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