Research progress on pathological mechanism and clinical correlation between medial meniscus posterior root tear and tibial rotation_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

REN Fuji , WU Jiang ,  HUANG Jingmin

Second Ward of Sports Injuries and Arthroscopy, Tianjin Hospital (Tianjin University Hospital), Tianjin, 300211, P. R. China;

Corresponding author：

HUANG Jingmin, Email: huangjingmin@126.com

Keywords：

Medial meniscus posterior root tear; tibial rotation; pathological mechanism; clinical correlation

DOI：

10.7507/1002-1892.202311035

Video：

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Objective To summarize the current research progress on the concept, clinical presentation, diagnosis, biomechanical changes, and pathological mechanisms of the medial meniscus posterior root tear (MMPRT), and its clinical correlations with tibial rotation. Methods The research literature on MMPRT and its relationship with tibial rotation at home and abroad in recent years was extensively consulted and summarized. Results MMPRT is a specific and common type of medial meniscus injury of the knee joint. The occurrence of posterior medial pumping pain events following low-energy trauma in patients provides important clues for the diagnosis of this injury, with MRI being the preferred imaging modality. The biomechanical effects generated by MMPRT are similar to those caused by total removal of the medial meniscus. And this injury is usually associated with tibial rotation. MMPRT induces pathological external rotation of the tibia, which can be restored by timely medial meniscus posterior root repair. Furthermore, changes in tibial rotation are related to the healing status after medial meniscus posterior root repair. Conclusion MMPRT is closely related to tibial rotation. Understanding the biomechanics, pathological mechanisms, and clinical correlations between the two is of great significance for improving the diagnosis and treatment strategies.

Citation： REN Fuji, WU Jiang, HUANG Jingmin. Research progress on pathological mechanism and clinical correlation between medial meniscus posterior root tear and tibial rotation. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(3): 368-372. doi: 10.7507/1002-1892.202311035 Copy

1.	Han SB, Shetty GM, Lee DH, et al. Unfavorable results of partial meniscectomy for complete posterior medial meniscus root tear with early osteoarthritis: a 5- to 8-year follow-up study. Arthroscopy, 2010, 26(10): 1326-1332.
2.	Matheny LM, Ockuly AC, Steadman JR, et al. Posterior meniscus root tears: associated pathologies to assist as diagnostic tools. Knee Surg Sports Traumatol Arthrosc, 2015, 23(10): 3127-3131.
3.	Padalecki JR, Jansson KS, Smith SD, et al. Biomechanical consequences of a complete radial tear adjacent to the medial meniscus posterior root attachment site: in situ pull-out repair restores derangement of joint mechanics. Am J Sports Med, 2014, 42(3): 699-707.
4.	Papalia R, Vasta S, Franceschi F, et al. Meniscal root tears: from basic science to ultimate surgery. Br Med Bull, 2013, 106: 91-115.
5.	Allaire R, Muriuki M, Gilbertson L, et al. Biomechanical consequences of a tear of the posterior root of the medial meniscus. Similar to total meniscectomy. J Bone Joint Surg (Am), 2008, 90(9): 1922-1931.
6.	Furumatsu T, Okazaki Y, Okazaki Y, et al. Injury patterns of medial meniscus posterior root tears. Orthop Traumatol Surg Res, 2019, 105(1): 107-111.
7.	Carreau JH, Sitton SE, Bollier M. Medial meniscus root tear in the middle aged patient: A case based review. Iowa Orthop J, 2017, 37: 123-132.
8.	Cinque ME, Chahla J, Moatshe G, et al. Meniscal root tears: a silent epidemic. Br J Sports Med, 2018, 52(13): 872-876.
9.	Hwang BY, Kim SJ, Lee SW, et al. Risk factors for medial meniscus posterior root tear. Am J Sports Med, 2012, 40(7): 1606-1610.
10.	Okazaki Y, Furumatsu T, Kodama Y, et al. Transtibial pullout repair of medial meniscus posterior root tear restores physiological rotation of the tibia in the knee-flexed position. Orthop Traumatol Surg Res, 2019, 105(1): 113-117.
11.	Seil R, Dück K, Pape D. A clinical sign to detect root avulsions of the posterior horn of the medial meniscus. Knee Surg Sports Traumatol Arthrosc, 2011, 19(12): 2072-2075.
12.	Lee DW, Ha JK, Kim JG. Medial meniscus posterior root tear: a comprehensive review. Knee Surg Relat Res, 2014, 26(3): 125-134.
13.	LaPrade CM, Ellman MB, Rasmussen MT, et al. Anatomy of the anterior root attachments of the medial and lateral menisci: a quantitative analysis. Am J Sports Med, 2014, 42(10): 2386-2392.
14.	Chahla J, Moulton SG, LaPrade CM, et al. Posterior meniscal root repair: the transtibial double tunnel pullout technique. Arthrosc Tech, 2016, 5(2): e291-e296.
15.	James EW, Johannsen AM, Cinque ME, et al. An evidence-based approach to the diagnosis and treatment of meniscal root tears. Minerva Ortopedica e Traumatologica, 2017, 68(2): 81-90.
16.	Chung KS, Ha JK, Ra HJ, et al. A meta-analysis of clinical and radiographic outcomes of posterior horn medial meniscus root repairs. Knee Surg Sports Traumatol Arthrosc, 2016, 24(5): 1455-1468.
17.	Chung KS, Ha JK, Yeom CH, et al. Comparison of clinical and radiologic results between partial meniscectomy and refixation of medial meniscus posterior root tears: A minimum 5-year follow-up. Arthroscopy, 2015, 31(10): 1941-1950.
18.	Brophy RH, Wojahn RD, Lillegraven O, et al. Outcomes of arthroscopic posterior medial meniscus root repair: Association with body mass index. J Am Acad Orthop Surg, 2019, 27(3): 104-111.
19.	Krych AJ, Bernard CD, Kennedy NI, et al. Medial versus lateral meniscus root tears: Is there a difference in injury presentation, treatment decisions, and surgical repair outcomes? Arthroscopy, 2020, 36(4): 1135-1141.
20.	Lee DW, Moon SG, Kim NR, et al. Medial knee osteoarthritis precedes medial meniscal posterior root tear with an event of painful popping. Orthop Traumatol Surg Res, 2018, 104(7): 1009-1015.
21.	Moro-oka TA, Hamai S, Miura H, et al. Dynamic activity dependence of in vivo normal knee kinematics. J Orthop Res, 2008, 26(4): 428-434.
22.	Tanifuji O, Sato T, Kobayashi K, et al. Three-dimensional in vivo motion analysis of normal knees using single-plane fluoroscopy. J Orthop Sci, 2011, 16(6): 710-718.
23.	Vedi V, Williams A, Tennant SJ, et al. Meniscal movement. An in vivo study using dynamic MRI. J Bone Joint Surg (Br), 1999, 81(1): 37-41.
24.	Bae JH, Paik NH, Park GW, et al. Predictive value of painful popping for a posterior root tear of the medial meniscus in middle-aged to older Asian patients. Arthroscopy, 2013, 29(3): 545-549.
25.	Masuda S, Furumatsu T, Okazaki Y, et al. Medial meniscus posterior root tear induces pathological posterior extrusion of the meniscus in the knee-flexed position: An open magnetic resonance imaging analysis. Orthop Traumatol Surg Res, 2018, 104(4): 485-489.
26.	Stärke C, Kopf S, Lippisch R, et al. Tensile forces on repaired medial meniscal root tears. Arthroscopy, 2013, 29(2): 205-212.
27.	Sasaki K, Neptune RR. Individual muscle contributions to the axial knee joint contact force during normal walking. J Biomech, 2010, 43(14): 2780-2784.
28.	Shirazi R, Shirazi-Adl A, Hurtig M. Role of cartilage collagen fibrils networks in knee joint biomechanics under compression. J Biomech, 2008, 41(16): 3340-3348.
29.	Hasegawa M, Chin T, Oki S, et al. Effects of methods of descending stairs forwards versus backwards on knee joint force in patients with osteoarthritis of the knee: a clinical controlled study. Sports Med Arthrosc Rehabil Ther Technol, 2010, 2: 14.
30.	Marsh CA, Martin DE, Harner CD, et al. Effect of posterior horn medial meniscus root tear on in vivo knee kinematics. Orthop J Sports Med, 2014, 2(7): 2325967114541220.
31.	Harner CD, Mauro CS, Lesniak BP, et al. Biomechanical consequences of a tear of the posterior root of the medial meniscus. Surgical technique. J Bone Joint Surg (Am), 2009, 91 Suppl 2: 257-270.
32.	Okazaki Y, Furumatsu T, Kodama Y, et al. Medial meniscus posterior root repair influences sagittal length and coronal inclination of the anterior cruciate ligament: a retrospective study. Eur J Orthop Surg Traumatol, 2023, 33(4): 1255-1262.
33.	Hiranaka T, Furumatsu T, Okazaki Y, et al. Postoperative external tibial rotation is correlated with inferior meniscal healing following pullout repair of a medial meniscus posterior root tear. Knee Surg Sports Traumatol Arthrosc, 2022, 30(4): 1491-1498.
34.	Kodama Y, Furumatsu T, Kamatsuki Y, et al. Preliminary diagnosis of medial meniscus posterior root tears using the Rosenberg radiographic view. Knee Surg Relat Res, 2019, 31(1): 9.
35.	Okamura H, Ishikawa H, Ohno T, et al. Potential of the non-weight-bearing tunnel view in diagnosing medial meniscus posterior root tear: a pilot study of X-ray characteristics. J Exp Orthop, 2021, 8(1): 99.
36.	Kamatsuki Y, Furumatsu T, Fujii M, et al. Complete tear of the lateral meniscus posterior root is associated with meniscal extrusion in anterior cruciate ligament deficient knees. J Orthop Res, 2018, 36(7): 1894-1900.
37.	Hiranaka T, Furumatsu T, Okazaki Y, et al. Bilateral anterior cruciate ligament tear combined with medial meniscus posterior root tear. Acta Med Okayama, 2019, 73(6): 523-528.
38.	Chernchujit B, Prasetia R. Both posterior root lateral-medial meniscus tears with anterior cruciate ligament rupture: the step-by-step systematic arthroscopic repair technique. Arthrosc Tech, 2017, 6(5): e1937-e1943.
39.	Kim YJ, Kim JG, Chang SH, et al. Posterior root tear of the medial meniscus in multiple knee ligament injuries. Knee, 2010, 17(5): 324-328.
40.	LaPrade RF, Ho CP, James E, et al. Diagnostic accuracy of 3.0 T magnetic resonance imaging for the detection of meniscus posterior root pathology. Knee Surg Sports Traumatol Arthrosc, 2015, 23(1): 152-157.
41.	Willinger L, Athwal KK, Holthof S, et al. Role of the anterior cruciate ligament, anterolateral complex, and lateral meniscus posterior root in anterolateral rotatory knee instability: A biomechanical study. Am J Sports Med, 2023, 51(5): 1136-1145.
42.	Papageorgiou CD, Gil JE, Kanamori A, et al. The biomechanical interdependence between the anterior cruciate ligament replacement graft and the medial meniscus. Am J Sports Med, 2001, 29(2): 226-231.

1. Han SB, Shetty GM, Lee DH, et al. Unfavorable results of partial meniscectomy for complete posterior medial meniscus root tear with early osteoarthritis: a 5- to 8-year follow-up study. Arthroscopy, 2010, 26(10): 1326-1332.
2. Matheny LM, Ockuly AC, Steadman JR, et al. Posterior meniscus root tears: associated pathologies to assist as diagnostic tools. Knee Surg Sports Traumatol Arthrosc, 2015, 23(10): 3127-3131.
3. Padalecki JR, Jansson KS, Smith SD, et al. Biomechanical consequences of a complete radial tear adjacent to the medial meniscus posterior root attachment site: in situ pull-out repair restores derangement of joint mechanics. Am J Sports Med, 2014, 42(3): 699-707.
4. Papalia R, Vasta S, Franceschi F, et al. Meniscal root tears: from basic science to ultimate surgery. Br Med Bull, 2013, 106: 91-115.
5. Allaire R, Muriuki M, Gilbertson L, et al. Biomechanical consequences of a tear of the posterior root of the medial meniscus. Similar to total meniscectomy. J Bone Joint Surg (Am), 2008, 90(9): 1922-1931.
6. Furumatsu T, Okazaki Y, Okazaki Y, et al. Injury patterns of medial meniscus posterior root tears. Orthop Traumatol Surg Res, 2019, 105(1): 107-111.
7. Carreau JH, Sitton SE, Bollier M. Medial meniscus root tear in the middle aged patient: A case based review. Iowa Orthop J, 2017, 37: 123-132.
8. Cinque ME, Chahla J, Moatshe G, et al. Meniscal root tears: a silent epidemic. Br J Sports Med, 2018, 52(13): 872-876.
9. Hwang BY, Kim SJ, Lee SW, et al. Risk factors for medial meniscus posterior root tear. Am J Sports Med, 2012, 40(7): 1606-1610.
10. Okazaki Y, Furumatsu T, Kodama Y, et al. Transtibial pullout repair of medial meniscus posterior root tear restores physiological rotation of the tibia in the knee-flexed position. Orthop Traumatol Surg Res, 2019, 105(1): 113-117.
11. Seil R, Dück K, Pape D. A clinical sign to detect root avulsions of the posterior horn of the medial meniscus. Knee Surg Sports Traumatol Arthrosc, 2011, 19(12): 2072-2075.
12. Lee DW, Ha JK, Kim JG. Medial meniscus posterior root tear: a comprehensive review. Knee Surg Relat Res, 2014, 26(3): 125-134.
13. LaPrade CM, Ellman MB, Rasmussen MT, et al. Anatomy of the anterior root attachments of the medial and lateral menisci: a quantitative analysis. Am J Sports Med, 2014, 42(10): 2386-2392.
14. Chahla J, Moulton SG, LaPrade CM, et al. Posterior meniscal root repair: the transtibial double tunnel pullout technique. Arthrosc Tech, 2016, 5(2): e291-e296.
15. James EW, Johannsen AM, Cinque ME, et al. An evidence-based approach to the diagnosis and treatment of meniscal root tears. Minerva Ortopedica e Traumatologica, 2017, 68(2): 81-90.
16. Chung KS, Ha JK, Ra HJ, et al. A meta-analysis of clinical and radiographic outcomes of posterior horn medial meniscus root repairs. Knee Surg Sports Traumatol Arthrosc, 2016, 24(5): 1455-1468.
17. Chung KS, Ha JK, Yeom CH, et al. Comparison of clinical and radiologic results between partial meniscectomy and refixation of medial meniscus posterior root tears: A minimum 5-year follow-up. Arthroscopy, 2015, 31(10): 1941-1950.
18. Brophy RH, Wojahn RD, Lillegraven O, et al. Outcomes of arthroscopic posterior medial meniscus root repair: Association with body mass index. J Am Acad Orthop Surg, 2019, 27(3): 104-111.
19. Krych AJ, Bernard CD, Kennedy NI, et al. Medial versus lateral meniscus root tears: Is there a difference in injury presentation, treatment decisions, and surgical repair outcomes? Arthroscopy, 2020, 36(4): 1135-1141.
20. Lee DW, Moon SG, Kim NR, et al. Medial knee osteoarthritis precedes medial meniscal posterior root tear with an event of painful popping. Orthop Traumatol Surg Res, 2018, 104(7): 1009-1015.
21. Moro-oka TA, Hamai S, Miura H, et al. Dynamic activity dependence of in vivo normal knee kinematics. J Orthop Res, 2008, 26(4): 428-434.
22. Tanifuji O, Sato T, Kobayashi K, et al. Three-dimensional in vivo motion analysis of normal knees using single-plane fluoroscopy. J Orthop Sci, 2011, 16(6): 710-718.
23. Vedi V, Williams A, Tennant SJ, et al. Meniscal movement. An in vivo study using dynamic MRI. J Bone Joint Surg (Br), 1999, 81(1): 37-41.
24. Bae JH, Paik NH, Park GW, et al. Predictive value of painful popping for a posterior root tear of the medial meniscus in middle-aged to older Asian patients. Arthroscopy, 2013, 29(3): 545-549.
25. Masuda S, Furumatsu T, Okazaki Y, et al. Medial meniscus posterior root tear induces pathological posterior extrusion of the meniscus in the knee-flexed position: An open magnetic resonance imaging analysis. Orthop Traumatol Surg Res, 2018, 104(4): 485-489.
26. Stärke C, Kopf S, Lippisch R, et al. Tensile forces on repaired medial meniscal root tears. Arthroscopy, 2013, 29(2): 205-212.
27. Sasaki K, Neptune RR. Individual muscle contributions to the axial knee joint contact force during normal walking. J Biomech, 2010, 43(14): 2780-2784.
28. Shirazi R, Shirazi-Adl A, Hurtig M. Role of cartilage collagen fibrils networks in knee joint biomechanics under compression. J Biomech, 2008, 41(16): 3340-3348.
29. Hasegawa M, Chin T, Oki S, et al. Effects of methods of descending stairs forwards versus backwards on knee joint force in patients with osteoarthritis of the knee: a clinical controlled study. Sports Med Arthrosc Rehabil Ther Technol, 2010, 2: 14.
30. Marsh CA, Martin DE, Harner CD, et al. Effect of posterior horn medial meniscus root tear on in vivo knee kinematics. Orthop J Sports Med, 2014, 2(7): 2325967114541220.
31. Harner CD, Mauro CS, Lesniak BP, et al. Biomechanical consequences of a tear of the posterior root of the medial meniscus. Surgical technique. J Bone Joint Surg (Am), 2009, 91 Suppl 2: 257-270.
32. Okazaki Y, Furumatsu T, Kodama Y, et al. Medial meniscus posterior root repair influences sagittal length and coronal inclination of the anterior cruciate ligament: a retrospective study. Eur J Orthop Surg Traumatol, 2023, 33(4): 1255-1262.
33. Hiranaka T, Furumatsu T, Okazaki Y, et al. Postoperative external tibial rotation is correlated with inferior meniscal healing following pullout repair of a medial meniscus posterior root tear. Knee Surg Sports Traumatol Arthrosc, 2022, 30(4): 1491-1498.
34. Kodama Y, Furumatsu T, Kamatsuki Y, et al. Preliminary diagnosis of medial meniscus posterior root tears using the Rosenberg radiographic view. Knee Surg Relat Res, 2019, 31(1): 9.
35. Okamura H, Ishikawa H, Ohno T, et al. Potential of the non-weight-bearing tunnel view in diagnosing medial meniscus posterior root tear: a pilot study of X-ray characteristics. J Exp Orthop, 2021, 8(1): 99.
36. Kamatsuki Y, Furumatsu T, Fujii M, et al. Complete tear of the lateral meniscus posterior root is associated with meniscal extrusion in anterior cruciate ligament deficient knees. J Orthop Res, 2018, 36(7): 1894-1900.
37. Hiranaka T, Furumatsu T, Okazaki Y, et al. Bilateral anterior cruciate ligament tear combined with medial meniscus posterior root tear. Acta Med Okayama, 2019, 73(6): 523-528.
38. Chernchujit B, Prasetia R. Both posterior root lateral-medial meniscus tears with anterior cruciate ligament rupture: the step-by-step systematic arthroscopic repair technique. Arthrosc Tech, 2017, 6(5): e1937-e1943.
39. Kim YJ, Kim JG, Chang SH, et al. Posterior root tear of the medial meniscus in multiple knee ligament injuries. Knee, 2010, 17(5): 324-328.
40. LaPrade RF, Ho CP, James E, et al. Diagnostic accuracy of 3.0 T magnetic resonance imaging for the detection of meniscus posterior root pathology. Knee Surg Sports Traumatol Arthrosc, 2015, 23(1): 152-157.
41. Willinger L, Athwal KK, Holthof S, et al. Role of the anterior cruciate ligament, anterolateral complex, and lateral meniscus posterior root in anterolateral rotatory knee instability: A biomechanical study. Am J Sports Med, 2023, 51(5): 1136-1145.
42. Papageorgiou CD, Gil JE, Kanamori A, et al. The biomechanical interdependence between the anterior cruciate ligament replacement graft and the medial meniscus. Am J Sports Med, 2001, 29(2): 226-231.

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