[Comparison of efficacy between Pull-out reconstruction and Fast-fix suture techniques for the treatment of posterior root injury of the medial meniscus].

OBJECTIVE: To investigate the effects of the Pull-out reconstruction technique and the fast-fix all-inside suture technique on mid-term knee joint function, osteoarthritis progression, and meniscal extrusion in patients with posterior root tear of the medial meniscus.

METHODS: A total of 75 patients with posterior root tear of the medial meniscus who underwent surgical intervention between June 2019 and January 2022 were enrolled in this study. These patients were categorized into the Pull-out reconstruction group and the Fast-fix suture group based on the distinct surgical techniques employed. There were 44 patients in the Pull-out reconstruction group, including 9 males and 35 females, with an average age of (51.23±4.89) years;17 patients were on the left side and 27 patients on the right side. The Fast-fix suture group consisted of 31 patients, including 7 males and 24 females, with an average age of (52.13±5.47) years;11 patients were on the left side and 20 patients on the right side. The Lysholm functional questionnaire and the International Knee Documentation Committee (IKDC) score were used to evaluate the knee joint function of patients. Knee joint X-ray and MRI examinations were performed to assess the progression of osteoarthritis and the healing of the meniscus.

RESULTS: Both groups of patients were followed up, with (52.05±8.27) months in the Pull-out reconstruction group and (52.00±7.13) months in the Fast-fix suture group.The operation time of the Pull-out reconstruction group was (50.94±5.66) minutes, which was longer than that of the Fast-fix suture group (31.34±3.99) minutes, and the difference was statistically significant (P=0.000). In the Pull-out reconstruction group, 34 patients achieved complete healing, 9 patients partial healing, and 1 patient non-healing;in the Fast-fix suture group, 21 patients achieved complete healing, 8 patients partial healing, and 2 patients non-healing;the difference was not statistically significant (P>0.05). There were no statistically significant differences in the preoperative and last follow-up K-L grades as well as the cartilage injury grades assessed by MRI between the two groups(P>0.05). Neither group showed a statistically significant difference in these grades between the last follow-up and preoperative period(P>0.05). At the last follow-up, there were no statistically significant differences in the total Lysholm score and total IKDC score between the two groups (P>0.05). In the Pull-out reconstruction group, 22 cases had meniscal extrusion before surgery and 30 cases had meniscal extrusion at the final follow-up, with a statistically significant difference(P=0.010);in the Fast-fix suture group, 17 cases had meniscal extrusion before surgery and 23 cases had meniscal extrusion at the final follow-up, with a statistically significant difference(P=0.000). In the Pull-out reconstruction group, the meniscal extrusion was 3.05(2.50, 4.08) mm before surgery and 3.35(2.73, 4.00) mm at the final follow-up, with no statistically significant difference (P=0.183);in the Fast-fix suture group, the meniscal extrusion was 3.50(2.30, 4.30) mm before surgery and 3.60(2.90, 4.60) mm at the final follow-up, with a statistically significant difference(P=0.000).There were no statistically significant differences in the incidence and degree of meniscal extrusion between the two groups at the final follow-up (P>0.05).

CONCLUSION: Both Pull-out repair and Fast-fix suture can improve knee joint function in patients with posterior root tear of the medial meniscus. Both treatments achieved satisfactory healing rates and did not lead to rapid progression of knee osteoarthritis.