Clinical and Radiological Outcomes after Radial Tear Repair of the Meniscus
Authors: Saloum Mohamed Labib Amin Abdelfattah , Ghazaly Sherif Ahmed El , Sobhy Mohamed Hassan , Awad Mohamed Elsayed 
Published: November 2024

Abstract

Background
Radial meniscal tears cut through the longitudinal collagen bundles that extend from the free edge to the periphery, running perpendicular to the meniscal axis and tibial plateau. They, by default, contains an element extending to white-white and red-white zones. This is why they were once considered a non repairable tear and not capable of healing and they were usually menisectomized. Radial tears were found in 15% of patients with meniscal tears. Additionally, they were detected in 7% of arthroscopy-detected meniscal tears in patients with a preoperative diagnosis of knee OA and/or chronic meniscal tears. They are equivalent to total meniscectomy in terms of increasing focal contact pressure and excessive stress concentration and meniscal extrusion. Moreover, we know that the peripheral 1/3 of a meniscus has a blood supply adequate enough to bring healing nutrients to the area of the tear. Therefore, it was always assumed that only tears within the outer 1/3 of a meniscus would heal once they are repaired. Recent research has shown that tears with little blood supply are still capable of healing after they have been sutured.

Methods
From September 2020 to March 2023, we performed a prospective case series on 15 patients reviewed in our institutions hospital by history taking, trauma mode, clinical examination, magnetic resonance imaging, and subjective scores (Lysholm and International Knee Documentation Committee (IKDC)) to describe the functional and radiological outcome of radial meniscal tear repair with two horizontal suture configurations. All selected 15 patients had radial meniscal tears, with a mean time between injury and surgery is 2 month. All patients met the inclusion criteria, all cases are evaluated clinically and by the same examiner. The mean duration of follow up was 19.5 months(ranging from 18 to 28 months). Full history and clinical examination was done for all patients, followed by X-rays and MRI if needed. All patients were assessed regarding pain, ROM, IKDC, Lysholm, score and radiological outcomes. Postoperative complications were recorded. The evaluation was done preoperatively and each time of follow up with a minimum period of 18 months.

Results
Our study included 15 patients with radial meniscal tears who underwent arthroscopic repair either with outside in or all-inside technique. Our results showed improved clinical scores of the repair either with medial or lateral menisci. No differences were found in results with concomitant ACL tears or the use of fibrin clots. Also, different repair techniques did not show significant difference in functional outcomes. All patients had significant improvement in functional outcomes. Functional outcomes included functional scores and ROM. Regarding functional scores, we assessed IKDC and lysholm score prior to surgery, 6 months and 18 months following surgery. At 18 months follow up, we found significant improvement in all patients in both IKDC and lysholm score (p value of 0.025 and 0.023 respectively) and the mean difference of both sores measured 41.8 and 36.1 respectively. Most of the patients showed most of the improvement in IKDC and Lysholm scores at the first 6 months (mean difference between 0 and 6 months 40.92 and 34.2 respectively). Also, ROM and Joint line tenderness improved for 14 patients at 6 months postoperative. There was 1 patient who was 31 years old and had PHMM injury that was repaired using all-inside technique but showed persistent knee pain and limited ROM. MRI was done and it showed high signal intensity at the site of injury with no signs of healing. Therefore, we re-operated this patient after 7 months and his second look arthroscopy revealed no signs of healing and menisectomy was done. At 18 months follow up, ROM and JLT were improved.

Conclusion
Patients underwent arthroscopic repair of radial meniscal tears showed good short term functional outcomes. Being able to return to their previous level of activity with preservation of the meniscus.