Transtibial repair in medial meniscus root avulsions; 2 years clinical results

INTRODUCTION: Medial meniscus posterior root avulsion injuries exhibited a similar extent of increasing contact pressure and decreasing contact area, as that in the total meniscectomized knee and resulting articular cartilage loss in medial compartment of the knee joint. Although partial meniscectomy is the traditional treatment in symptomatic posterior root avulsions, this method can not restore cartilage loss. The recommended surgical treatment for posterior root avulsions is repair in non degenerated knees. PATIENTS AND METHODS: Arthroscopic transtibial repair was performed in 11 patients who were diagnosed as symptomatic posterior root avulsions with clinical examination and magnetic resonance imaging findings and minimum 2 years results were evaluated. There were 8 women and 3 men, and the mean age of the patients were 51 (46-58). The mean time interval between injury and surgery was 4 weeks (5 days and 8 weeks). Conservative treatment was given to all of patients except one, and surgical treatment was performed for patients whose mechanical sypmtoms and pain weren’t relieved at the end of conservative treatment. The repair method was arthroscopic pull-out technique with fixation of the posterior attachment area through a tibial tunnel. Walking 4-6 weeks non-weight bearing with two crutches and physical treatment was given that includes muscle strengthening and range of motion exercises. Patients were evaluated with preoperative and 2 years postoperative Lysholm knee scores, clinical examination and radiographic changes. RESULTS: Mean Lysholm scores were increased preoperative from 55 to postoperative 86 that was found statictically significant. In ten patients complaints were resolved after surgical treatment and daily living began normally after surgery. In one patient arthroscopic partial meniscectomy was done due to rerupture after five months from index surgery. In two patients medial joint space narrowing was found radiologically at the end of two years but there were no clinical complaints. CONCLUSIONS: Repair must be considered in symptomatic medial meniscus posterior root avulsions also in older age if there is no degenerative osteoarthritis. The root tear that has similar effects as total meniscectomy will cause cartilage loss if not treated.