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Long-term Outcomes of Partial Meniscectomy for Degenerative Medial Meniscus Posterior Root Tears
Abhinav Lamba1, Christina Regan1, Bruce A Levy1
1Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Background:
Previous studies have demonstrated that medial meniscus posterior root tear (MMPRT) repair is superior to debridement in terms of patient-reported outcomes, rates of conversion to total knee arthroplasty (TKA), and long-term costs. Despite the known poor midterm outcomes, there is a paucity of long-term results of partial meniscectomy for degenerative MMPRTs.
Purpose:
To 1) evaluate long-term patient-reported and radiographic outcomes of patients who underwent partial medial meniscectomy (PMM) for MMPRTs, and 2) determine the rate of and risk factors for conversion to total knee TKA.
Study Design:
Case series; Level of evidence, 4.
Methods:
A previously identified cohort of 26 patients treated with partial meniscectomy for isolated MMPRTs between 2005 and 2013 was prospectively followed for long-term outcomes at a minimum 10-year follow-up. Patients were evaluated for International Knee Documentation Committee (IKDC) outcome score, reoperation, and conversion to TKA. Failure was defined as conversion to arthroplasty or a severely abnormal IKDC subjective score <75.4.
Results:
This study included 26 patients (10 men, 16 women; mean age, 54 ± 8.7 years [range, 38-71 years] at diagnosis; body mass index, 32.9 ± 5.5) who were followed for a mean of 14.0 ± 3.6 years (range, 10.1-19.6 years). At the final follow-up, 1 patient was deceased and 18 (72%) of the remaining 25 patients had progressed to TKA, with 1 (4%) patient undergoing repeat meniscectomy. The 6 (24%) patients who had not progressed to TKA or revision surgery reported a mean IKDC score of 57 ± 23. Nineteen patients underwent subsequent surgery and 5 demonstrated severely abnormal IKDC scores resulting in a clinical failure rate of 96% (24 of the 25 living patients) at a mean 14-year follow-up.
Conclusion:
PMM for medial meniscus posterior horn root tears demonstrated 72% progression to TKA and 96% failure according to subjective clinical outcomes at a minimum 10-year follow-up.
Insights
Partial medial meniscectomy for medial meniscus posterior root tears leads to high rates of total knee arthroplasty (TKA) and poor long-term outcomes. This study highlights the significant failure rate of this procedure over a decade.
Area of Science:
- Orthopedic Surgery
- Knee Biomechanics
- Regenerative Medicine
Background:
- Medial meniscus posterior root tears (MMPRTs) are a significant knee injury.
- Previous research indicates MMPRT repair surpasses debridement for patient outcomes and cost-effectiveness.
- Long-term data on partial meniscectomy for degenerative MMPRTs remains limited.
Purpose of the Study:
- To assess long-term patient-reported and radiographic outcomes following partial medial meniscectomy (PMM) for MMPRTs.
- To determine the incidence and risk factors for conversion to total knee arthroplasty (TKA) after PMM.
Main Methods:
- A cohort of 26 patients with isolated MMPRTs treated with PMM between 2005-2013 was prospectively followed.
- Long-term outcomes were evaluated at a minimum 10-year follow-up, including International Knee Documentation Committee (IKDC) scores, reoperation, and TKA.
- Clinical failure was defined as TKA conversion or a severely abnormal IKDC subjective score (<75.4).
Main Results:
- The study included 26 patients (mean age 54 years) followed for a mean of 14 years.
- At follow-up, 72% of patients (18 of 25 living) progressed to TKA, with 4% undergoing repeat meniscectomy.
- The clinical failure rate was 96% (24 of 25 living patients), with a mean IKDC score of 57 ± 23 in those not converted to TKA.
Conclusions:
- Partial medial meniscectomy for medial meniscus posterior root tears demonstrates a high rate of progression to TKA (72%) at long-term follow-up.
- The procedure is associated with a 96% clinical failure rate based on subjective outcomes at a minimum 10-year follow-up.
- These findings underscore the suboptimal long-term efficacy of PMM for degenerative MMPRTs.
