A Study Of Medial Meniscus Posterior Root Tear In Medial Compartment Knee Osteoarthritis

Background Meniscus tear(MT)is a kind of traumatic disease that often occurs during sports.It is mainly because the meniscus gets stuck between femur and tibia due to the uncoordinated joint movement during sports,which lead the meniscus force uneven,and the meniscus fibrocartilage is finally broken.Due to anatomical reasons,the position of medial meniscus posterior root tear(MMPRT)is relatively fixed and the activity degree is relatively small,so it is more likely to occur during the movement of medial meniscus posterior root tear(MMPRT).According to the injury cause and disease course,MMPRT can be divided into traumatic/acute MMPRT and degenerative/chronic MMPRT,the latter of which is often associated with medial compartment knee osteoarthritis(MCKOA).At present,the overall treatment principle of MMPRT is to choose stepped and individualized treatment according to the patient’s age,gender,weight,risk factors,lesion site and degree.Treatments of MMPRT mainly including conservative treatment and surgical treatment.Conservative treatments mainly including drug therapy,physical therapy,moderate functional exercise and other physiotherapy.If conservative treatment is ineffective,surgical treatment can be performed by comprehensively evaluation of proper surgical indication.Surgical treatments mainly including arthroscopic partial medial meniscus resection and arthroscopic medial meniscus root repair for lower limb force line is basically normal.For abnormal force line of lower limbs,high tibial osteotomy(HTO)and medial meniscus root repair combined with HTO arthroscopy can be used.However,based on previous experience and literature reports,partial meniscectomy(PM)alone will damage the normal anatomical structure of the meniscus and increase the risk of knee degenerative changes.At present,medial posterior meniscus root repair,HTO and HTO combined posterior meniscus root repair are advocated in clinical surgical treatment,but there are still some controversies.MMPRT is correlated with a variety of factors,including lower limb negative gravity line(WBA),body mass index(BMI)and gender,which may affect the occurrence of medial meniscus root tear.When the mechanical axis of the lower limb is changed,the mechanical transmission between femur and tibia will change,so the meniscus is subjected to uneven force and prone to tear.When the meniscus is torn,the knee loses the protective effect of meniscus buffer and so on,and the risk of knee osteoarthritis(KOA)will greatly increase.This can place a burden on families and society,so research and treatment of meniscal tears could help slow the development of osteoarthritis.However,the causal relationship between degenerative MMPRT and MCKOA remains to be further explored.This topic mainly discusses the related problems of degenerative MMPRT,which is one of the hot spots in sports medicine research.This project is divided into three parts.The first part is to understand the normal anatomical structure,injury cause,injury mechanism and treatment of medial meniscus by searching relevant literature.Search keywords through Pub Med and Sciencedirect: relevant literature was obtained through [ " Meniscus " ],[ " root tear " ] or [ " Avulsion " ],and was screened by reading titles and summaries.The full text was carefully read,and the final literature was selected according to inclusion and exclusion criteria.Finally,95 literatures were selected and the full text was read to grasp the basic concept of medial meniscus tear and understand the latest progress of normal anatomical structure,injury cause,injury mechanism and treatment of medial meniscus at home and abroad.Part Ⅱ: Through the literature review and clinical observation in part I,it was found that degenerative MMPRT was more common in middle-aged and elderly patients and MCKOA.Combined with the actual situation of our hospital,the relevant data of HTO in MCKOA patients in our hospital were retrospectively analyzed,and the correlation between other factors and MMPRT was analyzed.Objective: To retrospectively analyze the relevant data of patients who underwent HTO on MCKOA in our hospital from January 1,2019 to January 30,2020,to explore the correlation between the degree of varus of force line,BMI,gender,age,MME and MMPRT.Methods: According to the inclusion and exclusion criteria,93 patients were divided into the medial posterior root tear group and 183 patients were divided into the non-tear group.Gender,age,BMI,medical history,force line,K-L grade,MME,medial osteophyte and so on were recorded for statistical analysis,with P value set at0.05.Results: There were no significant differences in gender,age,medical history and K-L grade between the two groups(P > 0.05).BMI,force line,MME and medial osteophyte size were statistically different between the two groups(P <0.05).Conclusion: MMPRT is positively correlated with BMI,varus degree of force line and MME.MME was positively correlated with varus degree of force line,size of medial osteophyte and K-L grading.Part Ⅲ: By analyzing the results of part II,the short-term clinical follow-up studies of MCKOA combined with MMPRT in our hospital were retrospectively analyzed in the simple HTO group and the root pull-out repair group combined with HTO.To explore the causal relationship between degenerative MMPRT and MCKOA,and to analyze the differences in surgical methods.Objective: To retrospectively analyze the patients with MCKOA combined with MMPRT in our hospital from January 1,2017 to January 30,2021 who underwent HTO alone and HTO combined with posterior root pull-out repair,and evaluate the imaging and clinical function scores of the two surgical schemes.Methods: According to inclusion and exclusion criteria,35 patients were divided into the HTO group and the HTO combined root pull-out repair group.Gender,age,medical history,BMI,force line,Laprade typing under arthroscopy of HKA and MMPRT,IKDC and WOMAC score were recorded,and statistical analysis was conducted.The P value is set to 0.05.Results: There were no statistically significant differences in gender,age,medical history,BMI,force line and HKA between the two groups before surgery(P >0.05).The Laprade classification under MMPRT arthroscopy had the largest proportion of type II tear(>70%).Preoperative and postoperative HKA,force line and functional score(IKDC and WOMAC score)were significantly improved in both groups,with statistical differences(P <0.05).However,there was no statistical difference between the two groups(P >0.05).Conclusion: Postoperative imaging and functional scores of MCKOA combined with MMPRT were significantly improved,while HTO combined with posterior root pull-out repair group had no obvious advantage.