title: Comparison between conservative treatment and arthroscopic pull-out repair of the medial meniscus root tear and analysis of prognostic factors for the determination of repair indication.
abstract: BACKGROUND
  This study was undertaken to compare the clinical outcomes between the conservative treatment and pull-out repair of the medial meniscus root tear (MMRT), and to analyze the prognostic factors of the MMRT repair for the determination of repair indication.
  
  
  METHODS
  38 patients, diagnosed with a MMRT between August 2010 and February 2012, were retrospectively evaluated. Among these patients, 25 patients (pull-out repair group) underwent arthroscopic pull-out repair and the remaining 13 patients (conservative treatment group) underwent conservative management. Two groups were compared using the final clinical outcomes (using Tegner and Lysholm activity scale, IKDC subjective score). For the analysis of prognostic factors of the pull-out repair, patients' factors, radiologic, and magnetic resonance imaging factors were evaluated. Degrees of varus alignment (≥5°) and cartilage status (≥outerbridge III) were employed as a cut-off value in comparing the final clinical outcomes among the subgroups.
  
  
  RESULTS
  In the final clinical results, the MMRT pull-out repair group had better IKDC subjective scores (p < 0.001), Tegner and Lysholm activity scale (p = 0.017). In the MMRT pull-out repair group, mild varus knee patient achieved better clinical outcome than the severe varus knee patient (p = 0.006). And the mild cartilage degenerative patient group achieved better outcomes than the severe cartilage degenerative patient group (p = 0.009). However, there was no significant difference between the severe varus alignment group and conservative treatment group (p = 0.487). Severe cartilage changes also show no significant difference (p = 0.643).
  
  
  CONCLUSIONS
  The MMRT pull-out repair group had better clinical results than that the conservative treatment group. However, severe varus alignment and severe degeneration of cartilage status were a poor prognostic factor, and there was no significant difference between the severe varus alignment or severe cartilage change and the conservative treatment group in the clinical results. The other optional treatment could be recommended for patients who have MMRT with a severe varus knee alignment or severe cartilage.
authors.affiliation: Department of Orthopaedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul, 110-746, Republic of Korea, jha3535@naver.com.
authors.forename: Jin Hwan
authors.initials: JH
authors.lastname: Ahn
authors.forename: Hwa Jae
authors.initials: HJ
authors.lastname: Jeong
authors.forename: Yong Seuk
authors.initials: YS
authors.lastname: Lee
authors.forename: Jai Hyung
authors.initials: JH
authors.lastname: Park
authors.forename: Jae Wook
authors.initials: JW
authors.lastname: Lee
authors.forename: Jong-Hyon
authors.initials: JH
authors.lastname: Park
authors.forename: Taeg Su
authors.initials: TS
authors.lastname: Ko
mesh_terms: D000328:Adult; D000368:Aged; D001182:Arthroscopy / Q000379:methods*; D002358:Cartilage, Articular / Q000473:pathology; D005260:Female; D006801:Humans; D007718:Knee Injuries / Q000628:therapy*; D065466:Lysholm Knee Score; D008279:Magnetic Resonance Imaging; D008297:Male; D008592:Menisci, Tibial / Q000601:surgery*; D008875:Middle Aged; D063868:Patient Outcome Assessment; D026741:Physical Therapy Modalities; D011379:Prognosis; D012189:Retrospective Studies; D000070600:Tibial Meniscus Injuries