2023 ISAKOS Biennial Congress Paper
Arthroscopic Capsulodesis Decreases Meniscal Extrusion At 1 Year Follow Up When Combined With Transtibial Repair of Posteromedial Root Lesion. A Multicenter Prospective Randomized Study
Simone Perelli, MD,PhD, Barcelona SPAIN
Mario Formagnana, MD, Sandigliano ITALY
Pablo E. Gelber, MD, PhD, Barcelona SPAIN
Raúl Torres-Claramunt, PhD, Barcelona SPAIN
Rodolfo Morales-Avalos, MD, PhD., Monterrey, NL MEXICO
Daniel Pérez-Prieto, MD, Barcelona SPAIN
Joan Carles Monllau, MD, PhD, Prof., Esplugues de Llobregat, Barcelona SPAIN
Department of Surgery and Morphologic Science, Universitat Autònoma de Barcelona, Hospital del Mar - Institut CAtalá de Traumatologia i Medicina de l’Esport (I.C.A.T.M.E.), Hospital Universitari Dexeus, Barcelona, SPAIN
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Summary
Adding a capsulodesis to transtibial posteromedial root repair, we can decrease the meniscal extrusion at 1 year follow up.
Abstract
Purpose
the aim of the present study was to assess whether arthroscopic capsulodesis associated with transtibial posteromedial root repair may reduce meniscal extrusion that is frequently associated with the clinical failure of this kind of repair.
Method
a multicenter randomized prospective study including patients with isolated lesions of the posteromedial meniscal root was performed. Only root lesion of type 2 and 4 according to LaPrade classification were included. Exclusion criteria were: varus knee > 4º and joint degeneration grade > 2 according to the Kellgren-Lawrence classification, BMI > 35. Power analysis was carried out using as primary outcome the difference in meniscal extrusion: 10 patients per group were enough for a power > 80%. We included 11 patients per group considering 10% of possible dropouts. The 22 patients were randomized: in group 1 a transtibial root repair was performed, in the group 2, in addition to the same repair, an arthroscopic capsulodesis was performed. A prospective follow-up by MRI at 3,6,12 months to assess meniscal extrusion was made. All measurements were performed by two different observers. For each case, measurements were taken twice, keeping the result of the first measurement blind. Inter and intra class agreements were calculated. The meniscal extrusion was calculated in coronal images at the maximum point of extrusion. Measurement was performed drawing two lines: one vertical line intersecting the peripheral margin of the lateral tibial plateau (LTP) at the point of transition from horizontal to vertical. A second perpendicular line was drawn from the outer margin of the meniscus to the former line to measure the degree of extrusion. Additionally, when the graft was extruded less than 3 mm beyond the LTP, it was considered minor extrusion, conversely, major extrusion was considered when the meniscus more than 3 mm of subluxation.
Results
the intraclass correlation coefficient obtained was considered excellent (0.89; 95% CI: 0.84-0.92) and the high calculated k coefficient (0.78; 95% CI: 0.62-0.84) showed excellent agreement between observers. No differences were detected in preoperative meniscal extrusion (group 1 28,35 ± 11,28 mm VS group 2 27.12 ± 12,37 mm; p= 0.342). The meniscal extrusion in group 2 was lower both at 6 and 12 months postoperative (p=0.019). In both groups at 12 months, preoperative extrusion decreased (p=0.005). Preoperatively in 8 cases of group and 9 cases of group 2 presented major extrusion (p=0.965) whereas at 12 months postoperatively major extrusion was detected in 7 cases of group 1 and in 3 cases of group 2 (p=0.031).
Conclusion
Arthroscopic capsulodesis limits meniscal extrusion at 1 year follow up when associated with transtibial repair of a posteromedial root tear. Longer-term clinical follow-up is needed to understand the clinical impact of this radiological finding.