Current Reviews in Musculoskeletal Medicine: Current Controversies for Treatment of Meniscus Root Tears |
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Authors: | Dustin R. Lee Anna K. Reinholz Sara E. Till Yining Lu Christopher L. Camp Thomas M. DeBerardino Michael J. Stuart Aaron J. Krych |
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Affiliation: | 1.Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA ;2.Department of Orthopaedics, Joe R. and Teresa Lozano Long School of Medicine, UT Health San Antonio, San Antonio, TX USA |
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Abstract: | Purpose of ReviewThe role of the meniscus in preserving the biomechanical function of the knee joint has been clearly defined. The hypothesis that meniscus root integrity is a prerequisite for meniscus function is supported by the development of progressive knee osteoarthritis (OA) following meniscus root tears (MRTs) treated either non-operatively or with meniscectomy. Consequently, there has been a resurgence of interest in the diagnosis and treatment of MRTs. This review examines the contemporary literature surrounding the natural history, clinical presentation, evaluation, preferred surgical repair technique and outcomes.Recent FindingsSurgeons must have a high index of suspicion in order to diagnose a MRT because of the nonspecific clinical presentation and difficult visualization on imaging. Compared with medial MRTs that commonly occur in middle age/older patients, lateral meniscus root injuries tend to occur in younger males with lower BMIs, less cartilage degeneration, and with concomitant ligament injury. Subchondral insufficiency fractures of the knee have been found to be associated with both MRTs and following arthroscopic procedures. Meniscus root repair has demonstrated good outcomes, and acute injuries with intact cartilage should be repaired. Cartilage degeneration, BMI, and malalignment are important considerations when choosing surgical candidates. Meniscus centralization has emerged as a viable adjunct strategy aimed at correcting meniscus extrusion.SummaryMeniscus root repair results in a decreased rate of OA and arthroplasty and is economically advantageous when compared with nonoperative treatment and partial meniscectomy. The transtibial pull-through technique with the addition of centralization for the medial meniscus is associated with encouraging early results. |
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Keywords: | Knee cartilage Meniscus root tear Meniscus extrusion Meniscus root repair Transtibial pull-through Subchondral insufficiency fractures of the knee |
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