poster title: outcomes of arthroscopic all-inside meniscal ......lateral meniscus root tears...

Poster Number: 62 Poster Title: Outcomes of Arthroscopic All-Inside Meniscal Root Repair versus Observation in Older Patients

Jason L. Dragoo, MD, Jaclyn A. Konopka, MD, Roberto A. Guzman, BS, Nicole Segovia, BS, Abdurrahman Kandil, MD, and George P. Pappas, MD PhD Investigation performed at the Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, California, US

DisclosureInformation

Grant/Research Support �  Arthrex and Smith & Nephew Consultant �  DePuy/ Medical Device Business Services,

Exactech, RTI Surgical, Zimmer Biomet, Arthrex, and Bioventus

Other � Arthrex, Stryker, and Zimmer Biomet

Background

� Meniscusroottears(MRTs)leadtode-tensioningofthemeniscusandincreasedcontactforcesandcartilagedamage

� MRTscanhavenegativeeffectsonkneehealthandfunctionduetothelossofthesecriticalfunctions

� MedialMRTsoccurinabimodaldistribution;acuteroottearstypicallyoccurinyoungerathletesduringhyperflexionofthekneeversusacute-on-chronictears,whichtypicallyoccurinolderpatientswithmoderateosteoarthritis

� Managementofolderpatientswithroottearsiscontroversial,andtheefficacyofdifferenttreatmentoptionsisunclear

Purpose

�  Tocomparetheclinicaloutcomesofpatientswithmoderateosteoarthritiswhoundergoanall-insidemeniscusrootrepairtechniqueversusnonoperativemanagementforeithermedialorlateralmeniscusroottears

MaterialsandMethods

�  Patientsdiagnosedwithaposteriormeniscusroottearwhounderwentarthroscopicrepair(AR:30knees)ornonoperativetreatmentwithobservation(O:18knees)werefollowedforaminimumof2years(meanfollow-up,4.4years)

�  Thearthroscopicrepairincludedall-insidesuturestoreducetherootbacktoitsremnant(reductionsutures),therebyre-tensioningthemeniscus,and1mattresssuturetostrengthentherepairbyreapproximatingtheconstructtotheposteriorcapsule

�  Thedatacollectedincluded�  KneeinjuryandOsteoarthritisOutcomeScore(KOOS)�  Lysholm�  Tegner�  VeteransRAND12-ItemHealthSurvey(VR-12)PhysicalComponentSummary(PCS)

�  MentalComponentSummary(MCS)scores�  Conversiontototalkneearthroplasty(TKA)

Figure1

Results

� Medialmeniscusroottearscomprised80.0%oftheARgroupand77.8%oftheOgroup

�  TheaverageKellgrenLawrencegradewas2inbothgroups

�  ThebaselinescoresfortheKOOSSymptomssubscalewerelowerforAR(50.2619.3)thanforO(66.5616.1)(P=.003),asweretheKOOSKnee-RelatedQualityofLifescores(AR,26.7616.1;O,39.6622.1)(P=.046)

Table1

Results

�  Nodifferenceswerefoundbetweengroupsfortheabsolutevaluesatfollow-upexceptthatfollow-upTegnerscoreswerelowerintheOgroupthanintheARgroup(P=.004)

�  SignificantimprovementswereseenintheARgroupfrombaselinetoultimatefollow-upinthefollowing

�  AverageKOOSsubscalescores(P=.001)�  Lysholmscores(P=.001)�  Tegnerscores(P=.0002)�  VR-12PCSscores(P=.001)

�  SignificantimprovementswereseenintheOgroupfrombaselinetoultimatefollow-upinthefollowing

�  AverageKOOSPain(P=.003)�  KOOSFunctioninDailyLiving(P=.006)�  VR-12PCS(P=.038)

Table2

Table3

Results

�  ComparedwiththeOgroup,theARgrouphadasignificantlylargerimprovementfrombaselinetofollow-upin

�  AverageKOOSPain(P=.009)�  KOOSSymptoms(P=.029)�  Lysholmscores(P=.016)

�  Duringfollow-up,3.3%oftheARgroupunderwentaTKAcomparedwith33.3%oftheOgroup(P=.008)

�  ThehazardratioofTKAconversionwas93.2%lowerfortheARgroupcomparedwiththeOgroup(P=.013)

Figure2

�  All-insidemedialorlateralmeniscusrootrepairshowedimprovedfunctionaloutcomesanddecreasedTKAconversionratescomparedwithnonoperativetreatmentandmaybeconsideredasatreatmentoptionforthemanagementofmeniscusroottearsinolderpatientswithmoderateosteoarthritis.

Conclusion