Summary

In patients with concomitant medial and lateral meniscus root tears, we compared patient demographics, patient-reported outcomes and survivorship of patients receiving concurrent medial and lateral meniscus root dual-repairs to patients receiving either a singular repair or no meniscal root repair at all.

Abstract

Introduction

The lateral and medial menisci play an important role in knee kinematics and form a shock absorbing layer that reduces contact forces between the tibia and femur. Meniscal root tears have received increased attention in recent years due to their impact on joint biomechanics that contribute to accelerated development of osteoarthritis and degeneration. While there are many reports discussing the efficacy of either medial or lateral individual root repairs, there is a paucity of research discussing the demographics and outcomes of concurrent medial and lateral meniscus roots with associated repairs. In patients with concomitant medial and lateral meniscus root tears, our purpose was to compare patient-reported outcomes and survivorship of patients receiving concurrent medial and lateral meniscus root dual-repairs to patients receiving either a singular repair or no meniscal root repair at all.

Methods

A retrospective review was conducted of patients who were documented to have concurrent medial and lateral meniscus root tears at a single institution (blindedforreview) from 1/1/2014 to 1/1/2022. Demographic data, repair type, and concomitant procedures were also collected. Patients <18 years old or who had previously refused to participate in research were excluded. Patient-reported outcomes (PROs) were obtained preoperatively and at minimum 2-years postoperatively. PROs included IKDC, Lysholm, WOMAC, SF-12, Tegner activity scale and patient satisfaction (1-10, 10=highest satisfaction). All subsequent ipsilateral knee surgeries were reviewed for circumstance.

Results

Minimum 2-year outcomes (subjective follow-up and/or knowledge of a subsequent surgery) were obtained for 15/18 (83%) eligible knees. Among those 15, 7 subjects received dual-repair treatment while 8 subjects received non-dual-repair treatment. The median age of the patients at the time of surgery was 57 (range:18-73), and the dual-repair group comprised of 71% male subjects whereas the non-repair-group comprised of 88% female subjects (p=0.041). The non-dual-repair group had higher instance of concomitant chondral defects compared to the dual-repair group (75% vs. 43%. p=0.315), although the difference was not significant. Two patients (29%) in the dual-repair group had an MCL tear compared to none in the non-dual-repair group, and 5 patients (63%) in the non-dual-repair group had an ACL tear compared to 3 patients (43%) in the dual-repair group. At minimum 2-year follow-up (median:3.94years), the dual-repair group attained better PRO scores than the non-dual-repair group, although it was not statistically significant. When comparing baseline and minimum 2-year follow-up PROs in dual-repair subjects, there is a statistically significant improvement in WOMAC Pain, WOMAC Function, WOMAC Total, and Lysholm scores (all p<0.05). However, the non-dual-repair group did not show significant improvement from baseline to long-term follow-up in any PROs.

Conclusion

This study investigates the rare clinical entity of concomitant medial and lateral meniscus tears which, in this small study, occurred at a mean age of 57 years, with a BMI of 23, and 60% of the time in the setting of ACL insufficiency. The dual-repair group improved significantly from baseline to follow-up in half of the PROs. Future studies should evaluate outcomes following dual-repair in large cohorts to understand the efficacy of this understudied procedure.