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Preoperative Knee Bone Marrow Edema Is Associated With Poor Clinical Outcomes Following Posterior Medial Meniscal
Annika N Hiredesai1, Sailesh V Tummala2, Joseph C Brinkman2
1Mayo Clinic Alix School of Medicine, Scottsdale, Arizona, U.S.A.
Purpose:
To determine if preoperative femoral or tibial bone marrow edema (BME) is indicative of higher rates of re-tear and conversion to total knee arthroplasty (TKA) after posterior medial meniscal root tear repair, and, secondarily, whether preoperative BME impacted patient-reported outcome measures and rates of infection and arthrofibrosis.
Methods:
Patients that underwent posterior medial meniscal root tear repair between 2013 and 2021 with a 2-year minimum follow-up were retrospectively analyzed. Primary outcome measures included re-tears and TKA conversion. Secondary outcomes included International Knee Documentation Committee (IKDC) score and Lysholm score, infection, and arthrofibrosis. Cohort-specific minimally clinically important difference and Patient Acceptable Symptomatic Scale rates were calculated. Two-tailed t-tests, Wilcoxon rank-sum tests, and Fisher's exact tests were used where appropriate.
Results:
The study population consisted of 97 knees (74 without BME [NBME], 23 with BME) with average follow-up of 38.9 months (24-68). Preoperatively, the NBME group had higher IKDC scores (P = .008). Postoperatively, the NBME group had higher IKDC scores at 6 months, 1 year, and 2 years (84.5 [6.0] vs 68.5 [11.0]) (P = .041, <.001, <.001). IKDC minimally clinically important difference rates were not significantly different between groups at all follow-ups. Patient Acceptable Symptomatic Scale rates were higher for the NBME group at 1-year and final follow-up (100.0% vs 60.9%) (P < .001 for both). Lysholm scores were higher for the NBME group at 1-year and final follow-up (84.0 [5.6] vs 74.6 [12.8]) (P = .019 and .008, respectively). Re-tear occurred in 17.4% of the BME group and 0% of the NBME group (P = .003). TKA conversion rates were 21.7% in the BME group and 2.7% in the NBME group (P = .008). There was no difference in arthrofibrosis or infection rates.
Conclusions:
Preoperative BME in patients undergoing posterior medial meniscal root tear repair is associated with higher rates of recurrent meniscal root tearing and conversion to TKA in addition to lower subjective IKDC and Lysholm scores compared to patients without preoperative BME.
Level Of Evidence:
Level III, retrospective prognostic case control series.
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