Arthroscopic Transtibial Pullout Repair for Posterior Medial Meniscus Root Tears: A Systematic Review of Clinical, Radiographic, and Second-Look Arthroscopic Results

Abstract

Purpose: To systematically review the results of arthroscopic transtibial pullout repair (ATPR) for posterior medial meniscus root tears.

Methods: A systematic electronic search of the PubMed database and the Cochrane Library was performed in September 2014 to identify studies that reported clinical, radiographic, or second-look arthroscopic outcomes of ATPR for posterior medial meniscus root tears. Included studies were abstracted regarding study characteristics, patient demographic characteristics, surgical technique, rehabilitation, and outcome measures. The methodologic quality of the included studies was assessed with the modified Coleman Methodology Score.

Results: Seven studies with a total of 172 patients met the inclusion criteria. The mean patient age was 55.3 years, and 83% of patients were female patients. Preoperative and postoperative Lysholm scores were reported for all patients. After a mean follow-up period of 30.2 months, the Lysholm score increased from 52.4 preoperatively to 85.9 postoperatively. On conventional radiographs, 64 of 76 patients (84%) showed no progression of Kellgren-Lawrence grading. Magnetic resonance imaging showed no progression of cartilage degeneration in 84 of 103 patients (82%) and showed reduced medial meniscal extrusion in 34 of 61 patients (56%). On the basis of second-look arthroscopy and magnetic resonance imaging in 137 patients, the healing status was rated as complete in 62%, partial in 34%, and failed in 3%. Overall, the methodologic quality of the included studies was fair, with a mean modified Coleman Methodology Score of 63.

Conclusions: ATPR significantly improves functional outcome scores and seems to prevent the progression of osteoarthritis in most patients, at least during a short-term follow-up. Complete healing of the repaired root and reduction of meniscal extrusion seem to be less predictable, being observed in only about 60% of patients. Conclusions about the progression of osteoarthritis and reduction of meniscal extrusion are limited by the small portion of patients undergoing specific evaluation (44% and 35% of the study group, respectively).

Level of evidence: Level IV, systematic review of Level III and IV studies.