The Effect of Centralization on Medial Meniscal Extrusion for Medial Meniscus Posterior Root Tear Repair

• Medial meniscus posterior root tear (MMPRT) repair with meniscus centralization (Procedure): The centralization technique involves placement of 1.8-mm Knotless FiberTak suture anchors along the periphery of the tibial plateau, starting from the posteromedial corner and progressing anteriorly. The anchors are deployed using a curved drill guide, and sutures are passed in a mattress configuration to re-tension the meniscotibial ligament to centralize the meniscus. Once centralization is complete, the posterior root tear is repaired using an anatomic suture anchor for aperture medial meniscus root fixation.
• Medial meniscus posterior root tear (MMPRT) repair without meniscus centralization (Procedure): The posterior root tear is repaired using an anatomic suture anchor for aperture medial meniscus root fixation.

Primary outcomes

• Meniscus extrusion measurement [Baseline (Preoperatively), 6 months]: Meniscus extrusion is measured in millimeters (mm) on coronal MRI at the level of the tibial spine

Secondary outcomes

• Change in Kellgren-Lawrence grade on X-ray [Baseline (Screening), 12 months, 24 months]: The Kellgren-Lawrence (KL) system is a 0-4 scale used to grade the severity of knee osteoarthritis (OA) based on X-ray. It ranges from Grade 0 (no changes) to Grade 4 (severe).
• Change in Tegner Activity Score [Baseline, 2 weeks, 6 weeks, 3 months, 6 months, 12 months, 24 months]: The Tegner Activity Questionnaire is a 1-item questionnaire rating physical activity from 0 (Disabled) to 10 (Elite competitive athlete). Total scores range from 0 - 10, with higher scores indicating a higher level of activity.
• Change in Visual Analog Scale (VAS) Questionnaire score [Baseline, 2 weeks, 6 weeks, 3 months, 6 months, 12 months, 24 months]: The VAS is a 2-item questionnaire assessing pain using a scale of 0 (No pain) to 10 (Worst pain). Total scores range from 0 - 10, lower scores indicating lower pain and higher scores indicating greater pain.
• Change in Knee Injury and Osteoarthritis Outcome Score Jr. (KOOS, JR) Questionnaire score [Baseline, 2 weeks, 6 weeks, 3 months, 6 months, 12 months, 24 months]: The KOOS JR is a questionnaire designed to measure outcomes for patients with knee replacements. Questions focus on knee stiffness, pain, and function for daily activities and are assessed on a 5 point Likert-scale between 0 (None) and 4 (Extreme). Total scores range from 0 - 28, with higher scores indicating a greater impact of pain on daily functioning.
• Change in International Knee Documentation Committee (IKDC) Questionnaire score [Baseline, 2 weeks, 6 weeks, 3 months, 6 months, 12 months, 24 months]: The International Knee Documentation Committee (IKDC) Subjective Knee Evaluation assesses overall function over 3 domains: symptoms, athletic activity, and knee function. Higher scores indicate higher levels of function and lower levels of symptoms.
• Change in Likert Knee Questionnaire score [Baseline, 2 weeks, 6 weeks, 3 months, 6 months, 12 months, 24 months]: The Likert Knee Questionnaire is a 1-item survey asking the patient to rate knee pain post-surgery on a Likert scale where 0 (Much better than before surgery) and 5 (Much worse than before surgery).
• Surgery Satisfaction Questionnaire [2 weeks, 6 weeks, 3 months, 6 months, 12 months, 24 months]: The Surgery Satisfaction Questionnaire is a 1-item survey asking the patient to rate satisfaction with knee surgery on a Likert scale where 0 (Not at all) and 10 (Most Satisfied).

Sex: All, ages: 18 Years to 65 Years

Inclusion Criteria:

* Type 2 Medial Meniscus Posterior Root Tear demonstrated on MRI
* Notable extrusion (>3 mm) on preoperative MRI
* Patient able to consent for themselves
* Patient agrees to comply with trial schedules and plan

Pre-operative Exclusion:

* Concomitant ligamentous or meniscal procedures
* Meniscal extrusion > 6 mm on pre-operative MRI
* Kellgren-Lawrence grade > 2
* Varus malalignment > 10 degrees
* Asymmetric varus alignment > 5 degrees
* Varus thrust while weightbearing
* Grade 3 bipolar medial compartment changes (isolated grade 3 changes on single articular surface with ≤ grade 2 changes on the opposing surface remains eligible)
* Previous surgery of the affected knee
* Associated fractures requiring surgery
* Concurrent Vascular injuries
* Hypermobility/Ehlers-Danlos Syndrome
* Inflammatory or autoimmune disease
* Severe mental/physical disability precluding post operative rehabilitation demands
* Contraindications to MRI
* Pregnant women

Arthroscopy Inclusion Criteria:

* Complete radial tears within 9 mm of medial meniscus posterior root
* ICRS Grade 3 or better

Arthroscopy Exclusion Criteria:

* Requiring concomitant procedures other than MMPRT
* ICRS Grade 4 changes

• Aaron J. Krych, MD, Principal investigator, Mayo Clinic