Time Dependent Increase in Medial Meniscus Extrusion may require Meniscal Repair in Partial Medial Meniscus Posterior Root Tears

Written By : Dr Supreeth D R |Medically Reviewed By : Dr. Kamal Kant Kohli Published On 2023-10-22T20:00:00+05:30 | Updated On 23 Oct 2023 10:27 AM IST

Koki Kawada et al conducted a study to compare medial meniscus extrusion (MME) in patients with partial medial meniscus posterior root tears (MMPRTs) through magnetic resonance imaging (MRI) conducted at two-time points and to determine whether patient characteristics or MME measurements differ in patients who respond to nonoperative treatment compared with those who require surgical treatment.

The study was conducted at Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Shikata-cho, Kita-ku, Okayama, Japan. The study has been published in ‘Indian Journal of Orthopaedics.’

Medial meniscus posterior root tears (MMPRTs) occur frequently in middle-aged adults and cause painful posteromedial popping with descending actions, such as stairs or downhill. Recently, meniscal repair has been widely performed for MMPRTs and is more effective than conservative therapy or meniscectomy in preventing cartilage damage and reducing additional surgery.

37 patients with partial MMPRTs underwent two MRI scans during nonoperative management or before pull-out repair. Among these, 17 patients received nonoperative management, and 20 underwent pull-out repair. Partial MMPRTs were diagnosed based on the MRI findings. MME measurements were performed on both MRI scans. Statistical and receiver operating curve (ROC) analyses were performed.

Key findings of the study were:

• The duration from the onset to the first MRI scan (23.2±16.1 days vs. 23.9±37.8 days, p=0.200) and the follow-up duration (22.6 ± 12.2 months vs. 25.1 ± 12.8 months, p = 0.583) were not significantly different between the two groups.

• The duration between the two MRI scans was significantly shorter in the pull-out repair group than in the nonoperative management group.

• The increase in MME (ΔMME) on MRI scans was significantly greater in the pull-out repair group than in the nonoperative management group.

• Linear regression analysis revealed a weak correlation between the MRI interval and ΔMME in the nonoperative management group and a moderate correlation in the pull-out repair group.

• In the ROC construction, the cut-off value for ΔMME that requires surgical intervention was 0.41 mm, with a sensitivity and specificity of 85.0% and 52.9%, respectively.

The authors concluded – “Patients with partial MMPRTs requiring surgical treatment had greater MME progression in a shorter time and a time-dependent increase in MME. Therefore, a ΔMME of ≥0.41 mm may be useful in deciding surgical intervention based on MRI retests.”

Level of evidence III.

MBBS, Dip. Ortho, DNB ortho, MNAMS

Dr Supreeth D R (MBBS, Dip. Ortho, DNB ortho, MNAMS) is a practicing orthopedician with interest in medical research and publishing articles. He completed MBBS from mysore medical college, dip ortho from Trivandrum medical college and sec. DNB from Manipal Hospital, Bengaluru. He has expirence of 7years in the field of orthopedics. He has presented scientific papers & posters in various state, national and international conferences. His interest in writing articles lead the way to join medical dialogues. He can be contacted at editorial@medicaldialogues.in.

Dr. Kamal Kant Kohli

Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751