Meniscal Root Tears: Take the time to fix them and which ones I - - PowerPoint PPT Presentation

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Sep 23, 2023 773 likes •887 views

Meniscal Root Tears: Take the time to fix them and which ones I dont. MARC LABB, M.D. CHIEF OF SURGERY HOUSTON METHODIST THE WOODLANDS HOSPITAL What is the big deal?! Root tear disrupts meniscal hoop Posterior Root

SLIDE 1

Meniscal Root Tears: Take the time to fix them and which ones I don’t.

MARC LABBÉ, M.D. CHIEF OF SURGERY HOUSTON METHODIST THE WOODLANDS HOSPITAL

SLIDE 2

What is the big deal?!

Root tear disrupts meniscal

“hoop”

Posterior
Root disruption = complete

meniscectomy

Posteromedial repair restores

“hoop”

Posterolateral repair is better

than tear but not normal

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SLIDE 3

When to expect them

Older 40+

Medial
Minor trauma or degenerative
SPONK 80%
Associated chondromalacia
Popping with squatting
Posterior pain

Younger >40

Lateral
ACL tears
8% with ACL tear
0.8% without ACL tear

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SLIDE 4

56yo. with 3 mo. pain fails shot and PT

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SLIDE 5

Radial root tear with Grade 2-3 changes chondromalacia

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SLIDE 6

How to make a decision

Radial (Type 1) – Debride

majority

Consider repair with age and

tear extension into vascular zones

Complete Tear (Types 2-5)
Repair with age and

chondromalacia

40-45 yo. = relative cutoff

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SLIDE 7

Outcomes

Medial

Feucht

Lysholm 52 to 86
K-L Grade 84% no progression of OA
Healed 62%
Partial healing 34%
Failure to heal 3%

Chung

Compare partial meniscectomy & repair
Both had incr. K-L but repair less
35% conversion rate to TKA in

meniscectomy group

Lateral

Ahn
25 patients, 18 mo f/u
Good clinical and MRI resuls
LaPrade
50 patients (15 lateral)
No lateral failures
6.7% reoperation (<50 yo. medial repairs)
Outcomes improved regardless of M/L or

age under/over 50 yo.

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SLIDE 8

Rehabilitation

Non-weight bearing 6 weeks than progress to full WB
0-90 deg. Motion 0-2 weeks than full ROM
No closed-chain strength exercises in flexion > 70 deg. for 6 mo.
Full rehab. after 6 months and progress to sport

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SLIDE 9

THANK YOU

Resources

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Repair: Why, When and How? Davide Edoardo Bonasia, Pietro Pellegrino, Andrea D’Amelio,UmbertoCottino, and Roberto Rossi

Bhatia S, LaPrade CM, Ellman MB, LaPrade RF. Meniscal root

tears: significance, diagnosis, and treatment. Am J Sport Med

2014. 42:3016-30.
Acta Orthop. 2016 Oct; 87(5): 452–458. PMCID: PMC5016902

Posterior meniscal root injuries A comprehensive review from anatomy to surgical treatment Gilbert Moatshe, Jorge Chahla, Erik Slette, Lars Engebretsen, and Robert F Laprade

LaPrade CM, James EW, Cram TR, Feagin JA, Engebretsen L,

LaPrade RF. Meniscal Root Tears: A Classification System Based on Tear Morphology. American Journal of Sports Medicine. 2014: Vol 43 (2): 363-369.

Hein CN, Deperio JG, Ehrensberger MT, Marzo JM. Effects of

medial meniscal posterior horn avulsion and repair on meniscal

displacement. Knee 2011;18:189-92.
Stärke C, Kopf S, Lippisch R, et al. Tensile forces on repaired

medial meniscal root tears. Arthroscopy 2013;29:205-12.

Knee. 2009 Jan;16(1):77-80. Epub 2008 Oct 18. Arthroscopic all

inside repair of the lateral meniscus root tear. Ahn JH1, Lee YS, Chang JY, Chang MJ, Eun SS, Kim SM.

Am J Sports Med. 2017 Mar;45(4):884-891. Epub 2016 Dec 5.

Posterior Meniscal Root Repairs: Outcomes of an Anatomic Transtibial Pull-Out Technique. LaPrade RF Matheny LM, Moulton SG, James EW, Dean CS.

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