View

Lerer D, Umans H, Hu M, Jones M . The role of meniscal root pathology and radial meniscal tear in medial meniscal extrusion. Skeletal Radiol. 2004; 33(10):569-74. DOI: 10.1007/s00256-004-0761-2. View

Ro K, Kim J, Heo J, Lee D . Clinical and Radiological Outcomes of Meniscal Repair Versus Partial Meniscectomy for Medial Meniscus Root Tears: A Systematic Review and Meta-analysis. Orthop J Sports Med. 2020; 8(11):2325967120962078. PMC: 7675875. DOI: 10.1177/2325967120962078. View

Umans H, Morrison W, DiFelice G, Vaidya N, Winalski C . Posterior horn medial meniscal root tear: the prequel. Skeletal Radiol. 2014; 43(6):775-80. DOI: 10.1007/s00256-014-1837-2. View

Kaplan D, Alaia E, Dold A, Meislin R, Strauss E, Jazrawi L . Increased extrusion and ICRS grades at 2-year follow-up following transtibial medial meniscal root repair evaluated by MRI. Knee Surg Sports Traumatol Arthrosc. 2017; 26(9):2826-2834. DOI: 10.1007/s00167-017-4755-8. View

Gorbachova T, Amber I, Beckmann N, Bennett D, Chang E, Davis L . Nomenclature of Subchondral Nonneoplastic Bone Lesions. AJR Am J Roentgenol. 2019; 213(5):963-982. DOI: 10.2214/AJR.19.21571. View

Faucett S, Geisler B, Chahla J, Krych A, Kurzweil P, Garner A . Meniscus Root Repair vs Meniscectomy or Nonoperative Management to Prevent Knee Osteoarthritis After Medial Meniscus Root Tears: Clinical and Economic Effectiveness. Am J Sports Med. 2018; 47(3):762-769. DOI: 10.1177/0363546518755754. View

Harner C, Mauro C, Lesniak B, Romanowski J . Biomechanical consequences of a tear of the posterior root of the medial meniscus. Surgical technique. J Bone Joint Surg Am. 2009; 91 Suppl 2:257-70. DOI: 10.2106/JBJS.I.00500. View

10.

Kocher M, Steadman J, Briggs K, Sterett W, Hawkins R . Reliability, validity, and responsiveness of the Lysholm knee scale for various chondral disorders of the knee. J Bone Joint Surg Am. 2004; 86(6):1139-45. DOI: 10.2106/00004623-200406000-00004. View

11.

Hancock K, Glass N, Anthony C, Hettrich C, Albright J, Amendola A . Performance of PROMIS for Healthy Patients Undergoing Meniscal Surgery. J Bone Joint Surg Am. 2017; 99(11):954-958. DOI: 10.2106/JBJS.16.00848. View

12.

Roos E, Lohmander L . The Knee injury and Osteoarthritis Outcome Score (KOOS): from joint injury to osteoarthritis. Health Qual Life Outcomes. 2003; 1:64. PMC: 280702. DOI: 10.1186/1477-7525-1-64. View

13.

Chung K, Ha J, Yeom C, Ra H, Jang H, Choi S . 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):1941-50. DOI: 10.1016/j.arthro.2015.03.035. View

14.

Feucht M, Kuhle J, Bode G, Mehl J, Schmal H, Sudkamp N . Arthroscopic Transtibial Pullout Repair for Posterior Medial Meniscus Root Tears: A Systematic Review of Clinical, Radiographic, and Second-Look Arthroscopic Results. Arthroscopy. 2015; 31(9):1808-16. DOI: 10.1016/j.arthro.2015.03.022. View

15.

Krych A, Bernard C, Kennedy N, Tagliero A, Camp C, Levy B . Medial Versus Lateral Meniscus Root Tears: Is There a Difference in Injury Presentation, Treatment Decisions, and Surgical Repair Outcomes?. Arthroscopy. 2020; 36(4):1135-1141. DOI: 10.1016/j.arthro.2019.11.098. View

16.

Moon H, Koh Y, Kim Y, Park Y, Jo S, Kwon S . 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. DOI: 10.1177/0363546511435622. View

17.

Peterfy C, Guermazi A, Zaim S, Tirman P, Miaux Y, White D . Whole-Organ Magnetic Resonance Imaging Score (WORMS) of the knee in osteoarthritis. Osteoarthritis Cartilage. 2004; 12(3):177-90. DOI: 10.1016/j.joca.2003.11.003. View

18.

Kornaat P, Kloppenburg M, Sharma R, Botha-Scheepers S, Hellio le Graverand M, Coene L . Bone marrow edema-like lesions change in volume in the majority of patients with osteoarthritis; associations with clinical features. Eur Radiol. 2007; 17(12):3073-8. PMC: 2077908. DOI: 10.1007/s00330-007-0711-1. View

19.

Joseph G, Baum T, Alizai H, Carballido-Gamio J, Nardo L, Virayavanich W . Baseline mean and heterogeneity of MR cartilage T2 are associated with morphologic degeneration of cartilage, meniscus, and bone marrow over 3 years--data from the Osteoarthritis Initiative. Osteoarthritis Cartilage. 2012; 20(7):727-35. PMC: 3595156. DOI: 10.1016/j.joca.2012.04.003. View

20.

Chung K, Ha J, Ra H, Yu W, Kim J . Root Repair Versus Partial Meniscectomy for Medial Meniscus Posterior Root Tears: Comparison of Long-term Survivorship and Clinical Outcomes at Minimum 10-Year Follow-up. Am J Sports Med. 2020; 48(8):1937-1944. DOI: 10.1177/0363546520920561. View