Camilo Partezani Helito1, Paulo Victor Partezani Helito2, Marcel Faraco Sobrado3, Pedro Nogueira Giglio4, Tales Mollica Guimaraes4, José Ricardo Pécora4, Riccardo Gomes Gobbi4, Marcelo Bordalo Rodrigues2, Bruno Vande Berg5. 1. - Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil; - Hospital Sírio Libanês, São Paulo, Brazil. 2. - Hospital Sírio Libanês, São Paulo, Brazil; - Grupo de radiologia musculoesqueléticas, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil. 3. - Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil; - Hospital Sírio Libanês, São Paulo, Brazil. Electronic address: marcelfs@gmail.com. 4. - Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil. 5. - Université Catholique de Louvain - UCLouvain | UCLouvain · Department of Radiology and Medical Imaging - RAIM.
Abstract
PURPOSE: To report the arthroscopic treatment results of a degenerative medial meniscus tear with a displaced flap into the meniscotibial recess, tibial peripheral reactive bone edema and focal knee medial pain. As a secondary objective, we propose to identify possible factors associated with a good or poor prognosis of the surgical treatment of this lesion. METHODS: From 2012 to 2018 patients who had this specific meniscus pathology that underwent arthroscopic surgical treatment were retrospectively evaluated. Patients with Kellgren-Lawrence (KL) classification greater than 2 were excluded. KL classification, the presence of an Outerbridge grade III/V chondral lesion of the medial compartment, limb alignment, body mass index (BMI), and smoking were evaluated. The subjective outcomes included the International Knee Documentation Committee (IKDC) score, improvement in the pain reported by patients, and the Global Perceived Effect (GPE) scale score. RESULTS: A total of 69 patients were evaluated. The mean age was 58.6 ± 7.1 years. The follow-up time was 48.7 ± 20.8 months. Fifty-five (79.7%) patients reported pain improvement. The postoperative IKDC was 62.6 ± 15.4, and the mean GPE was 2.3 ± 2.6. Fourteen patients (20.3%) showed no improvement in pain and seven patients (10.2%) presented complications. Groups that improved (GPE >0) and not improved (GPE<0) did not present differences regarding age, sex, follow-up time, chondral lesions, or BMI. Patients without improvement had a higher incidence of smoking (p=0.001), varus alignment (p=0.008), and more advanced KL classification (p< 0.001). In the multivariate analysis based on the GPE score, KL classification (p=0.038) and smoking (p=0.003) were significant. CONCLUSION: Arthroscopic surgical treatment of degenerative medial meniscal tears with a meniscal flap displaced into the meniscotibial recess and adjacent focal bone edema in the tibia shows good results in approximately 80% of cases. Smoking and KL grade 2 were factors associated with poor prognosis of surgical treatment.
PURPOSE: To report the arthroscopic treatment results of a degenerative medial meniscus tear with a displaced flap into the meniscotibial recess, tibial peripheral reactive bone edema and focal knee medial pain. As a secondary objective, we propose to identify possible factors associated with a good or poor prognosis of the surgical treatment of this lesion. METHODS: From 2012 to 2018 patients who had this specific meniscus pathology that underwent arthroscopic surgical treatment were retrospectively evaluated. Patients with Kellgren-Lawrence (KL) classification greater than 2 were excluded. KL classification, the presence of an Outerbridge grade III/V chondral lesion of the medial compartment, limb alignment, body mass index (BMI), and smoking were evaluated. The subjective outcomes included the International Knee Documentation Committee (IKDC) score, improvement in the pain reported by patients, and the Global Perceived Effect (GPE) scale score. RESULTS: A total of 69 patients were evaluated. The mean age was 58.6 ± 7.1 years. The follow-up time was 48.7 ± 20.8 months. Fifty-five (79.7%) patients reported pain improvement. The postoperative IKDC was 62.6 ± 15.4, and the mean GPE was 2.3 ± 2.6. Fourteen patients (20.3%) showed no improvement in pain and seven patients (10.2%) presented complications. Groups that improved (GPE >0) and not improved (GPE<0) did not present differences regarding age, sex, follow-up time, chondral lesions, or BMI. Patients without improvement had a higher incidence of smoking (p=0.001), varus alignment (p=0.008), and more advanced KL classification (p< 0.001). In the multivariate analysis based on the GPE score, KL classification (p=0.038) and smoking (p=0.003) were significant. CONCLUSION: Arthroscopic surgical treatment of degenerative medial meniscal tears with a meniscal flap displaced into the meniscotibial recess and adjacent focal bone edema in the tibia shows good results in approximately 80% of cases. Smoking and KL grade 2 were factors associated with poor prognosis of surgical treatment.