Clinical Research Directory

Arthroscopic Capsulodesis Decreases Meniscal Extrusion at 1 Year Follow up When Combined With Transtibial Pull Out Repair of Posteromedial Root Lesion. A Prospective Randomized Study

Primary objective is to compare isolated single tunnel transtibial pull out posterior medial meniscus root repair (PMMRR) with the same repair augmented by arthroscopic capsulodesis. Study design: Prospective randomized controlled trial. The study will be registered in the international Clinical Trials registry. Inclusion criteria: symptomatic isolated PMMRT confirmed by MRI, type 2 or type 4 tears according to the LaPrade classification, age between 18 and 65 years, neutral coronal alignment (mechanical axis deviation \<4° varus), as confirmed on standardized full-length standing radiographs. Exclusion criteria: previous ipsilateral meniscal or ligament surgery, body mass index (BMI) \>35 kg/m², advanced osteoarthritis (Kellgren-Lawrence grade III-IV), inflammatory arthropathy, metabolic bone disease, spontaneous osteonecrosis of the knee or inability to adhere to the standardized postoperative rehabilitation protocol. Randomization: Eligible patients will be randomized in a 1:1 ratio to either isolated posterior medial meniscus root repair group (PMMRR) or PMMRR augmented with arthroscopic capsulodesis group, performed centrally by an independent statistician using a computer-generated randomization sequence with variable block sizes of 4 to 6. Image control with MRI will be performed at 3, 6 and 12 month and evaluated by two fellowship-trained musculoskeletal radiologists blinded to treatment allocation, clinical information, and temporal sequence of scans.The primary endpoint (medial meniscal extrusion at 12 months) will be analyzed using analysis of covariance (ANCOVA), with treatment group as the fixed effect, baseline extrusion as a covariate, and study center included as a random effect to account for clustering.

Transtibial Pull Out Method Versus Suture Anchor Method for Meniscus Extrusion

The concept of meniscal extrusion has recently been recognized as an important pathological condition associated with meniscal dysfunction. Meniscal extrusion is the medial or lateral displacement of the meniscus beyond the edges of the tibial plateau. Some meniscal extrusions are physiologic, but large degrees of extrusion are thought to be pathologic. Meniscal extrusion can vary in extent from minimal physiological extrusion to extrusions exceeding 10 mm. The generally accepted threshold value is considered to be 3 mm. To date, the gold standard for measuring meniscal extrusion is T2-weighted MRI. MRI is valuable not only due to its ability to define other meniscal or knee pathologies but also because it provides good sensitivity and specificity. Surgical treatment of meniscal extrusion is preferred in young, active, symptomatic patients and individuals with acute injuries. The treatment approach may vary depending on the underlying cause. One of these methods is centralization surgery, which aims to achieve the anatomical reduction of the extruded meniscus. The aim of this study is to compare the functional outcomes of transtibial pull-out and suture anchor techniques used in centralization surgery and to contribute to standardization.