ISAKOS Congress 2021

2021 ISAKOS Biennial Congress Paper

 

Degenerative Medial Meniscus Tear With a Displaced Flap Into the Meniscotibial Recess and Tibial Peripheral Reactive Bone Edema Presents Good Results With Arthroscopic Surgical Treatment

Camilo P. Helito, MD, PhD, São Paulo, SP BRAZIL
Paulo Helito, MD, São Paulo, SP BRAZIL
Marcel F. Sobrado, MD, São Paulo, SP BRAZIL
Pedro N. Giglio, MD, São Paulo, SP BRAZIL
Tales Mollica Guimarães, MD, São Paulo, São Paulo BRAZIL
José R. Pécora, Prof., São Paulo, SP BRAZIL
Riccardo Gomes Gobbi, MD, PhD, São Paulo, SP BRAZIL
Marcelo Bordalo-Rodrigues, MD, São Paulo BRAZIL
bruno vande berg, MD, louvain BELGIUM

University of São Paulo, São Paulo, São Paulo, BRAZIL

FDA Status Cleared

Summary

Arthroscopic surgical treatment of degenerative medial meniscal tears with a meniscal flap displaced into the meniscotibial recess and adjacent focal bone edema in the tibia shows good results in approximately 80% of cases. Smoking and KL grade 2 were associated with poor prognosis. The treatment of such lesions should be considered separately from the spectrum of degenerative meniscus lesions

Abstract

Purpose

To report the arthroscopic treatment results of a degenerative medial meniscus tear with a displaced flap into the meniscotibial recess, tibial peripheral reactive bone edema and focal knee medial pain.

Methods

From 2012 to 2018 patients who had this specific meniscus pathology that underwent arthroscopic surgical treatment were retrospectively evaluated. Patients with diffuse pain, previous knee surgeries, inflammatory diseases, concomitant surgical procedures and Kellgren- Lawrence (KL) classification greater than 2 were excluded. Patient demographic data, KL classification, the presence of an Outerbridge grade III or IV chondral lesion of the medial compartment, limb alignment, body mass index (BMI), and smoking were evaluated. The subjective outcomes included the International Knee Documentation Committee (IKDC) score, improvement in the pain reported by patients, and the Global Perceived Effect (GPE) scale score.

Results

A total of 69 patients were evaluated. The mean age was 58.6 ± 7.1 years. The follow-up time was 48.7 ± 20.8 months. Fifty-five (79.7%) patients reported pain improvement. The postoperative IKDC was 62.6 ± 15.4, and the mean GPE was 2.3 ± 2.6. Fourteen patients (20.3%) showed no improvement in pain and seven patients (10.2%) presented complications. Groups that improved (GPE >0) and not improved (GPE<0) did not present differences regarding age, sex, follow-up time, chondral lesions, or BMI. Patients without improvement had a higher incidence of smoking (p=0.001), varus alignment (p=0.008), and more advanced KL classification (p< 0.001). In the multivariate analysis based on the GPE score, KL classification (p=0.038) and smoking (p=0.003) were significant.

Conclusion

Arthroscopic surgical treatment of degenerative meniscal tears with a meniscal flap displaced into the meniscotibial recess and adjacent focal bone edema in the tibia shows good results in approximately 80% of cases. Smoking and KL grade 2 were factors associated with poor prognosis of surgical treatment.
Level of evidence: Level IV (case series)

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