Hula Hoops

[Michael McMurray]

Have a read – stick it in your library

Post some comments – especially in relation to Nick’s case.

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[August Winter]

Certainly interesting reads that will inform how I will treat and refer patients with these symptoms/findings.

Some thoughts on them:
– Seems like your patient, Nic, seems to meet all the risk factors for this sort of tear (middle age, female, increased BMI, decreased sports activity)
– There seems to be several reasons why surgical management may be important for these patients. The presence of extrusion due to loss of hoop stress resistance being associated with worsening OA is mentioned several times in each article, but what I found most interesting was a possible mechanism of increased tibial external rotation and lateral glide resulting in increased varus moment at the knee and medial compartment compression. For this patient with mid-grade OA in the medial joint space this might be especially relevant.
– Given our discussion about the poor consistency of MRI findings for the low back, the fact that 33% of these tears are missed on MRI makes me want to pay more attention to this clinical presentation so that I am not contributing to potential issues diagnosing this patient in the future.
– I would be curious how many surgeons do this surgery in the surrounding area and what sorts of results they have. Given this surgeon group stressing the difficulty of correctly performing this repair because of the anatomy, I can’t imagine it is too widespread.
– The precautions listed in the second article include no CKC knee flexion greater than 70 degrees for 4 months, which very well may be appropriate given this patient’s age and the potential size of the tear, but I have a feeling like this patient in particular may have a poor outcome because I highly doubt she would be compliant with being this conservative. It sounded like she ascribed to the belief that more was better, and I think she might require frequent and detailed education on the importance of compliance if surgery is eventually carried out.

[Scott Resetar]

Great articles.

One thing that stuck out to me was that the contact forces between the tibia and femur were no different in patients who had a complete meniscectomy vs a posterior root tear. This shows how important those hoop stresses really are!

The second article has a lot of studies of previous outcomes for root repair, which seem promising. However, it was interesting that one article found that in patients who were found to have a posterior root tear that was previously undiagnosed during ACL reconstruction, if the root tear was left untouched during surgery, there was no difference in arthritic changes 10 years post surgery vs controls. No mention in that study of the quality of the tissue at the root tear, complete vs incomplete tear, loss of hoop stress vs no loss, etc

In Nic’s case, I believe this patient was a bit older… I can’t really remember. If I was, say 55-60 years old and I had a posterior root tear, I think I would rather have a TKA vs having the root repair with that crazy recovery period. If I was really young… I would consider the repair.

We recently had a 70 year old male in the clinic with a posterior root repair, and he is not doing well with the recovery at this time. He’s having a hard time getting ROM back, lots of pain even 3 months post…

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