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Mild to Moderate Varus Alignment in Relation to Surgical Repair of a Medial Meniscus Root Tear: A Matched-Cohort Controlled Study With 2 Years of Follow-up

Authors
 Hyun-Soo Moon  ;  Chong-Hyuk Choi  ;  Je-Hyun Yoo  ;  Min Jung  ;  Tae-Ho Lee  ;  Byeong-Hun Jeon  ;  Sung-Hwan Kim 
Citation
 AMERICAN JOURNAL OF SPORTS MEDICINE, Vol.49(4) : 1005-1016, 2021-03 
Journal Title
 AMERICAN JOURNAL OF SPORTS MEDICINE 
ISSN
 0363-5465 
Issue Date
2021-03
Keywords
arthroscopic transtibial pullout repair ; medial meniscus root tear ; prognostic factor ; varus alignment
Abstract
Background: Increased varus alignment of the lower extremity is known to be a poor prognostic factor for the surgical repair for a medial meniscus root tear (MMRT). However, given the concept of constitutional varus, which is present in a substantial portion of the normal population, the generally accepted surgical indication for MMRT concerning a varus alignment of 5° may be unnecessarily narrow. Purpose: To compare the surgical outcomes of arthroscopic transtibial pullout repair of MMRT according to the degree of varus alignment of the lower extremity. Study design: Cohort study; Level of evidence, 3. Methods: Patients who underwent isolated arthroscopic transtibial pullout repair of MMRT between January 2010 and July 2017 at one institution and had a minimum follow-up of 2 years were included in this study. Patients were classified into 1 of 2 groups: the experimental group (n = 22) included patients with a preoperative hip-knee-ankle angle between 5° and 10° varus (mild to moderate varus alignment) and the control group (n = 51) included those with a preoperative hip-knee-ankle angle <5° varus (neutral alignment). Clinical scores and radiographic parameters were compared between the groups to assess surgical outcomes, which were statistically matched for potential confounders (age, body mass index, the severity of cartilage lesion) by use of the inverse probability of treatment weighting. A noninferiority trial was performed comparing the experimental and control groups in terms of subjective outcomes (International Knee Documentation Committee subjective and Lysholm scores) and objective outcomes (postoperative medial meniscal extrusion and the rate of osteoarthritis progression). Results: There were no statistically significant differences in surgical outcomes between the groups in subjective and objective aspects, which were consistent before and after inverse probability of treatment weighting. Apart from the clinical improvement observed in both groups, overall degenerative changes in the knee were found, although progression rates did not differ between the groups. In terms of the noninferiority trial, the overall surgical outcomes in the experimental group were not inferior to those in the control group. Conclusion: The short-term surgical outcomes of arthroscopic transtibial pullout repair for MMRT of patients with mild to moderate varus alignment were not inferior to but rather comparable with those with neutral alignment in terms of subjective and objective aspects. Therefore, it would be inappropriate to exclude patients with a diagnosis of MMRT from being indicated for the surgery simply because of mild to moderate varus alignment.
Full Text
https://journals.sagepub.com/doi/10.1177/0363546520988072
DOI
10.1177/0363546520988072
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Orthopedic Surgery (정형외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Sung Hwan(김성환) ORCID logo https://orcid.org/0000-0001-5743-6241
Moon, Hyun-Soo(문현수)
Jung, Min(정민) ORCID logo https://orcid.org/0000-0002-7527-4802
Choi, Chong Hyuk(최종혁) ORCID logo https://orcid.org/0000-0002-9080-4904
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/182230
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