2025 ISAKOS Congress in Munich, Germany

2025 ISAKOS Biennial Congress Paper


Investigation of Tibial Bone Marrow Lesion Associated with Medial Meniscus Posterior Root Tear

Yuhei Otsuki, MD, Kobe JAPAN
Takehiko Matsushita, MD, PhD, Kobe, Hyogo JAPAN
Takeo Tokura, MD, Kobe, Hyogo JAPAN
Yuta Nakanishi, MD, PhD, Kobe, Hyogo JAPAN
Tetsuya Yamamoto, MD, PhD, Kobe, Hyogo JAPAN
Kyohei Nishida , MD, PhD, Kobe, Hyogo JAPAN
Kanto Nagai, MD, PhD, Kobe, Hyogo JAPAN
Noriyuki Kanzaki, MD, PhD, Kobe, Hyogo JAPAN
Yuichi Hoshino, MD, PhD, Kobe, Hyogo JAPAN
Ryosuke Kuroda, MD, PhD, Kobe, Hyogo JAPAN

Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, JAPAN

FDA Status Not Applicable

Summary

The study investigated tibial bone marrow lesions (BMLs) in medial meniscus posterior root tear (MMPRT). Results showed a higher incidence of BML, subchondral insufficiency fractures of the knee joint (SIFK), and meniscotibial ligament (MTL) injury in MMPRT patients. BMLs were predominantly found in the antero-medial tibial plateau. MMPRT was also linked to larger medial meniscal extrusion (MME).

Abstract

【Introduction】
Medial meniscus posterior root tear (MMPRT) often compromises the hoop stress of the medial meniscus, which is sometimes associated with the rapid progression of osteoarthritis (OA) of the medial compartment of the knee. It is widely known that bone marrow lesion (BML) and subchondral insufficiency fracture of the knee joint (SIFK) are often seen after MMPRT. However, there are paucity of data showing its location and associated conditions. The aim of the present study was to investigate the frequency, location, and associated conditions of tibial BMLs in MMPRT
【The study design】
Retrospective case control study
【Methods】
The study included 100 patients (mean age 60.4 ± 8.8 years) diagnosed as MMPRT by magnetic resonance imaging (MRI) within six months of onset (Group M). A control group consisted of 100 patients (mean age 54.4 ± 12.9 years) diagnosed as medial meniscus tears other than MMPRT (Group C). Patients with a history of surgery or associated ligament injuries were excluded. The presence of tibial BML and SIFK, meniscotibial ligament (MTL) injury and the location of BML were assessed by MRI. To evaluate the anterior-posterior (AP) location, the coronal slice including the anterior edge of the medial collateral ligament (MCL) was defined as slice number 0, and positive numbers were assigned to the anterior slices sequentially, while negative numbers were assigned to the posterior slices. To evaluate the medial-lateral (ML) location, the medial tibial plateau was divided into three zones (Zone I, medial; Zone II, middle; Zone III, lateral). The AP and ML location of BML were recorded according to its presence on each slice. In addition, medial meniscal extrusion (MME) was measured on each coronal slice of MRI.
【Results】
The incidence ratio of BML, SIFK, and MTL injury in Group M vs those in Group C were 54% vs 31%, 14% vs 0%, and 39% vs 9%, respectively. There were statistically significant differences between the two groups in incidence ratio of the three lesions (All, p<0.05). BMLs were commonly located around slice 0 in both groups. BML in Group M tended to be observed more frequently in the anterior slices (slices 1 and 2) and in Zone I than in Group C. MME was largest at slice 1 in both groups and the average MME in Group M was significantly larger than that in Group C (4.1 mm ±1.4 m vs. 2.2 ±1.3 mm, P < 0.05 ).
【Conclusion】
Over half of the patients with MMPRT exhibited tibial BML, with lesions primarily occurring in the antero-medial regions of the medial tibial plateau. In addition, MMPRT was more frequently associated with SIFK, MTL injury and larger MME. Physicians should pay a close attention to tibial BML and associated pathological findings if MMPRT is found.