# Patients with preoperative bone marrow oedema benefit more substantially from medial meniscus posterior root repair

## TL;DR

Patients with preoperative bone marrow edema show greater functional improvement after medial meniscus root repair, despite similar overall outcomes.

## Contribution

Identifies preoperative bone marrow edema as a predictor of greater functional benefit after medial meniscus root repair.

## Key findings

- Patients with BME had higher rates of achieving patient acceptable symptom state after surgery.
- BME was associated with greater improvement beyond minimal clinically important difference in IKDC scores.
- BME presence did not affect short- or mid-term clinical outcomes but predicted better functional improvement.

## Abstract

To analyze the clinical outcomes of the surgical repair of medial meniscus posterior root tear (MMRT) in patients with preoperative bone marrow oedema (BME).

Patients who underwent arthroscopic pull‐out repair for MMRT between 2010 and 2022 were retrospectively reviewed, and those with a minimum of two years of follow‐up were included. The patients were then classified into two groups based on the presence of BME in the medial compartment of the knee on preoperative magnetic resonance imaging (Group 1: patients without BME, Group 2: patients with BME). A comparative analysis was conducted for subjective and objective outcomes, including clinical scores and radiological parameters, at 2 years post‐operatively and at the final follow‐up. In particular, the minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptom state (PASS) values for both the International Knee Documentation Committee (IKDC) subjective and Lysholm scores were used to evaluate post‐operative clinical improvement compared to preoperative baseline scores.

A total of 95 patients were included (Group 1: 54 patients, mean follow‐up 4.1 ± 2.1 years; Group 2: 41 patients, mean follow‐up 4.2 ± 2.3 years). There were no significant differences in demographic and preoperative data, radiological parameters, or clinical scores at 2 years post‐operatively or at the final follow‐up. Similar results were observed consistently across subgroup analyses stratified by BME severity. However, the proportion of patients who achieved PASS, improvement beyond MCID at 2 years post‐operatively, and SCB at the final follow‐up for IKDC subjective score was significantly higher in Group 2 (p = 0.049, p = 0.047 and p = 0.038, respectively).

Preoperative BME in patients undergoing surgical repair for MMRT did not appear to affect short‐ and mid‐term outcomes but was indeed associated with a higher likelihood of functional improvement. Thus, preoperative BME need not be a concern in the surgical repair of MMRT.

Level III.