Preoperative Subchondral Insufficiency Fractures Are Associated With Decreased Clinically Significant Outcome Achievement, Higher Reoperation Rates, and Greater Osteoarthritis Progression After Medial Meniscus Posterior Root Repair at a Minimum 2‐Yea
Jose Rafael Garcia, Eric M. Cohen, Ron Gilat, Michael Ralls, Myles A. Atkins, Michael Murray, Kyleen Jan, Udit Dave, Brian J. Cole, Adam B. Yanke, Nikhil N. Verma, Jorge ChahlaPurpose
To evaluate the effect of preoperative subchondral insufficiency fracture of the knee (SIFK) on the outcomes of medial meniscus posterior root tear repair.
Methods
Patients undergoing repair of an isolated primary medial meniscus posterior root tear with ≥2‐year follow‐up were included. Data encompassed demographics, history, magnetic resonance imaging‐confirmed SIFK, subsequent surgery, radiographic osteoarthritis progression, and patient‐reported outcome measures: Knee Injury and Osteoarthritis Outcome Score, Joint Replacement; International Knee Documentation Committee; and Veterans RAND 12‐Item Health Survey. Patients were stratified by SIFK status. Clinically significant improvement was assessed using cohort‐specific minimal clinically important difference thresholds.
Results
Ninety‐one patients (mean age: 56.5 ± 9.4 years, 73.6% women; mean body mass index: 32.5 ± 6.1) were included with a follow‐up of 38.3 ± 15.3 months (range, 24‐82), which did not differ between groups ( P = .841). Thirty‐four patients (37.4%) had SIFK, and 85% had SIFK grade 1 or 2. Baseline characteristics did not differ between groups. Compared with patients without SIFK, those with SIFK showed lower rates of achieving the minimal clinically important difference and patient‐acceptable symptom state for Knee Injury and Osteoarthritis Outcome Score, Joint Replacement (80.7% vs 38.2%, P < .001; 61.4% vs 35.3%, P = .028, respectively). Patients with SIFK demonstrated higher rates of subsequent surgery (20.6% [95% confidence interval, 8.7%‐37.9%] vs 5.3% [95% confidence interval, 1.1%‐14.6%]; risk difference, 15.3% [95% confidence interval, 1.6%‐31.9%]; P = .036) and a higher postoperative Kellgren‐Lawrence grade (median [interquartile range], 3.0 [3.0‐4.0] vs 2.0 [2.0‐3.0]; P = .013), with smaller postoperative joint space (2.8 ± 0.6 mm vs 3.8 ± 1.0 mm, P = .002).
Conclusions
Preoperative SIFK is associated with lower rates of achieving meaningful clinical improvement along with a higher likelihood of subsequent surgeries and inferior postoperative radiographic osteoarthritis outcomes after medial meniscus posterior root tear repair.
Level of Evidence
Level III, retrospective cohort study.