Meniscal Centralization Improves Outcomes and Limits Extrusion After Medial Meniscus Posterior Root Repair: A Systematic Review
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Logan D Moews1,2, Gabriella O'Connor1,2, Parker A Cavendish1,2
1Department of Orthopaedic Surgery and Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A.
Purpose:
To systematically evaluate patient-reported outcomes, radiographic outcomes, and complications after medial meniscus posterior root repair augmented with meniscal centralization.
Methods:
A systematic search of PubMed, Embase, and Scopus was conducted to identify clinical studies reporting outcomes after medial meniscus posterior root tear repair with concomitant centralization. Extracted outcomes included patient-reported outcome measures, medial meniscal extrusion, osteoarthritis progression, and complications. Study quality was assessed using the Methodological Index for Non-Randomized Studies criteria and the Cochrane risk-of-bias 2 tool. Owing to heterogeneity, results were synthesized qualitatively.
Results:
Six studies encompassing 148 patients (mean age 55.6 years, range, 50.1-62.1 years; follow-up 19.8 months, range, 7.0-35.0 months) met inclusion criteria. All studies reported significant improvements in patient-reported outcome measures after combined root repair and centralization. Lysholm scores improved by 21.1 to 42.3 points, International Knee Documentation Committee scores increased by 24.1 points, Tegner activity scores improved by 0.5 to 4.0 points, and visual analog scale pain scores decreased by 1.7 to 3.1 points. Radiographically, 5 of 6 studies showed that postoperative medial meniscal extrusion reduced to below 3 mm, whereas 1 randomized controlled trial reported increased extrusion despite centralization, although the increase was significantly smaller than isolated root repair. Minimal progression of Kellgren-Lawrence grades was observed at short- to mid-term follow-up. Reported complications were infrequent and included 1 repair failure (6.7%), 1 case of arthrofibrosis requiring manipulation under anesthesia (4.0%), and 2 conversions to total knee arthroplasty (7.7%).
Conclusions:
Medial meniscus posterior root repair augmented with meniscal centralization is associated with meaningful improvements in patient-reported outcomes, generally effective control of meniscal extrusion, minimal short-term osteoarthritic progression, and a low complication rate. Although results are promising, conclusions are limited by study heterogeneity and the paucity of comparative trials.
Level Of Evidence:
Level IV, systematic review of Level II to IV studies.