Magnetic Resonance Imaging Evaluation of Medial Meniscal Posterior Root Tear with an Event of Painful Popping
Author(s):
Kim J. (South Korea (ROK))
Kim J. (South Korea (ROK))
Affiliations:
ESSKA Academy. Kim J. 05/09/18; 209772; P15-1267 Topic: C2 - Meniscal repair
Prof. Jin Goo Kim
Prof. Jin Goo Kim
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Abstract
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Objectives: An event of painful popping has been known as a highly predictive clinical sign of medial meniscal posterior root tears (MMPRTs) in the middle-aged to older population. However, there have been still lacks of studies about the prevalence of a painful popping event and the condition of the medial compartment at the time of popping event in MMPRTs. The purpose of the present study was to assess magnetic resonance imaging (MRI) and radiologic findings of MMPRTs with an event of painful popping within 3 weeks.

Methods: A total of 97 patients who were diagnosed as MMPRTs without concomitant injuries from March 2015 to December 2016 on MRIs were retrospectively reviewed, and 38 patients who had a single event of painful popping within 3 weeks were included. As MRI assessments, absolute medial meniscal extrusion (MME), relative percentage of extrusion (RPE), medial compartment articular cartilage loss according to modified Outerbridge scale (MOS), articulation width of medial femoral condyle (MFC) and medial tibial condyle (MTC) were measured. Mechanical axis of lower extremities and Kellgren-Lawrence (K-L) grade were assessed as radiographic data. Patients were divided into the MME > or = 3 mm (group 1, n = 20) and MME < 3 mm (group 2, n = 18), and parameters were compared between two groups.

Results: The means of MME parameters (absolute MME, RPE, MME- MFC/MTC at 0° ratio) and MOS were 2.9 ± 1.2 mm, 22.0 ± 10.3 %, 3.2 ± 1.3, and 2.1 ± 0.7. The means of mechanical axis of involved limb and uninvolved limb were varus 3.4° ± 2.6° and 3.0° ± 2.2°, respectively, and the mean of K-L grade was 1.9 ± 0.6. All MME parameters showed strong positive correlation with MOS and K-L grade. The MME parameters were significantly greater in the group 1 than group 2 (3.8 ± 0.8 mm vs. 1.9 ± 0.6 mm, 29.1 % vs. 14.5 %, and 4.2 vs. 2.1, and p < 0.001, respectively), and MME > or = 3 mm was significantly associated with MOS > or = 2 (p = 0.012). There were moderate positive correlations between RPE and MFC/MTC at 0° and MFC/MTC at 90° (p = 0.041 and 0.031).

Conclusions: More than half of MMPRTs with an event of painful popping within 3 weeks on MRIs showed that MME > or = 3mm and medial compartment articular cartilage loss with MOS > or = 2 were preexisted, supporting that medial joint degeneration preceded the event of popping. The MME > or = 3 mm showed significant association with MOS and K-L grade > or = 2.

Keywords:
Medial meniscus; Posterior meniscus root; Root tear; Meniscus root tears; Ligament degeneration; Extrusion; Popping
Objectives: An event of painful popping has been known as a highly predictive clinical sign of medial meniscal posterior root tears (MMPRTs) in the middle-aged to older population. However, there have been still lacks of studies about the prevalence of a painful popping event and the condition of the medial compartment at the time of popping event in MMPRTs. The purpose of the present study was to assess magnetic resonance imaging (MRI) and radiologic findings of MMPRTs with an event of painful popping within 3 weeks.

Methods: A total of 97 patients who were diagnosed as MMPRTs without concomitant injuries from March 2015 to December 2016 on MRIs were retrospectively reviewed, and 38 patients who had a single event of painful popping within 3 weeks were included. As MRI assessments, absolute medial meniscal extrusion (MME), relative percentage of extrusion (RPE), medial compartment articular cartilage loss according to modified Outerbridge scale (MOS), articulation width of medial femoral condyle (MFC) and medial tibial condyle (MTC) were measured. Mechanical axis of lower extremities and Kellgren-Lawrence (K-L) grade were assessed as radiographic data. Patients were divided into the MME > or = 3 mm (group 1, n = 20) and MME < 3 mm (group 2, n = 18), and parameters were compared between two groups.

Results: The means of MME parameters (absolute MME, RPE, MME- MFC/MTC at 0° ratio) and MOS were 2.9 ± 1.2 mm, 22.0 ± 10.3 %, 3.2 ± 1.3, and 2.1 ± 0.7. The means of mechanical axis of involved limb and uninvolved limb were varus 3.4° ± 2.6° and 3.0° ± 2.2°, respectively, and the mean of K-L grade was 1.9 ± 0.6. All MME parameters showed strong positive correlation with MOS and K-L grade. The MME parameters were significantly greater in the group 1 than group 2 (3.8 ± 0.8 mm vs. 1.9 ± 0.6 mm, 29.1 % vs. 14.5 %, and 4.2 vs. 2.1, and p < 0.001, respectively), and MME > or = 3 mm was significantly associated with MOS > or = 2 (p = 0.012). There were moderate positive correlations between RPE and MFC/MTC at 0° and MFC/MTC at 90° (p = 0.041 and 0.031).

Conclusions: More than half of MMPRTs with an event of painful popping within 3 weeks on MRIs showed that MME > or = 3mm and medial compartment articular cartilage loss with MOS > or = 2 were preexisted, supporting that medial joint degeneration preceded the event of popping. The MME > or = 3 mm showed significant association with MOS and K-L grade > or = 2.

Keywords:
Medial meniscus; Posterior meniscus root; Root tear; Meniscus root tears; Ligament degeneration; Extrusion; Popping
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