Meniscal extrusion consensus statement: A collaborative survey within the Meniscus International Network (MenIN) Study Group.
classification
extrusion
international
meniscus
survey
Journal
Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA
ISSN: 1433-7347
Titre abrégé: Knee Surg Sports Traumatol Arthrosc
Pays: Germany
ID NLM: 9314730
Informations de publication
Date de publication:
12 Apr 2024
12 Apr 2024
Historique:
revised:
21
03
2024
received:
21
02
2024
accepted:
02
04
2024
medline:
12
4
2024
pubmed:
12
4
2024
entrez:
12
4
2024
Statut:
aheadofprint
Résumé
The purpose of the present study was to perform a survey administered to members of the Meniscus International Network (MenIN) Study Group, seeking to delineate the most contentious aspects of meniscal extrusion classification and provide a foundation for new, more comprehensive definitions and treatments for these pathologies. MenIN Study Group is a group of international experts treating and performing research on meniscus pathology and treatment. All MenIN Study Group members were asked to complete a survey aimed at establishing criteria for the optimal classification system for meniscal extrusion. Data obtained from the completed questionnaires were transferred into a spreadsheet and then analysed. All responses are presented as counts, percentages or means. Forty-seven (85.5%) MenIN Study Group members completed the survey and were included in this analysis. Key aspects recommended for inclusion in a comprehensive classification system for meniscal extrusion included laterality (93.6%), anatomical location (76.6%), patient age (76.6%), body mass index (BMI) (68.1%) and aetiology (68.1%). For classifying meniscal extrusion, 53.2% considered the distance in millimetres from the tibial plateau's outer margin as the most reliable measurement technique on imaging. Preferences for imaging modalities varied, with 44.7% favouring weight-bearing magnetic resonance imaging (MRI) and 36.2% opting for weight-bearing ultrasound due to its greater availability. Respondents advocated for a classification system addressing stability or progression of meniscal extrusion (66%), reducibility (53.2%), potential progression of knee osteoarthritis (OA) (83%), influencing treatment approaches (83%), a gradation system (83%), consideration of dynamic factors (66%), association with clinical outcomes and prognosis (76.6%) and investigation around centralization procedures (57.4%). In conclusion, the findings of this survey shed light on the global perspectives regarding meniscal extrusion classification. It was generally felt that a new classification of extrusion measured on MRI scans at the mid-tibial plateau should be developed, which considers factors such as laterality, anatomical location, age, BMI and aetiology. Additionally, the results support the integration of dynamic factors and clinical outcomes in MRI-based classifications to inform treatment approaches. Level IV.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : None
Informations de copyright
© 2024 European Society of Sports Traumatology, Knee Surgery and Arthroscopy.
Références
Bin, S.‐I., Jeong, T.‐W., Kim, S.‐J. & Lee, D.‐H. (2016) A new arthroscopic classification of degenerative medial meniscus root tear that correlates with meniscus extrusion on magnetic resonance imaging. The Knee, 23(2), 246–250. Available from: https://doi.org/10.1016/j.knee.2015.07.003
Bloecker, K., Wirth, W., Hudelmaier, M., Burgkart, R., Frobell, R. & Eckstein, F. (2012) Morphometric differences between the medial and lateral meniscus in healthy men—a three‐dimensional analysis using magnetic resonance imaging. Cells Tissues Organs, 195(4), 353–364. Available from: https://doi.org/10.1159/000327012
Compagnoni, R., Ferrua, P., Minoli, C., Fajury, R., Ravaglia, R., Menon, A. et al. (2023) The meniscal extrusion index is a reliable indirect sign of different meniscal lesion patterns: a classification based on percentage of meniscal extrusion. Knee Surgery, Sports Traumatology, Arthroscopy, 31(11), 5005–5011. Available from: https://doi.org/10.1007/s00167-023-07525-6
Crema, M.D., Roemer, F.W., Felson, D.T., Englund, M., Wang, K., Jarraya, M. et al. (2012) Factors associated with meniscal extrusion in knees with or at risk for osteoarthritis: the multicenter osteoarthritis study. Radiology, 264(2), 494–503. Available from: https://doi.org/10.1148/radiol.12110986
Crema, M.D., Roemer, F.W., Marra, M.D., Burstein, D., Gold, G.E., Eckstein, F. et al. (2011) Articular cartilage in the knee: current MR imaging techniques and applications in clinical practice and research. Radiographics, 31(1), 37–61. Available from: https://doi.org/10.1148/rg.311105084
DePhillipo, N.N., LaPrade, R.F., Zaffagnini, S., Mouton, C., Seil, R. & Beaufils, P. (2021) The future of meniscus science: international expert consensus. Journal of Experimental Orthopaedics, 8(1), 24. Available from: https://doi.org/10.1186/s40634-021-00345-y
Englund, M., Guermazi, A., Gale, D., Hunter, D.J., Aliabadi, P., Clancy, M. et al. (2008) Incidental meniscal findings on knee MRI in middle‐aged and elderly persons. New England Journal of Medicine, 359(11), 1108–1115. Available from: https://doi.org/10.1056/NEJMoa0800777
Englund, M., Guermazi, A. & Lohmander, S.L. (2009) The role of the meniscus in knee osteoarthritis: a cause or consequence? Radiologic Clinics of North America, 47(4), 703–712. Available from: https://doi.org/10.1016/j.rcl.2009.03.003
Farivar, D., Hevesi, M., Fortier, L.M., Azua, E., LaPrade, R.F. & Chahla, J. (2023) Meniscal extrusion measurements after posterior medial meniscus root tears: a systematic review and meta‐analysis. The American Journal of Sports Medicine, 51(12), 3325–3334. Available from: https://doi.org/10.1177/03635465221131005
Farivar, D., Knapik, D.M., Vadhera, A.S., Condron, N.B., Hevesi, M., Shewman, E.F. et al. (2023) Isolated posterior lateral meniscofemoral ligament tears show greater meniscal extrusion in knee extension, and isolated posterior lateral meniscal root tears show greater meniscal extrusion at 30° using ultrasound: a cadaveric study. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 39(8), 1827–1837.e2. Available from: https://doi.org/10.1016/j.arthro.2023.02.007
Farivar, D., Knapik, D.M., Vadhera, A.S., Condron, N.B., Hevesi, M., Shewman, E.F. et al. (2023) Medial meniscal extrusion of greater than 3 millimeters on ultrasound suggests combined medial meniscotibial ligament and posterior medial meniscal root tears: a cadaveric analysis. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 39(8), 1815–1826.e1. Available from: https://doi.org/10.1016/j.arthro.2023.01.104
Gilat, R., Mitchnik, I.Y., Mimouni, T., Agar, G., Lindner, D. & Beer, Y. (2023) The meniscotibial ligament role in meniscal extrusion: a systematic review and meta‐analysis. Archives of Orthopaedic and Trauma Surgery, 143(9), 5777–5786. Available from: https://doi.org/10.1007/s00402-023-04934-7
Hiranaka, T., Furumatsu, T., Yokoyama, Y., Higashihara, N., Tamura, M., Kawada, K. et al. (2024) Weight loss enhances meniscal healing following transtibial pullout repair for medial meniscus posterior root tears. Knee Surgery, Sports Traumatology, Arthroscopy, 32(1), 143–150. Available from: https://doi.org/10.1002/ksa.12037
Ichiba, A., Ito, E. & Kino, K. (2023) Extrusion of the anterior segment of the medial meniscus extrusion initiates knee osteoarthritis: evaluation using magnetic resonance imaging. Journal of Experimental Orthopaedics, 10(1), 135. Available from: https://doi.org/10.1186/s40634-023-00693-x
Jackson, G.R., Mameri, E.S., Dzidzishvili, L., Alaia, M.J., Rodeo, S.A., Chahla, J. et al. (2024) Meniscus extrusion, radial tears, and root tears. Instructional Course Lectures, 73, 779–793.
Katz, J.N., Brophy, R.H., Chaisson, C.E., de Chaves, L., Cole, B.J., Dahm, D.L. et al. (2013) Surgery versus physical therapy for a meniscal tear and osteoarthritis. New England Journal of Medicine, 368(18), 1675–1684. Available from: https://doi.org/10.1056/NEJMoa1301408
Krych, A., Johnson, N., Mohan, R., Hevesi, M., Stuart, M., Littrell, L. et al. (2018) Arthritis progression on serial MRIs following diagnosis of medial meniscal posterior horn root tear. The Journal of Knee Surgery, 31(07), 698–704. Available from: https://doi.org/10.1055/s-0037-1607038
Krych, A.J., Bernard, C.D., Leland, D.P., Camp, C.L., Johnson, A.C., Finnoff, J.T. et al. (2020) Isolated meniscus extrusion associated with meniscotibial ligament abnormality. Knee Surgery, Sports Traumatology, Arthroscopy, 28(11), 3599–3605. Available from: https://doi.org/10.1007/s00167-019-05612-1
Langhans, M.T., Lamba, A., Saris, D.B.F., Smith, P. & Krych, A.J. (2023) Meniscal extrusion: diagnosis, etiology, and treatment options. Current Reviews in Musculoskeletal Medicine, 16(7), 316–327. Available from: https://doi.org/10.1007/s12178-023-09840-4
LaPrade, R.F., LaPrade, C.M. & Kennedy, N.I. (2023) Editorial commentary: meniscal extrusion. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 39(12), 2499–2501. Available from: https://doi.org/10.1016/j.arthro.2023.06.023
Losco, M., Familiari, F., Giron, F. & Papalia, R. (2017) Use and effectiveness of the cadaver‐lab in orthopaedic and traumatology education: an Italian survey. Joints, 05(04), 197–201. Available from: https://doi.org/10.1055/s-0037-1608949
Marzo, J.M. & Gurske‐DePerio, J. (2009) Effects of medial meniscus posterior horn avulsion and repair on tibiofemoral contact area and peak contact pressure with clinical implications. The American Journal of Sports Medicine, 37(1), 124–129. Available from: https://doi.org/10.1177/0363546508323254
Morales‐Avalos, R., Diabb‐Zavala, J.M., Mohamed‐Noriega, N., Vilchez‐Cavazos, F., Perelli, S. & Padilla‐Medina, J.R. et al. (2023) Effect of injury to the lateral meniscotibial ligament and meniscofibular ligament on meniscal extrusion: biomechanical evaluation of the capsulodesis and centralization techniques in a porcine knee model. Orthopaedic Journal of Sports Medicine, 11(11), 23259671231212856. Available from: https://doi.org/10.1177/23259671231212856
Nguyen, J.C., De Smet, A.A., Graf, B.K. & Rosas, H.G. (2014) MR Imaging–based Diagnosis and Classification of Meniscal Tears. Radiographics, 34(4), 981–999. Available from: https://doi.org/10.1148/rg.344125202
Nogueira‐Barbosa, M.H., Gregio‐Junior, E., Lorenzato, M.M., Guermazi, A., Roemer, F.W., Chagas‐Neto, F.A. et al. (2015) Ultrasound assessment of medial meniscal extrusion: a validation study using MRI as reference standard. American Journal of Roentgenology, 204(3), 584–588. Available from: https://doi.org/10.2214/AJR.14.12522
Rao, A.J., Erickson, B.J., Cvetanovich, G.L., Yanke, A.B., Bach, B.R. & Cole, B.J. (2015) The meniscus‐deficient knee. Orthopaedic Journal of Sports Medicine, 3(10), 232596711561138. Available from: https://doi.org/10.1177/2325967115611386
Stoller, D.W., Martin, C., Crues, J.V., Kaplan, L. & Mink, J.H. (1987) Meniscal tears: pathologic correlation with MR imaging. Radiology, 163(3), 731–735. Available from: https://doi.org/10.1148/radiology.163.3.3575724
Svensson, F., Felson, D.T., Turkiewicz, A., Guermazi, A., Roemer, F.W., Neuman, P. et al. (2019) Scrutinizing the cut‐off for “pathological” meniscal body extrusion on knee MRI. European Radiology, 29(5), 2616–2623. Available from: https://doi.org/10.1007/s00330-018-5914-0
Trasolini, N.A. (2024) Editorial commentary: early clinical results are promising for meniscus centralization as an augment to medial meniscus root repair. Arthroscopy. https://doi.org/10.1016/j.arthro.2023.10.039
Zhang, W., Moskowitz, R.W., Nuki, G., Abramson, S., Altman, R.D., Arden, N. et al. (2008) OARSI recommendations for the management of hip and knee osteoarthritis, part II: OARSI evidence‐based, expert consensus guidelines. Osteoarthritis and Cartilage, 16(2), 137–162. Available from: https://doi.org/10.1016/j.joca.2007.12.013