Relationship of Medial Meniscus Posterior Root Tears with Proximal Tibial Morphology and Knee Osteoarthritis

Relationship of Medial Meniscus Posterior Root Tears with Proximal Tibial Morphology and Knee Osteoarthritis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Relationship of Medial Meniscus Posterior Root Tears with Proximal Tibial Morphology and Knee Osteoarthritis Eren Çamur, Semra Duran This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4943752/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose: To investigate the relationship between proximal tibial morphology (PTM) and medial meniscus posterior root tears (MMPRT), and to evaluate the association between medial meniscal extrusion amount (MMEA) and osteoarthritis (OA) in patients with MMPRT. Material and method: This retrospective study analyzed knee MRIs of 100 patients with MMPRT and 100 age, gender, side paired controls. Medial posterior tibial slope angle (MPTSA), mediolateral length (MLL), medial anteroposteiror width (MAW), lateral anteroposteiror width (LAW), were used to evaluate PTM . MMEA and tear gap (TG) correlation and their relationship with knee OA severity was assessed. Results: MPTSA was significantly higher in MMPRT group compared to controls (p<0.001). Moderate positive correlation was found between MMEA and OA severity (R 2 =0.445, p<0.001). Cartilage loss was observed when MMEA exceeded 4 mm (sensitivity: 80.68%; specificity: 83.33%). MMEA increased by 1.10 mm for each 1 mm increase in TG. Conclusion: This groundbreaking study reveals that steeper medial tibial plateau is a significant risk factor for MMPRT. Strikingly, MMEA exceeding 4 mm serves as a critical threshold for cartilage loss, potentially revolutionizing treatment decisions. These findings not only enhance our understanding of MMPRT pathomechanics but also provide crucial insights for early intervention strategies, potentially altering the course of OA progression in patients with MMPRT. Meniscus root tear morphology osteoarthritis tibia Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 INTRODUCTION The meniscus plays crucial role in maintaining the function of the knee by contributing to load transmission, shock absorption, joint stability and lubrication, proprioception, and nutrient supply. Of these functions, the most important function for the prevention of arthritis is the maintenance of hoop tension that allows correct intraarticular load transmission for which the medial meniscus is approximately 90% responsible and the lateral meniscus is approximately 70% responsible. Medial meniscus posterior root tear (MMPRT) causes to the loss of hoop tension and, consequently, the meniscus's load transmission capability. As a result, the increased contact pressure on the weight-bearing surface accelerates joint degeneration[ 1 ]. Risk factors for meniscal tears include age, sex, lower limb alignment, obesity[ 2 ]. Recent studies also highlight that proximal tibial morphology (PTM) could be a risk factor for meniscal and ligament injuries 8,9,13 . PTM describes the geometric structure of tibia near the knee joint and tibial plateau. Various morphological measurements have been defined to assess PTM, including mediolateral length (MLL), medial anteroposterior width (MAW), lateral anteroposterior width (LAW), central-lateral length, central-medial length, tibial plateau surface area, medial posterior tibial slope angle (MPTSA), and lateral posterior tibial slope angle[ 3 , 4 ]. MPTSA has the most significant impact on knee biomechanics among these measurements[ 4 ]. There are just few studies associating MPTSA to MMPRT and this relationship has not yet been clearly elucidated[ 5 ]. Magnetic resonance imaging (MRI) is the gold standard non-invasive methods for diagnosing medial meniscus root tears and detecting accompanying knee pathologies [ 6 ]. The aim of this study is to investigate the effect of PTM on MMRTs and to determine the relationship between medial meniscal extrusion amount (MMEA) observed in root tears and osteoarthritis (OA). MATERIAL AND METHOD Patients who underwent knee MRI at our hospital between January 2020 and July 2022 were retrospectively evaluated. MRIs were obtained in the supine position with the knee in extension, using an extremity coil with a 1.5 Tesla MRI (Optima; GE Medical System, Milwaukee, Wisconsin, USA). A standardized MRI examination protocol was used (Table 1 ). Table 1 Sequences and parameters used in image acquasition in the study Sequences TR / TE (ms) Matriks Field of view ( cm) Slice thickness ( mm ) Sagittal T1W FSE 300–500/ 5–10 288 x 224 18 x 18 3 Sagittal 3D Cube FSE T2 1500 / 124,4 224 x 224 20 x 20 1 Sagittal Fatsat Proton Density FSE 2300–2800 / 20–40 256 x 192 18x18 3 Coronal Fatsat Proton Density FSE 2300–2800 / 20–40 288 x 224 20 x 20 3 Axial Fatsat Proton Density FSE 2300–2800 / 20–40 288 x 224 18 x 18 3 Patient images were anonymized and evaluated independently at different times by a radiology specialist with 5 years of experience and an associate professor of radiology with 10 years of experience in musculoskeletal radiology. The portion of the posterior horn of the medial meniscus 10 mm from posterior meniscal insertion to the tibial plateau was determined as posterior meniscal root. Patients with three main MRI findings were considered as MMRT: A linear high signal intensity perpendicular to the meniscus root in the axial plane. A vertical linear defect associated with > 3 mm medial meniscus extrusion at meniscus root. Reappearance of the disappearing meniscus on consecutive sagittal sequences, known as “ghost meniscus” sign (Fig. 1 ). Total of 141 patients with MMRT were evaluated. Patients with a history of surgery (9 patients) or trauma (12 patients), those with a secondary tear accompanying the root tear in the medial meniscus (5 patients), patients with mass lesions in the knee joint (2 patients), and those whose evaluation was not possible due to image quality or protocol issues (13 patients) were excluded from the study. Total of 100 patients were included as MMPRT group in the study. Control group was created with 100 patients matched for age, sex, and side, who had no meniscus or ligament pathology (Fig. 1 ). The distance between the most medial point of the extruded part of the medial meniscus and the medial corner of the medial tibial plateau in mid-coronal plane, was recorded as the “MMEA”[ 7 ]. Osteophytes at the level of the medial tibial plateau were not included in the measurement area (Fig. 2 ). The distance between the perpendicular line drawn from the ACL attachment and the torn meniscus root in coronal plane, was defined as the "tear gap" (TG)[ 8 ] (Fig. 3 ). Cartilage changes were evaluated and classified according to Modified Outerbridge classification for staging osteoarthritis at the knee joint[ 9 ] , [ 10 ](Table 2 ). Table 2 Modified Outerbridge Classification Grade Description 0 Normal cartilage 1 T2 signal increase in morphologically normal cartilage 2 Superficial partial cartilage defect involving less than 50% of total joint surface thickness 3 Deep partial cartilage defect involving more than 50% of total joint surface thickness 4 Full-thickness cartilage defect MLL, MAW, LAW, and MPTSA were used to evaluate PTM. For MLL, MAW, and LAW measurements, a line perpendicular to the medial tibial plateau extending 10 mm caudally was drawn in coronal plane. The lower end of this line was determined as the target point, and using reference lines in axial plane, MLL measurement was performed at this level on the x-axis. In the same section, MAW was measured at the point with the maximum anteroposterior width of the medial plateau on the y-axis, and LAW was measured at the point with the maximum anteroposterior width of the lateral plateau[ 11 ] (Fig. 4 ). MPTSA (the angle between the vertical line drawn to the tibial axis and the line passing from the anterior and posterior cortical points of medial tibial plateau in sagittal plane) was measured as described by Hudek et al.[ 12 ] (Figs. 5 a, 5 b, 5 c). Datas were evaluated using IBM SPSS Statistics Standard Concurrent User V 26 (IBM Corp., Armonk, New York, USA). Descriptive statistics were given as unit number (n), mean ± standard deviation, median (M), minimum (min), and maximum (max) values. The normal distribution of numerical variables was assessed with the Shapiro-Wilk normality test. The Mann-Whitney U test was used for comparisons of variables between two categories. The effect of independent variables was evaluated by linear regression analysis. The "Roc Curve" analysis method was used to compare the diagnostic performance of two or more diagnostic or measurement values. Two-way analysis of variance was used to evaluate dependent continuous variables with two or more independent categorical variables. Pearson and Fisher exact tests were used for comparisons between categorical variables. The effect of the MMEA variable on the tear gap and OA stage was evaluated by linear regression analysis. Differences in MLL, MAW, LAW, and MPTSA according to gender in the study groups were analyzed by two-way analysis of variance. Intra- and inter-observer agreement was evaluated with the Wilcoxon test for PTM measurements in both groups. P value < 0.05 was considered statistically significant. RESULTS The demographic features of the MMRT and control groups are shown in Table 3 . There was no statistically significant difference between the two groups in terms of age, gender, and side (p > 0.05). Table 3 Comparison of gender, age and side between groups Groups Test statistics MMRT group ( n = 100) Control group ( n = 100) p value >0,999 0,993 > 0,999 Gender , n (%) Male Female 47 (%47,0) 53 (%53,0) 47 (%47,0) 53 (%53,0) Age Mean ± sd Median ( min - max ) 54,54 ± 8,46 54 (40–79) 54,46 ± 6,37 51 (47–69) Side Right Left 46 54 46 54 The average of medial meniscal extrusion amount (MMEA) was 5.20 ± 1.74 mm, and TG was 5.54 ± 3.14 mm. In the linear regression analysis between the tear gap and MMEA, for every 1 mm increase in the tear gap, the extrusion amount increased by 1.10 mm. Knee OA was more severe in MMRT group (p < 0.001). OA was more severe in women than men in both groups (p = 0.026; p < 0.001). There was moderate positive correlation between MMEA and knee OA(p < 0.001, R 2 = 0,445)(Table 4 , 5 ). When MMEA exceeded 4 mm, cartilage loss was observed (sensitivity: 80.68%; specificity: 83.33%, AUC: 0.876, Fig. 6 ). Table 4 Comparison of OA grades according to gender Male Female p value OA grade OA grade MMRT group 2 (1–4) 3 (1–4) 0,026 Control group 0 (0–3) 1 (0–3) < 0,001 Table 5 Linear regression analysis of OA grade and MMEA β se zβ t P value OA grade MMEA (mm) 0,399 0,045 0,667 8,860 < 0,001 F = 78,505; p < 0,001; R 2 = 0,445 Durbin-Watson = 1,594 MLL, MAW, and LAW were smaller in women compared to men in both groups but There was no statistically significant difference between the two groups in terms of these PTM measurements (Table 6 ). Table 6 Comparison of MLL, LAW and MAW between groups Groups Test statistics MMRT group ( n = 100) Control group ( n = 100) p value MLL (cm) Male 7,51 ± 0,41 7,75 ± 0,43 0,202 0,304 Female 6,52 ± 0,29 6,74 ± 0,35 LAW (cm) Male 4,45 ± 0,33 4,68 ± 0,38 0,321 0,361 Female 3,85 ± 0,33 3,93 ± 0,30 MAW (cm) Male 5,27 ± 0,34 5,53 ± 0,26 0,272 0,295 Female 4,31 ± 0,34 4,62 ± 0,26 MPTSA was higher in women than in men in both groups, but this was not statistically significant (p > 0.05). MPTSA was significantly higher in the MMRT group compared to the control group for both genders (p < 0.001)(Table 7 ). Table 7 Comparison of MPTSA between groups Groups Test statistics MMRT group ( n = 100) Control group ( n = 100) p value MPTSA (degree) Male 6,67 ± 1,78 4,96 ± 2,10 < 0,001 0.05). DISCUSSION The first case of MMPRT was reported in 1991 by Pagnani et al[ 13 ]. MMPRT is meniscal tear, located within 10 mm of the posterior root insertion of the meniscus, they are usually degenerative and occur in middle-aged women and may represent 21.5% MMPRTs[ 14 ]. Similar to the literature 53% of patients with MMPRT were female, with a mean age above 50 years in our study[ 15 – 17 ]. Medial meniscus, a crescent-shaped fibrocartilaginous structure, maintains its anatomical position during weight-bearing stress, with the anchoring horns and circumferential fiber bundles of the medial meniscus providing tensile strength. Radial meniscus tears can lead to medial meniscus extrusion due to the disruption of these root attachments or circumferential fiber bundles. Medial meniscus extrusion is defined as the significant medial displacement of the medial meniscus relative to the central edge of medial tibial plateau. Lerer et al. considered MMEA abnormal if it was 3 mm or more[ 18 ] .The average MMEA patitent with MMPRT was 5.2 mm in our study and this result is consistent with the literature. The first sign of OA is cartilage loss. Studies has shown the relationship between medial tibiofemoral cartilage loss and MMPRTs based on MR imaging and arthroscopic findings[ 19 – 23 ]. Guermazi et al. reported that the likelihood of onset and progression of medial tibiofemoral cartilage degeneration is higher in isolated MMPRTs compared to other types of meniscal tears[ 24 ]. Similar to this study, knee OA was more severe in MMPRT group compared to the control group in our study. It is known that patients with MMPRT have higher MMEA compared to those with other types of meniscal tears[ 25 ]. Studies indicate that increased MMEA accelerates the development of OA, and as MMEA increases, the presence and severity of OA also increase[ 24 , 26 ]. We found that increased extrusion amount was associated with increased cartilage loss, the first sign of OA. Cartilage degeneration and loss were higher in women than in men. The mechanical disruption caused by meniscus tear or extrusion can alter the weight-bearing capacities of the tibiofemoral compartments, leading to damage to the joint cartilage and subchondral bone, thereby contributing to the development and progression of knee osteoarthritis[ 27 ]. Additionally, we revealed that cartilage loss begins when MMEA exceeds 4 mm, adding to the literature. Recent studies that compare the repair of MMPRT to total or partial meniscectomy and non-surgical treatment, showing superior outcomes with repair and lower rates of progression to knee OA and lower reoperation rate[ 28 , 29 ]. Our finding contribute the literature in this regard and suggests that repair of meniscus may give better results in patients with MMEA less than 4 mm, that is, in patients who have not yet started cartilage loss-knee OA. Therefore, patients with MMEA less than 4 mm may be candidates for repair. Nevertheless, clinically correlated new studies are needed. PTM and biomechanics of knee joint are associated with ACL and meniscal tears. The geometry of the tibial plateau directly affects the biomechanics of the tibiofemoral joint. The MPTSA is the most commonly used measurement for evaluating this geometry[ 30 – 32 ]. Kodama et al. identified steeper MPTSA as a risk factor for MMPRTs in young patients[ 32 ]. However, Altınayak et al. found no difference in MPTSA when comparing patients with MMPRTs to control group[ 31 ]. We found that the MPTSA was statistically significantly higher in the group with MMPRTs compared to the control group, supporting the findings of Kodama et al. Steeper tibial pleatua is associated with the magnitude of shear force on the tibial plateau and affects the biomechanics of the tibiofemoral joint by increasing the anterior translational force acting on the posterior root of the medial meniscus, which may increase the risk of meniscal injury in adults[ 30 , 33 ]. There is no study to our knowledge in the literature evaluating the relationship between MMPRT and MLL, MAW, and LAW measurements. This study is unique in the context in that it is the first study to evaluate these measurements. We found no difference in these tibial measurements between two groups. Zhang et al. reported that MLL, MAW and LAW were smaller in women than men in their study [ 34 ]. Similarly, we found that these measurements were smaller in women than in men. This study has few limitations. Arthroscopic correlation could not be performed for the included patients. Body mass index could not be evaluated due to the lack of height and weight information. Standard sequences were used to evaluate cartilage degeneration as specific sequences were not taken. Additionally, since our study was retrospective, clinical correlation with OA stage and MMPRT could not be performed. In conclusion, as MMEA increases in patients with MMPRT, cartilage degeneration and loss increase. Cartilage loss accompanies when MMEA exceeds 4 mm. MMPRT is associated with PTM. Steeper medial tibial plateau is a risk factor for MMPRT. Declarations Data availability: The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to their containing information that could compromise the privacy of patients. Conflict of interest: The authors declare that this study was conducted without any commercial or financial relationships that could be construed as a potential conflict of interest. The content of the publication is entirely the authors’ responsibility, and the authors examined and edited it as necessary. Each author states that the submitted article, either in full or in part, has not been previously published or is not being assessed for publication as an original article in either printed form or as digital media. Ethics Committee Approval: Ethics committee approval was received for this study from Ankara Bilkent City Hospital Ethics Committee 1, Faculty of Medicine, Health Sciences University (Ethics Committee Approval Number: E1-23-3233). Funding: No funding was received for this study. Author Contribution Statement Eren Çamur: Conceptualization, Data collection and analysis, Methodology, Manuscript writing&editing Semra Duran: Methodology, Manuscript review&editing References Allaire R, Muriuki M, Gilbertson L, Harner CD (2008) Biomechanical consequences of a tear of the posterior root of the medial meniscus. Similar to total meniscectomy, J Bone Joint Surg Am , vol. 90, no. 9, pp. 1922–1931, Sep. 10.2106/JBJS.G.00748 Okazaki Y et al (2021) Steep posterior slope and shallow concave shape of the medial tibial plateau are risk factors for medial meniscus posterior root tears, Knee Surgery, Sports Traumatology, Arthroscopy , vol. 29, no. 1, pp. 44–50, 10.1007/s00167-019-05590-4 Phombut C, Rooppakhun S, Sindhupakorn B (2021) Morphometric measurement of the proximal tibia to design the tibial component of total knee arthroplasty for the Thai population. J Exp Orthop 8(1). 10.1186/s40634-021-00429-9 Wang X et al (2020) Effects of medial meniscal slope and medial posterior tibial slope on the locations of meniscal tears: A retrospective observational study. Medicine 99(47):e23351. 10.1097/MD.0000000000023351 Moon HS, Choi CH, Jung M, Lee DY, Eum KS, Kim SH (2020) Medial Meniscal Posterior Horn Tears Are Associated With Increased Posterior Tibial Slope: A Case-Control Study. Am J Sports Med 48(7):1702–1710. 10.1177/0363546520917420 LaPrade RF, Ho CP, James E, Crespo B, LaPrade CM, Matheny LM (2015) Diagnostic accuracy of 3.0 T magnetic resonance imaging for the detection of meniscus posterior root pathology, Knee Surg Sports Traumatol Arthrosc , vol. 23, no. 1, pp. 152–157, Jan. 10.1007/S00167-014-3395-5 Xu D et al (2021) Are changes in meniscus volume and extrusion associated to knee osteoarthritis development? A structural equation model. Osteoarthritis Cartilage 29(10):1426–1431. 10.1016/j.joca.2021.07.007 Kim JY, Il Bin S, Kim JM, Lee BS, Oh SM, Park MH (2019) Tear gap and severity of osteoarthritis are associated with meniscal extrusion in degenerative medial meniscus posterior root tears. Orthop Traumatology: Surg Res 105(7):1395–1399. 10.1016/j.otsr.2019.09.015 Newman S, Ahmed H, Rehmatullah N (Dec. 2022) Radiographic vs. MRI vs. arthroscopic assessment and grading of knee osteoarthritis - are we using appropriate imaging? J Exp Orthop 9(1):1–6. 10.1186/S40634-021-00442-Y/TABLES/5 Kurt M, Öner AY, Uçar M, Aladağ Kurt S (2019) The relationship between patellofemoral arthritis and fat tissue volume, body mass index and popliteal artery intima-media thickness through 3T knee MRI. Turk J Med Sci 49(3):844–853. 10.3906/SAG-1811-166 Ranjan M, Rangaswamy N, Garika SS, Yadav C (Oct. 2022) Does One Size Really Fit All? Morphometric Analysis of Distal Femur and Proximal Tibia in an Ethnic Indian Population and Correlation to the Sizing of Existing Total Knee Arthroplasty Implants. Cureus 14(10). 10.7759/CUREUS.30824 Hudek R, Schmutz S, Regenfelder F, Fuchs B, Koch PP (2009) Novel measurement technique of the tibial slope on conventional MRI. Clin Orthop Relat Res 467(8):2066–2072. 10.1007/s11999-009-0711-3 Pagnani MJ, Cooper DE, Warren RF (1991) Extrusion of the medial meniscus. Arthroscopy 7(3):297–300. 10.1016/0749-8063(91)90131-G Matheny LM, Ockuly AC, Steadman JR, LaPrade RF (2015) Posterior meniscus root tears: associated pathologies to assist as diagnostic tools, Knee Surg Sports Traumatol Arthrosc , vol. 23, no. 10, pp. 3127–3131, Oct. 10.1007/S00167-014-3073-7 Kim SB et al (2011) Medial meniscus root tear refixation: comparison of clinical, radiologic, and arthroscopic findings with medial meniscectomy. Arthroscopy 27(3). 10.1016/J.ARTHRO.2010.08.005 Lee JH, Lim YJ, Kim KB, Kim KH, Song JH (2009) Arthroscopic pullout suture repair of posterior root tear of the medial meniscus: radiographic and clinical results with a 2-year follow-up, Arthroscopy , vol. 25, no. 9, pp. 951–958, Sep. 10.1016/J.ARTHRO.2009.03.018 Habata T, Uematsu K, Hattori K, Takakura Y, Fujisawa Y (Nov. 2004) Clinical features of the posterior horn tear in the medial meniscus. Arch Orthop Trauma Surg 124(9):642–645. 10.1007/S00402-004-0659-4 Lerer DB, Umans HR, Xu MX, Jones MH (2004) The role of meniscal root pathology and radial meniscal tear in medial meniscal extrusion, Skeletal Radiol , vol. 33, no. 10, pp. 569–574, Oct. 10.1007/S00256-004-0761-2 Koenig JH, Ranawat AS, Umans HR, DiFelice GS (Sep. 2009) Meniscal root tears: diagnosis and treatment. Arthroscopy 25(9):1025–1032. 10.1016/J.ARTHRO.2009.03.015 Lerer DB, Umans HR, Xu MX, Jones MH (2004) The role of meniscal root pathology and radial meniscal tear in medial meniscal extrusion, Skeletal Radiol , vol. 33, no. 10, pp. 569–574, Oct. 10.1007/S00256-004-0761-2 Lee YG, Shim JC, Choi YS, Kim JG, Lee GJ, Kim HK (2008) Magnetic resonance imaging findings of surgically proven medial meniscus root tear: tear configuration and associated knee abnormalities. J Comput Assist Tomogr 32(3):452–457. 10.1097/RCT.0B013E31812F4EB0 Lee DH et al (Feb. 2011) Predictors of degenerative medial meniscus extrusion: radial component and knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 19(2):222–229. 10.1007/S00167-010-1274-2 So YL, Jee WH, Kim JM (2008) Radial tear of the medial meniscal root: reliability and accuracy of MRI for diagnosis, AJR Am J Roentgenol , vol. 191, no. 1, pp. 81–85, Jul. 10.2214/AJR.07.2945 Guermazi A et al (2013) Sep., Medial Posterior Meniscal Root Tears Are Associated with Development or Worsening of Medial Tibiofemoral Cartilage Damage: The Multicenter Osteoarthritis Study, Radiology , vol. 268, no. 3, p. 814, 10.1148/RADIOL.13122544 Fong FJY, Ong BWL, Lee YHD (Mar. 2023) Medial Meniscal Extrusion in Patients With Medial Meniscus Root Tears: A Systematic Review and Meta-analysis. Orthop J Sports Med 11(3). 10.1177/23259671231151698 Kim JY, Il Bin S, Kim JM, Lee BS, Oh SM, Park MH (2019) Tear gap and severity of osteoarthritis are associated with meniscal extrusion in degenerative medial meniscus posterior root tears. Orthop Traumatology: Surg Res 105(7):1395–1399. 10.1016/j.otsr.2019.09.015 Crema MD et al (Aug. 2012) Factors Associated with Meniscal Extrusion in Knees with or at Risk for Osteoarthritis: The Multicenter Osteoarthritis Study. Radiology 264(2):494. 10.1148/RADIOL.12110986 Faucett SC et al (2019) Mar., Meniscus Root Repair vs Meniscectomy or Nonoperative Management to Prevent Knee Osteoarthritis After Medial Meniscus Root Tears: Clinical and Economic Effectiveness, Am J Sports Med , vol. 47, no. 3, pp. 762–769, 10.1177/0363546518755754 Ro KH, Kim JH, Heo JW, Lee DH (2020) Clinical and Radiological Outcomes of Meniscal Repair Versus Partial Meniscectomy for Medial Meniscus Root Tears: A Systematic Review and Meta-analysis. Orthop J Sports Med 8(11). 10.1177/2325967120962078 Melugin HP et al (2023) Oct., Increased Posterior Tibial Slope Increases Force on the Posterior Medial Meniscus Root, Am J Sports Med , vol. 51, no. 12, pp. 3197–3203, 10.1177/03635465231195841 Altinayak H, Karatekin YS (Oct. 2023) Increased Medial Femoral Condyle Angle and Narrow Intercondylar Notch Are Associated With Medial Meniscus Posterior Root Tear. Arthroscopy 39(10):2154–2163. 10.1016/J.ARTHRO.2023.02.020 Kodama Y et al (Jan. 2023) Steep posterior slope of the medial tibial plateau and anterior cruciate ligament degeneration contribute to medial meniscus posterior root tears in young patients. Knee Surg Sports Traumatol Arthrosc 31(1):279–285. 10.1007/S00167-022-07095-Z Deng X et al (Dec. 2021) The influence of the steep medial posterior tibial slope on medial meniscus tears in adolescent patients: a retrospective case-control study. BMC Musculoskelet Disord 22(1):1–7. 10.1186/S12891-021-04766-9/FIGURES/5 Zhang Y et al (Jul. 2018) Comparison between three-dimensional CT and conventional radiography in proximal tibia morphology. Med (United States) 97(30). 10.1097/MD.0000000000011632 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4943752","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":343504086,"identity":"579a207c-4482-4623-90b5-55aca52904de","order_by":0,"name":"Eren Çamur","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA3UlEQVRIiWNgGAWjYHAD5gNAwoKBgYd4LWwJDAwJEiRp4TEgTgu/9OFjDxhq7KINbp/5+Jj3h4QcP88Bxg8fc3BrkexLSzdgOJacu+Fc7mZjngQJY8neBmbJmdtwazE4w2MmwdjAnLvhDO82aaCWxA3nGdiYefFosT/D/w2opR6ohecZcVoMeHjYgFoOg7SwQbScbcCvReIMm5lEwrHjuTPPsBkbzkkD+qXnYDNev/D3MD+T+FBTndt3hvnhgzc2NsAQSz744SMeLWCQgMplbCCgfhSMglEwCkYBIQAAdgFHj/IDVkgAAAAASUVORK5CYII=","orcid":"","institution":"Ministry of Health Ankara 29 Mayis State Hospital","correspondingAuthor":true,"prefix":"","firstName":"Eren","middleName":"","lastName":"Çamur","suffix":""},{"id":343504087,"identity":"f85157fc-4236-4f53-a2e7-17f79ec73596","order_by":1,"name":"Semra Duran","email":"","orcid":"","institution":"Ankara Bilkent City Hospital","correspondingAuthor":false,"prefix":"","firstName":"Semra","middleName":"","lastName":"Duran","suffix":""}],"badges":[],"createdAt":"2024-08-20 09:22:26","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4943752/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4943752/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":64707241,"identity":"41f9a47a-d356-4878-b02d-4a2fa517cde4","added_by":"auto","created_at":"2024-09-18 01:28:47","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":25300,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart of the study\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4943752/v1/4fc15508bf03b6ec9806f726.jpg"},{"id":64707239,"identity":"109a2c9f-3b99-47b7-97c0-9d991585fde8","added_by":"auto","created_at":"2024-09-18 01:28:46","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":22428,"visible":true,"origin":"","legend":"\u003cp\u003eMeasurement of MMEA\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4943752/v1/9db3b7831faea8d51191810a.jpg"},{"id":64707242,"identity":"3bb2be28-435e-4d15-b900-9b1deaf0484c","added_by":"auto","created_at":"2024-09-18 01:28:47","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":24185,"visible":true,"origin":"","legend":"\u003cp\u003eMeasurement of TG\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4943752/v1/03616b839619b00e7fdb6076.jpg"},{"id":64708011,"identity":"c1642ba1-9aa2-4db2-a1bb-6f15bf620153","added_by":"auto","created_at":"2024-09-18 01:36:47","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":17909,"visible":true,"origin":"","legend":"\u003cp\u003eMeasurement of MLL, MAW, LAW\u003c/p\u003e","description":"","filename":"4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4943752/v1/91c3a6d76d0118d63173fd1f.jpg"},{"id":64707245,"identity":"d18bf630-a194-43e7-af75-ef5c59385322","added_by":"auto","created_at":"2024-09-18 01:28:47","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":369364,"visible":true,"origin":"","legend":"\u003cp\u003ea, b, c. Measurement of MPTSA\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-4943752/v1/5ba52490988846b2624eab12.png"},{"id":64707244,"identity":"d70a5b75-7cef-4327-84a8-60248ac0af3a","added_by":"auto","created_at":"2024-09-18 01:28:47","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":4923,"visible":true,"origin":"","legend":"\u003cp\u003eAMME-ROC graph according to OA grade\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-4943752/v1/7bc525c03146be687a0b22d0.png"},{"id":64709138,"identity":"82405720-4bd6-4927-852e-9bc84698659e","added_by":"auto","created_at":"2024-09-18 01:44:49","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1021023,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4943752/v1/464d9353-1e6b-422a-9d01-43454f11751d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Relationship of Medial Meniscus Posterior Root Tears with Proximal Tibial Morphology and Knee Osteoarthritis","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eThe meniscus plays crucial role in maintaining the function of the knee by contributing to load transmission, shock absorption, joint stability and lubrication, proprioception, and nutrient supply. Of these functions, the most important function for the prevention of arthritis is the maintenance of hoop tension that allows correct intraarticular load transmission for which the medial meniscus is approximately 90% responsible and the lateral meniscus is approximately 70% responsible. Medial meniscus posterior root tear (MMPRT) causes to the loss of hoop tension and, consequently, the meniscus's load transmission capability. As a result, the increased contact pressure on the weight-bearing surface accelerates joint degeneration[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRisk factors for meniscal tears include age, sex, lower limb alignment, obesity[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Recent studies also highlight that proximal tibial morphology (PTM) could be a risk factor for meniscal and ligament injuries\u003csup\u003e8,9,13\u003c/sup\u003e. PTM describes the geometric structure of tibia near the knee joint and tibial plateau. Various morphological measurements have been defined to assess PTM, including mediolateral length (MLL), medial anteroposterior width (MAW), lateral anteroposterior width (LAW), central-lateral length, central-medial length, tibial plateau surface area, medial posterior tibial slope angle (MPTSA), and lateral posterior tibial slope angle[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. MPTSA has the most significant impact on knee biomechanics among these measurements[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. There are just few studies associating MPTSA to MMPRT and this relationship has not yet been clearly elucidated[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMagnetic resonance imaging (MRI) is the gold standard non-invasive methods for diagnosing medial meniscus root tears and detecting accompanying knee pathologies [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe aim of this study is to investigate the effect of PTM on MMRTs and to determine the relationship between medial meniscal extrusion amount (MMEA) observed in root tears and osteoarthritis (OA).\u003c/p\u003e"},{"header":"MATERIAL AND METHOD","content":"\u003cp\u003ePatients who underwent knee MRI at our hospital between January 2020 and July 2022 were retrospectively evaluated. MRIs were obtained in the supine position with the knee in extension, using an extremity coil with a 1.5 Tesla MRI (Optima; GE Medical System, Milwaukee, Wisconsin, USA). A standardized MRI examination protocol was used (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSequences and parameters used in image acquasition in the study\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSequences\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTR / TE (ms)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMatriks\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eField of view ( cm)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSlice thickness ( mm )\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSagittal T1W FSE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e300\u0026ndash;500/ 5\u0026ndash;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e288 x 224\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18 x 18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSagittal 3D Cube FSE T2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1500 / 124,4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e224 x 224\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20 x 20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSagittal Fatsat Proton Density FSE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2300\u0026ndash;2800 / 20\u0026ndash;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e256 x 192\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18x18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCoronal Fatsat Proton Density FSE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2300\u0026ndash;2800 / 20\u0026ndash;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e288 x 224\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20 x 20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAxial Fatsat Proton Density FSE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2300\u0026ndash;2800 / 20\u0026ndash;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e288 x 224\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18 x 18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003ePatient images were anonymized and evaluated independently at different times by a radiology specialist with 5 years of experience and an associate professor of radiology with 10 years of experience in musculoskeletal radiology. The portion of the posterior horn of the medial meniscus 10 mm from posterior meniscal insertion to the tibial plateau was determined as posterior meniscal root. Patients with three main MRI findings were considered as MMRT:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eA linear high signal intensity perpendicular to the meniscus root in the axial plane.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eA vertical linear defect associated with \u0026gt;\u0026thinsp;3 mm medial meniscus extrusion at meniscus root.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eReappearance of the disappearing meniscus on consecutive sagittal sequences, known as \u0026ldquo;ghost meniscus\u0026rdquo; sign (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eTotal of 141 patients with MMRT were evaluated. Patients with a history of surgery (9 patients) or trauma (12 patients), those with a secondary tear accompanying the root tear in the medial meniscus (5 patients), patients with mass lesions in the knee joint (2 patients), and those whose evaluation was not possible due to image quality or protocol issues (13 patients) were excluded from the study. Total of 100 patients were included as MMPRT group in the study. Control group was created with 100 patients matched for age, sex, and side, who had no meniscus or ligament pathology (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe distance between the most medial point of the extruded part of the medial meniscus and the medial corner of the medial tibial plateau in mid-coronal plane, was recorded as the \u0026ldquo;MMEA\u0026rdquo;[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Osteophytes at the level of the medial tibial plateau were not included in the measurement area (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe distance between the perpendicular line drawn from the ACL attachment and the torn meniscus root in coronal plane, was defined as the \"tear gap\" (TG)[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eCartilage changes were evaluated and classified according to Modified Outerbridge classification for staging osteoarthritis at the knee joint[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003csup\u003e,\u003c/sup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e](Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eModified Outerbridge Classification\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDescription\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNormal cartilage\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT2 signal increase in morphologically normal cartilage\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSuperficial partial cartilage defect involving less than 50% of total joint surface thickness\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDeep partial cartilage defect involving more than 50% of total joint surface thickness\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFull-thickness cartilage defect\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eMLL, MAW, LAW, and MPTSA were used to evaluate PTM. For MLL, MAW, and LAW measurements, a line perpendicular to the medial tibial plateau extending 10 mm caudally was drawn in coronal plane. The lower end of this line was determined as the target point, and using reference lines in axial plane, MLL measurement was performed at this level on the x-axis. In the same section, MAW was measured at the point with the maximum anteroposterior width of the medial plateau on the y-axis, and LAW was measured at the point with the maximum anteroposterior width of the lateral plateau[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eMPTSA (the angle between the vertical line drawn to the tibial axis and the line passing from the anterior and posterior cortical points of medial tibial plateau in sagittal plane) was measured as described by Hudek et al.[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] (Figs.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003ea, \u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003eb, \u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003ec).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eDatas were evaluated using IBM SPSS Statistics Standard Concurrent User V 26 (IBM Corp., Armonk, New York, USA). Descriptive statistics were given as unit number (n), mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation, median (M), minimum (min), and maximum (max) values. The normal distribution of numerical variables was assessed with the Shapiro-Wilk normality test. The Mann-Whitney U test was used for comparisons of variables between two categories. The effect of independent variables was evaluated by linear regression analysis. The \"Roc Curve\" analysis method was used to compare the diagnostic performance of two or more diagnostic or measurement values. Two-way analysis of variance was used to evaluate dependent continuous variables with two or more independent categorical variables. Pearson and Fisher exact tests were used for comparisons between categorical variables. The effect of the MMEA variable on the tear gap and OA stage was evaluated by linear regression analysis. Differences in MLL, MAW, LAW, and MPTSA according to gender in the study groups were analyzed by two-way analysis of variance. Intra- and inter-observer agreement was evaluated with the Wilcoxon test for PTM measurements in both groups. P value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eThe demographic features of the MMRT and control groups are shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. There was no statistically significant difference between the two groups in terms of age, gender, and side (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of gender, age and side between groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eGroups\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTest statistics\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMMRT group\u003c/p\u003e \u003cp\u003e(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003cp\u003egroup\u003c/p\u003e \u003cp\u003e(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cem\u003ep value\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u0026gt;0,999\u003c/p\u003e \u003cp\u003e0,993\u003c/p\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0,999\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e, \u003cem\u003en\u003c/em\u003e (%)\u003c/p\u003e \u003cp\u003eMale\u003c/p\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47 (%47,0)\u003c/p\u003e \u003cp\u003e53 (%53,0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47 (%47,0)\u003c/p\u003e \u003cp\u003e53 (%53,0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;sd\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eMedian\u003c/em\u003e (\u003cem\u003emin\u003c/em\u003e-\u003cem\u003emax\u003c/em\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54,54\u0026thinsp;\u0026plusmn;\u0026thinsp;8,46\u003c/p\u003e \u003cp\u003e54 (40\u0026ndash;79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54,46\u0026thinsp;\u0026plusmn;\u0026thinsp;6,37\u003c/p\u003e \u003cp\u003e51 (47\u0026ndash;69)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSide\u003c/b\u003e\u003c/p\u003e \u003cp\u003eRight\u003c/p\u003e \u003cp\u003eLeft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46\u003c/p\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46\u003c/p\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe average of medial meniscal extrusion amount (MMEA) was 5.20\u0026thinsp;\u0026plusmn;\u0026thinsp;1.74 mm, and TG was 5.54\u0026thinsp;\u0026plusmn;\u0026thinsp;3.14 mm. In the linear regression analysis between the tear gap and MMEA, for every 1 mm increase in the tear gap, the extrusion amount increased by 1.10 mm.\u003c/p\u003e \u003cp\u003eKnee OA was more severe in MMRT group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). OA was more severe in women than men in both groups (p\u0026thinsp;=\u0026thinsp;0.026; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). There was moderate positive correlation between MMEA and knee OA(p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, R\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0,445)(Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, \u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). When MMEA exceeded 4 mm, cartilage loss was observed (sensitivity: 80.68%; specificity: 83.33%, AUC: 0.876, Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of OA grades according to gender\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep value\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOA grade\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOA grade\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMMRT group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (1\u0026ndash;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (1\u0026ndash;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0,026\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eControl group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0\u0026ndash;3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0\u0026ndash;3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0,001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eLinear regression analysis of OA grade and MMEA\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eβ\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003ese\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ezβ\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP value\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eOA grade\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMMEA (mm)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0,399\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,045\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0,667\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e8,860\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0,001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003eF\u003c/em\u003e\u0026thinsp;=\u0026thinsp;78,505; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0,001; \u003cem\u003eR\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0,445\u003c/p\u003e \u003cp\u003eDurbin-Watson\u0026thinsp;=\u0026thinsp;1,594\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eMLL, MAW, and LAW were smaller in women compared to men in both groups but There was no statistically significant difference between the two groups in terms of these PTM measurements (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of MLL, LAW and MAW between groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eGroups\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTest statistics\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMMRT group\u003c/p\u003e \u003cp\u003e(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;100)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003cp\u003egroup (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;100)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep value\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMLL (cm)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7,51\u0026thinsp;\u0026plusmn;\u0026thinsp;0,41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7,75\u0026thinsp;\u0026plusmn;\u0026thinsp;0,43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0,202\u003c/p\u003e \u003cp\u003e0,304\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6,52\u0026thinsp;\u0026plusmn;\u0026thinsp;0,29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6,74\u0026thinsp;\u0026plusmn;\u0026thinsp;0,35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLAW (cm)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4,45\u0026thinsp;\u0026plusmn;\u0026thinsp;0,33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4,68\u0026thinsp;\u0026plusmn;\u0026thinsp;0,38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0,321\u003c/p\u003e \u003cp\u003e0,361\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3,85\u0026thinsp;\u0026plusmn;\u0026thinsp;0,33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3,93\u0026thinsp;\u0026plusmn;\u0026thinsp;0,30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMAW (cm)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5,27\u0026thinsp;\u0026plusmn;\u0026thinsp;0,34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5,53\u0026thinsp;\u0026plusmn;\u0026thinsp;0,26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0,272\u003c/p\u003e \u003cp\u003e0,295\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4,31\u0026thinsp;\u0026plusmn;\u0026thinsp;0,34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4,62\u0026thinsp;\u0026plusmn;\u0026thinsp;0,26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eMPTSA was higher in women than in men in both groups, but this was not statistically significant (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). MPTSA was significantly higher in the MMRT group compared to the control group for both genders (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001)(Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of MPTSA between groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eGroups\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTest statistics\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMMRT group\u003c/p\u003e \u003cp\u003e(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;100)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003cp\u003egroup (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;100)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep value\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMPTSA (degree)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6,67\u0026thinsp;\u0026plusmn;\u0026thinsp;1,78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4,96\u0026thinsp;\u0026plusmn;\u0026thinsp;2,10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c5\" namest=\"c4\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u003c/b\u003e\u0026thinsp;\u003cb\u003e0,001\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u003c/b\u003e\u0026thinsp;\u003cb\u003e0,001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6,81\u0026thinsp;\u0026plusmn;\u0026thinsp;2,03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5,15\u0026thinsp;\u0026plusmn;\u0026thinsp;1,83\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIntraobserver and interobserver agreement was present for PTM measurements (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe first case of MMPRT was reported in 1991 by Pagnani et al[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. MMPRT is meniscal tear, located within 10 mm of the posterior root insertion of the meniscus, they are usually degenerative and occur in middle-aged women and may represent 21.5% MMPRTs[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Similar to the literature 53% of patients with MMPRT were female, with a mean age above 50 years in our study[\u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMedial meniscus, a crescent-shaped fibrocartilaginous structure, maintains its anatomical position during weight-bearing stress, with the anchoring horns and circumferential fiber bundles of the medial meniscus providing tensile strength. Radial meniscus tears can lead to medial meniscus extrusion due to the disruption of these root attachments or circumferential fiber bundles. Medial meniscus extrusion is defined as the significant medial displacement of the medial meniscus relative to the central edge of medial tibial plateau. Lerer et al. considered MMEA abnormal if it was 3 mm or more[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] .The average MMEA patitent with MMPRT was 5.2 mm in our study and this result is consistent with the literature.\u003c/p\u003e \u003cp\u003eThe first sign of OA is cartilage loss. Studies has shown the relationship between medial tibiofemoral cartilage loss and MMPRTs based on MR imaging and arthroscopic findings[\u003cspan additionalcitationids=\"CR20 CR21 CR22\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Guermazi et al. reported that the likelihood of onset and progression of medial tibiofemoral cartilage degeneration is higher in isolated MMPRTs compared to other types of meniscal tears[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Similar to this study, knee OA was more severe in MMPRT group compared to the control group in our study.\u003c/p\u003e \u003cp\u003eIt is known that patients with MMPRT have higher MMEA compared to those with other types of meniscal tears[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Studies indicate that increased MMEA accelerates the development of OA, and as MMEA increases, the presence and severity of OA also increase[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. We found that increased extrusion amount was associated with increased cartilage loss, the first sign of OA. Cartilage degeneration and loss were higher in women than in men. The mechanical disruption caused by meniscus tear or extrusion can alter the weight-bearing capacities of the tibiofemoral compartments, leading to damage to the joint cartilage and subchondral bone, thereby contributing to the development and progression of knee osteoarthritis[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Additionally, we revealed that cartilage loss begins when MMEA exceeds 4 mm, adding to the literature. Recent studies that compare the repair of MMPRT to total or partial meniscectomy and non-surgical treatment, showing superior outcomes with repair and lower rates of progression to knee OA and lower reoperation rate[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Our finding contribute the literature in this regard and suggests that repair of meniscus may give better results in patients with MMEA less than 4 mm, that is, in patients who have not yet started cartilage loss-knee OA. Therefore, patients with MMEA less than 4 mm may be candidates for repair. Nevertheless, clinically correlated new studies are needed.\u003c/p\u003e \u003cp\u003ePTM and biomechanics of knee joint are associated with ACL and meniscal tears. The geometry of the tibial plateau directly affects the biomechanics of the tibiofemoral joint. The MPTSA is the most commonly used measurement for evaluating this geometry[\u003cspan additionalcitationids=\"CR31\" citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Kodama et al. identified steeper MPTSA as a risk factor for MMPRTs in young patients[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. However, Altınayak et al. found no difference in MPTSA when comparing patients with MMPRTs to control group[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. We found that the MPTSA was statistically significantly higher in the group with MMPRTs compared to the control group, supporting the findings of Kodama et al. Steeper tibial pleatua is associated with the magnitude of shear force on the tibial plateau and affects the biomechanics of the tibiofemoral joint by increasing the anterior translational force acting on the posterior root of the medial meniscus, which may increase the risk of meniscal injury in adults[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThere is no study to our knowledge in the literature evaluating the relationship between MMPRT and MLL, MAW, and LAW measurements. This study is unique in the context in that it is the first study to evaluate these measurements. We found no difference in these tibial measurements between two groups. Zhang et al. reported that MLL, MAW and LAW were smaller in women than men in their study [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Similarly, we found that these measurements were smaller in women than in men.\u003c/p\u003e \u003cp\u003eThis study has few limitations. Arthroscopic correlation could not be performed for the included patients. Body mass index could not be evaluated due to the lack of height and weight information. Standard sequences were used to evaluate cartilage degeneration as specific sequences were not taken. Additionally, since our study was retrospective, clinical correlation with OA stage and MMPRT could not be performed.\u003c/p\u003e \u003cp\u003eIn conclusion, as MMEA increases in patients with MMPRT, cartilage degeneration and loss increase. Cartilage loss accompanies when MMEA exceeds 4 mm. MMPRT is associated with PTM. Steeper medial tibial plateau is a risk factor for MMPRT.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eData availability:\u003c/strong\u003e The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to their containing information that could compromise the privacy of patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest:\u003c/strong\u003e The authors declare that this study was conducted without any commercial or financial relationships that could be construed as a potential conflict of interest. The content of the publication is entirely the authors\u0026rsquo; responsibility, and the authors examined and edited it as necessary. Each author states that the submitted article, either in full or in part, has not been previously published or is not being assessed for publication as an original article in either printed form or as digital media.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Committee Approval:\u003c/strong\u003e Ethics committee approval was received for this study from Ankara Bilkent City Hospital Ethics Committee 1, Faculty of Medicine, Health Sciences University (Ethics Committee Approval Number: E1-23-3233).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e No funding was received for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contribution Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEren \u0026Ccedil;amur: Conceptualization, Data collection and analysis, Methodology, Manuscript writing\u0026amp;editing\u003c/p\u003e\n\u003cp\u003eSemra Duran: Methodology, Manuscript review\u0026amp;editing\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAllaire R, Muriuki M, Gilbertson L, Harner CD (2008) Biomechanical consequences of a tear of the posterior root of the medial meniscus. Similar to total meniscectomy, \u003cem\u003eJ Bone Joint Surg Am\u003c/em\u003e, vol. 90, no. 9, pp. 1922\u0026ndash;1931, Sep. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2106/JBJS.G.00748\u003c/span\u003e\u003cspan address=\"10.2106/JBJS.G.00748\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOkazaki Y et al (2021) Steep posterior slope and shallow concave shape of the medial tibial plateau are risk factors for medial meniscus posterior root tears, \u003cem\u003eKnee Surgery, Sports Traumatology, Arthroscopy\u003c/em\u003e, vol. 29, no. 1, pp. 44\u0026ndash;50, \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00167-019-05590-4\u003c/span\u003e\u003cspan address=\"10.1007/s00167-019-05590-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePhombut C, Rooppakhun S, Sindhupakorn B (2021) Morphometric measurement of the proximal tibia to design the tibial component of total knee arthroplasty for the Thai population. J Exp Orthop 8(1). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s40634-021-00429-9\u003c/span\u003e\u003cspan address=\"10.1186/s40634-021-00429-9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang X et al (2020) Effects of medial meniscal slope and medial posterior tibial slope on the locations of meniscal tears: A retrospective observational study. Medicine 99(47):e23351. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/MD.0000000000023351\u003c/span\u003e\u003cspan address=\"10.1097/MD.0000000000023351\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoon HS, Choi CH, Jung M, Lee DY, Eum KS, Kim SH (2020) Medial Meniscal Posterior Horn Tears Are Associated With Increased Posterior Tibial Slope: A Case-Control Study. Am J Sports Med 48(7):1702\u0026ndash;1710. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/0363546520917420\u003c/span\u003e\u003cspan address=\"10.1177/0363546520917420\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLaPrade RF, Ho CP, James E, Crespo B, LaPrade CM, Matheny LM (2015) Diagnostic accuracy of 3.0 T magnetic resonance imaging for the detection of meniscus posterior root pathology, \u003cem\u003eKnee Surg Sports Traumatol Arthrosc\u003c/em\u003e, vol. 23, no. 1, pp. 152\u0026ndash;157, Jan. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/S00167-014-3395-5\u003c/span\u003e\u003cspan address=\"10.1007/S00167-014-3395-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXu D et al (2021) Are changes in meniscus volume and extrusion associated to knee osteoarthritis development? A structural equation model. Osteoarthritis Cartilage 29(10):1426\u0026ndash;1431. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.joca.2021.07.007\u003c/span\u003e\u003cspan address=\"10.1016/j.joca.2021.07.007\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim JY, Il Bin S, Kim JM, Lee BS, Oh SM, Park MH (2019) Tear gap and severity of osteoarthritis are associated with meniscal extrusion in degenerative medial meniscus posterior root tears. Orthop Traumatology: Surg Res 105(7):1395\u0026ndash;1399. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.otsr.2019.09.015\u003c/span\u003e\u003cspan address=\"10.1016/j.otsr.2019.09.015\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNewman S, Ahmed H, Rehmatullah N (Dec. 2022) Radiographic vs. MRI vs. arthroscopic assessment and grading of knee osteoarthritis - are we using appropriate imaging? J Exp Orthop 9(1):1\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/S40634-021-00442-Y/TABLES/5\u003c/span\u003e\u003cspan address=\"10.1186/S40634-021-00442-Y/TABLES/5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKurt M, \u0026Ouml;ner AY, U\u0026ccedil;ar M, Aladağ Kurt S (2019) The relationship between patellofemoral arthritis and fat tissue volume, body mass index and popliteal artery intima-media thickness through 3T knee MRI. Turk J Med Sci 49(3):844\u0026ndash;853. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3906/SAG-1811-166\u003c/span\u003e\u003cspan address=\"10.3906/SAG-1811-166\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRanjan M, Rangaswamy N, Garika SS, Yadav C (Oct. 2022) Does One Size Really Fit All? Morphometric Analysis of Distal Femur and Proximal Tibia in an Ethnic Indian Population and Correlation to the Sizing of Existing Total Knee Arthroplasty Implants. Cureus 14(10). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.7759/CUREUS.30824\u003c/span\u003e\u003cspan address=\"10.7759/CUREUS.30824\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHudek R, Schmutz S, Regenfelder F, Fuchs B, Koch PP (2009) Novel measurement technique of the tibial slope on conventional MRI. Clin Orthop Relat Res 467(8):2066\u0026ndash;2072. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s11999-009-0711-3\u003c/span\u003e\u003cspan address=\"10.1007/s11999-009-0711-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePagnani MJ, Cooper DE, Warren RF (1991) Extrusion of the medial meniscus. Arthroscopy 7(3):297\u0026ndash;300. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/0749-8063(91)90131-G\u003c/span\u003e\u003cspan address=\"10.1016/0749-8063(91)90131-G\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMatheny LM, Ockuly AC, Steadman JR, LaPrade RF (2015) Posterior meniscus root tears: associated pathologies to assist as diagnostic tools, \u003cem\u003eKnee Surg Sports Traumatol Arthrosc\u003c/em\u003e, vol. 23, no. 10, pp. 3127\u0026ndash;3131, Oct. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/S00167-014-3073-7\u003c/span\u003e\u003cspan address=\"10.1007/S00167-014-3073-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim SB et al (2011) Medial meniscus root tear refixation: comparison of clinical, radiologic, and arthroscopic findings with medial meniscectomy. Arthroscopy 27(3). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/J.ARTHRO.2010.08.005\u003c/span\u003e\u003cspan address=\"10.1016/J.ARTHRO.2010.08.005\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee JH, Lim YJ, Kim KB, Kim KH, Song JH (2009) Arthroscopic pullout suture repair of posterior root tear of the medial meniscus: radiographic and clinical results with a 2-year follow-up, \u003cem\u003eArthroscopy\u003c/em\u003e, vol. 25, no. 9, pp. 951\u0026ndash;958, Sep. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/J.ARTHRO.2009.03.018\u003c/span\u003e\u003cspan address=\"10.1016/J.ARTHRO.2009.03.018\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHabata T, Uematsu K, Hattori K, Takakura Y, Fujisawa Y (Nov. 2004) Clinical features of the posterior horn tear in the medial meniscus. Arch Orthop Trauma Surg 124(9):642\u0026ndash;645. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/S00402-004-0659-4\u003c/span\u003e\u003cspan address=\"10.1007/S00402-004-0659-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLerer DB, Umans HR, Xu MX, Jones MH (2004) The role of meniscal root pathology and radial meniscal tear in medial meniscal extrusion, \u003cem\u003eSkeletal Radiol\u003c/em\u003e, vol. 33, no. 10, pp. 569\u0026ndash;574, Oct. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/S00256-004-0761-2\u003c/span\u003e\u003cspan address=\"10.1007/S00256-004-0761-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKoenig JH, Ranawat AS, Umans HR, DiFelice GS (Sep. 2009) Meniscal root tears: diagnosis and treatment. Arthroscopy 25(9):1025\u0026ndash;1032. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/J.ARTHRO.2009.03.015\u003c/span\u003e\u003cspan address=\"10.1016/J.ARTHRO.2009.03.015\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLerer DB, Umans HR, Xu MX, Jones MH (2004) The role of meniscal root pathology and radial meniscal tear in medial meniscal extrusion, \u003cem\u003eSkeletal Radiol\u003c/em\u003e, vol. 33, no. 10, pp. 569\u0026ndash;574, Oct. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/S00256-004-0761-2\u003c/span\u003e\u003cspan address=\"10.1007/S00256-004-0761-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee YG, Shim JC, Choi YS, Kim JG, Lee GJ, Kim HK (2008) Magnetic resonance imaging findings of surgically proven medial meniscus root tear: tear configuration and associated knee abnormalities. J Comput Assist Tomogr 32(3):452\u0026ndash;457. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/RCT.0B013E31812F4EB0\u003c/span\u003e\u003cspan address=\"10.1097/RCT.0B013E31812F4EB0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee DH et al (Feb. 2011) Predictors of degenerative medial meniscus extrusion: radial component and knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 19(2):222\u0026ndash;229. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/S00167-010-1274-2\u003c/span\u003e\u003cspan address=\"10.1007/S00167-010-1274-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSo YL, Jee WH, Kim JM (2008) Radial tear of the medial meniscal root: reliability and accuracy of MRI for diagnosis, \u003cem\u003eAJR Am J Roentgenol\u003c/em\u003e, vol. 191, no. 1, pp. 81\u0026ndash;85, Jul. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2214/AJR.07.2945\u003c/span\u003e\u003cspan address=\"10.2214/AJR.07.2945\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuermazi A et al (2013) Sep., Medial Posterior Meniscal Root Tears Are Associated with Development or Worsening of Medial Tibiofemoral Cartilage Damage: The Multicenter Osteoarthritis Study, \u003cem\u003eRadiology\u003c/em\u003e, vol. 268, no. 3, p. 814, \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1148/RADIOL.13122544\u003c/span\u003e\u003cspan address=\"10.1148/RADIOL.13122544\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFong FJY, Ong BWL, Lee YHD (Mar. 2023) Medial Meniscal Extrusion in Patients With Medial Meniscus Root Tears: A Systematic Review and Meta-analysis. Orthop J Sports Med 11(3). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/23259671231151698\u003c/span\u003e\u003cspan address=\"10.1177/23259671231151698\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim JY, Il Bin S, Kim JM, Lee BS, Oh SM, Park MH (2019) Tear gap and severity of osteoarthritis are associated with meniscal extrusion in degenerative medial meniscus posterior root tears. Orthop Traumatology: Surg Res 105(7):1395\u0026ndash;1399. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.otsr.2019.09.015\u003c/span\u003e\u003cspan address=\"10.1016/j.otsr.2019.09.015\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCrema MD et al (Aug. 2012) Factors Associated with Meniscal Extrusion in Knees with or at Risk for Osteoarthritis: The Multicenter Osteoarthritis Study. Radiology 264(2):494. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1148/RADIOL.12110986\u003c/span\u003e\u003cspan address=\"10.1148/RADIOL.12110986\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFaucett SC et al (2019) Mar., Meniscus Root Repair vs Meniscectomy or Nonoperative Management to Prevent Knee Osteoarthritis After Medial Meniscus Root Tears: Clinical and Economic Effectiveness, \u003cem\u003eAm J Sports Med\u003c/em\u003e, vol. 47, no. 3, pp. 762\u0026ndash;769, \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/0363546518755754\u003c/span\u003e\u003cspan address=\"10.1177/0363546518755754\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRo KH, Kim JH, Heo JW, Lee DH (2020) Clinical and Radiological Outcomes of Meniscal Repair Versus Partial Meniscectomy for Medial Meniscus Root Tears: A Systematic Review and Meta-analysis. Orthop J Sports Med 8(11). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/2325967120962078\u003c/span\u003e\u003cspan address=\"10.1177/2325967120962078\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMelugin HP et al (2023) Oct., Increased Posterior Tibial Slope Increases Force on the Posterior Medial Meniscus Root, \u003cem\u003eAm J Sports Med\u003c/em\u003e, vol. 51, no. 12, pp. 3197\u0026ndash;3203, \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/03635465231195841\u003c/span\u003e\u003cspan address=\"10.1177/03635465231195841\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAltinayak H, Karatekin YS (Oct. 2023) Increased Medial Femoral Condyle Angle and Narrow Intercondylar Notch Are Associated With Medial Meniscus Posterior Root Tear. Arthroscopy 39(10):2154\u0026ndash;2163. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/J.ARTHRO.2023.02.020\u003c/span\u003e\u003cspan address=\"10.1016/J.ARTHRO.2023.02.020\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKodama Y et al (Jan. 2023) Steep posterior slope of the medial tibial plateau and anterior cruciate ligament degeneration contribute to medial meniscus posterior root tears in young patients. Knee Surg Sports Traumatol Arthrosc 31(1):279\u0026ndash;285. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/S00167-022-07095-Z\u003c/span\u003e\u003cspan address=\"10.1007/S00167-022-07095-Z\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDeng X et al (Dec. 2021) The influence of the steep medial posterior tibial slope on medial meniscus tears in adolescent patients: a retrospective case-control study. BMC Musculoskelet Disord 22(1):1\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/S12891-021-04766-9/FIGURES/5\u003c/span\u003e\u003cspan address=\"10.1186/S12891-021-04766-9/FIGURES/5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang Y et al (Jul. 2018) Comparison between three-dimensional CT and conventional radiography in proximal tibia morphology. Med (United States) 97(30). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/MD.0000000000011632\u003c/span\u003e\u003cspan address=\"10.1097/MD.0000000000011632\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Meniscus, root, tear, morphology, osteoarthritis, tibia","lastPublishedDoi":"10.21203/rs.3.rs-4943752/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4943752/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose:\u003c/strong\u003e To investigate the relationship between proximal tibial morphology (PTM) and medial meniscus posterior root tears (MMPRT), and to evaluate the association between medial meniscal extrusion amount (MMEA) and osteoarthritis (OA) in patients with MMPRT.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterial and method:\u003c/strong\u003e This retrospective study analyzed knee MRIs of 100 patients with MMPRT and 100 age, gender, side paired controls. Medial posterior tibial slope angle (MPTSA), mediolateral length (MLL), medial anteroposteiror width (MAW), lateral anteroposteiror width (LAW), were used to evaluate PTM . MMEA and tear gap (TG) correlation and their relationship with knee OA severity was assessed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e MPTSA was significantly higher in MMPRT group compared to controls (p\u0026lt;0.001). Moderate positive correlation was found between MMEA and OA severity (R\u003csup\u003e2\u003c/sup\u003e=0.445, p\u0026lt;0.001). Cartilage loss was observed when MMEA exceeded 4 mm (sensitivity: 80.68%; specificity: 83.33%). MMEA increased by 1.10 mm for each 1 mm increase in TG.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e This groundbreaking study reveals that steeper medial tibial plateau is a significant risk factor for MMPRT. Strikingly, MMEA exceeding 4 mm serves as a critical threshold for cartilage loss, potentially revolutionizing treatment decisions. These findings not only enhance our understanding of MMPRT pathomechanics but also provide crucial insights for early intervention strategies, potentially altering the course of OA progression in patients with MMPRT.\u003c/p\u003e","manuscriptTitle":"Relationship of Medial Meniscus Posterior Root Tears with Proximal Tibial Morphology and Knee Osteoarthritis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-09-18 01:28:41","doi":"10.21203/rs.3.rs-4943752/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"fb7988b6-d779-4e36-a46f-7e858bf31d9f","owner":[],"postedDate":"September 18th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-09-18T01:28:44+00:00","versionOfRecord":[],"versionCreatedAt":"2024-09-18 01:28:41","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4943752","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4943752","identity":"rs-4943752","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}