Increased extrusion and ICRS grades at 2-year follow-up following transtibial medial meniscal root repair evaluated by MRI

Knee Surg Sports Traumatol Arthrosc. 2018 Sep;26(9):2826-2834. doi: 10.1007/s00167-017-4755-8. Epub 2017 Nov 2.


Purpose: The purpose of the current study was to evaluate the short-term results of meniscal root repair surgery, assessing clinical and radiographic outcomes, utilizing MRI to assess root healing and extent of post-operative extrusion.

Methods: This was a single-center, retrospective study evaluating patients who had undergone a medial meniscus posterior root repair using a transtibial pullout technique with two locking cinch sutures. Demographic data were collected from patient charts. Clinical outcomes were assessed with pre- and post-operative IKDC and Lysholm scores. Pre-op scores were taken at the patients' initial clinical visit, mean 1.55 months prior to surgery (± 1.8 months, min 0.3, max 7.3). Radiographic outcomes were assessed with MRI evaluation of root healing, meniscal extrusion, and cartilage degeneration using ICRS criteria. Tunnel placement was evaluated and compared to the anatomic footprint.

Results: Eighteen patients (47.2 years ± 11.9) were evaluated at mean follow-up of 24.9 months (± 7.2, min 18.4, max 35.6). The IKDC score significantly increased from 45.9 (± 12.6) pre-operatively to 76.8 (± 14.7) post-operatively (p < 0.001). Lysholm scores also increased from 50.9 (± 7.11) to 87.1 (± 9.8) (p < 0.001). Mean tunnel placement was 5.3 mm (± 3.5, range 0-11.8) away from the anatomic footprint. Mean extrusion increased from 4.74 mm (± 1.7) pre-operatively to 5.98 (± 2.8) post-operatively (p < 0.02). No patients with > 3 mm of extrusion on pre-operative MRI had < 3 mm of extrusion on post-operative MRI. Both medial femoral condyle and medial tibial plateau ICRS grades worsened significantly (p < 0.02 and p < 0.01, respectively). On MRI, one root appeared completely healed, 16 partially healed, and one not healed.

Conclusion: Patients treated with the transtibial suture pull-out technique with two locking cinch sutures had improved clinical outcomes, but only partial healing in the majority of cases, increased extrusion, and progression of medial compartment cartilage defect grade on follow-up MRI. Patients should be counseled that although clinical outcomes in the short term may be optimistic, long-term outcomes regarding progression to degenerative arthritis may not be as predictable.

Clinical level of evidence: III.

Keywords: Meniscal root repair outcomes; Meniscus; Meniscus root; Meniscus root outcomes; Meniscus root repair; Meniscus tear; Root; Transtibial tunnel outcomes.

MeSH terms

  • Adolescent
  • Adult
  • Arthroscopy
  • Cartilage Diseases / pathology
  • Female
  • Follow-Up Studies
  • Humans
  • Knee / diagnostic imaging
  • Magnetic Resonance Imaging
  • Male
  • Menisci, Tibial / surgery*
  • Middle Aged
  • Osteoarthritis / pathology
  • Postoperative Period
  • Retrospective Studies
  • Suture Techniques
  • Tibial Meniscus Injuries / surgery*
  • Young Adult