MENISCAL EXTRUSTION MEASUREMENTS AFTER POSTERIOR MEDIAL MENISCUS ROOT TEARS: A SYSTEMATIC REVIEW AND META-ANALYSIS
Figure 1 - PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for included studies. PMMR, posterior medial meniscus root; PMMRT, posterior medial meniscus root tear.
Background: Meniscal extrusion has become increasingly utilized when evaluating meniscus root abnormalities. However, no consensus definition or approach exists on how to measure extrusion.
Purpose/hypothesis: The purpose of this study was to evaluate the extent of heterogeneity in meniscal extrusion measurement techniques and reported extrusion values in knees with posterior medial meniscus root tears (PMMRTs). We hypothesized that meniscal extrusion measurement techniques would vary considerably throughout reported studies, with resultant wide-ranging published extrusion values.
Study design: Systematic review; Level of evidence, 4.
Figure 2 - Meniscal extrusion (d) demonstrating a reference line drawn based only on the position of the tibial plateau. When reported, all included studies used the represented method. However, select studies evaluating meniscal extrusion in the setting of non–posterior medial meniscus root tears, excluded from the current review, have also reported using a reference line connecting both the tibial plateau and the femoral condyle.
Figure 3 - Number of studies using different cross-sectional landmarks to measure ME. AP, anterior-posterior; ME, meniscal extrusion; MCL, medial collateral ligament; MM, medial meniscus.
Methods: A systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. The inclusion criteria consisted of all clinical and cadaveric studies reporting on meniscal extrusion after PMMRTs, excluding studies lacking data in full extension, those presenting only semiquantitative analyses, articles reporting only differences in meniscal extrusion, and review articles.
Results: A total of 45 studies were included. Imaging modality types included magnetic resonance imaging (89%), 3-dimensional reconstruction with computed tomography (7%), linear displacement transducers (2%), and a combination of magnetic resonance imaging and ultrasound (2%). The 3 most commonly used landmarks to acquire coronal images for meniscal extrusion measurements were the medial collateral ligament (38%), the midpoint of the anterior-posterior length of the medial meniscus (23%), and the middle of the medial femoral condyle (19%). The pooled mean extrusion values according to the measurement location were 3.5 ± 0.7 mm, 3.9 ± 0.8 mm, and 4.5 ± 2.1 mm, respectively, with no significant differences noted between the modality types (P = .23). The pooled mean meniscal extrusion from all included studies was 3.2 ± 2.0 mm.
Conclusion: Substantial variation exists in measurement techniques for meniscal extrusion, particularly as it relates to the coronal cross-sectional reference location. Further studies should aim to provide clear descriptions of the measurement method and have uniform measurement methodology to allow comparisons and pooling between studies.
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Published December 21, 2022 in the American Journal of Sports Medicine.