AJSM - 2026-05-15 - Journal Article
Delayed Surgical Treatment of Pediatric and Adolescent Medial Meniscus Posterior Root Tears Is Associated With Increased Odds of Medial Tibiofemoral Compartment Cartilage Injury: A Multicenter Study.
Moran J, Amaral JZ, Ortiz E, Farhat AG, Jones RH, Groff KD, Tollefson LV, LaPrade CM, Katz LD, Gardner E, Hsu J, Franklin C, Allen CR, Jimenez AE, Medvecky MJ, Hewett TE, Chahla J, McKay SD, Fabricant PD, LaPrade RF
Topics
Key Takeaway
Delayed MMPRT repair (≥90 days) carries 4.96-fold increased odds of medial tibiofemoral cartilage injury in patients under 19, with 45% of the cohort already demonstrating arthroscopic cartilage damage at time of surgery.
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Summary
This multicenter study examined risk factors for medial compartment cartilage injury in 75 patients under 19 undergoing transosseous MMPRT repair across 5 institutions from 2015–2025. Arthroscopic cartilage injury was present in 45% at surgery, predominantly ICRS grade 2 on the MFC, with 24% classified as high-grade (ICRS 3–4). Multivariable logistic regression identified delayed surgery ≥90 days (OR 4.96; 95% CI 1.6–15) and increasing age per year (OR 1.33; 95% CI 1.02–1.73) as independent predictors of cartilage injury.
Key Limitation
The absence of postoperative follow-up data means the study cannot determine whether early repair prevents cartilage progression or whether the identified ICRS grade 2 lesions are clinically consequential long-term.
Original Abstract
BACKGROUND
Medial meniscus posterior root tears (MMPRTs) have been associated with rapidly progressive cartilage degeneration when left untreated in adults. However, their clinical presentation, tear morphology, and associated cartilage pathology remain poorly characterized in pediatric and adolescent patients.
PURPOSE
To identify risk factors for medial tibiofemoral compartment cartilage injury in pediatric and adolescent patients undergoing MMPRT repair, and secondarily to characterize MMPRT morphologies and skeletal maturity-associated injury patterns.
STUDY DESIGN
Case series; Level of evidence, 4.
METHODS
Patients <19 years of age who underwent a transosseous MMPRT repair between 2015 and 2025 across 5 institutions were included. Operative records were reviewed to classify MMPRT morphology using the LaPrade classification and to document concomitant ligamentous procedures. The presence, location, and severity of arthroscopically identified medial tibiofemoral compartment cartilage injuries involving the medial femoral condyle (MFC) and/or medial tibial plateau were graded using the International Cartilage Regeneration & Joint Preservation Society (ICRS) classification. Patients with and without medial compartment cartilage injury were compared, and multivariable logistic regression was used to identify risk factors associated with its presence at the time of surgery.
RESULTS
A total of 75 patients underwent a transosseous MMPRT repair (mean age, 15.2 ± 2.3 years), and 40% were skeletally immature. The most common MMPRT morphology was a type 5 root avulsion (55%), followed by a type 2 complete radial root tear (36%). Skeletally immature patients more frequently sustained isolated MMPRTs (60% vs 11%; P < .001), whereas skeletally mature adolescents more commonly had ligament-associated MMPRTs (89% vs 40%; P < .001). Overall, medial compartment cartilage injury was arthroscopically identified in 34 patients (45%) at the time of surgery. Most cartilage injuries involved the MFC (82%) and were classified as ICRS grade 1 (15%) or grade 2 (62%), while 24% were high-grade (ICRS grade 3 or 4). Multivariable logistic regression demonstrated that age (OR per year, 1.33; 95% CI, 1.02-1.73; P = .03) and delayed surgery (≥90 days after injury) (OR, 4.96; 95% CI, 1.6-15; P = .005) were significantly associated with medial compartment cartilage injury. The association between delayed surgery and medial compartment cartilage injury remained consistent in a sensitivity analysis incorporating concomitant ligament injury.
CONCLUSION
Concomitant medial compartment cartilage injury was arthroscopically identified in 45% of pediatric and adolescent patients undergoing MMPRT repair. While most of these cartilage injuries involved the MFC and were classified as ICRS grade 2, nearly one-quarter were high-grade lesions (ICRS grade 3 or 4). Increasing age and delayed surgery (≥90 days after injury) were significantly associated with medial compartment cartilage injury. Overall, these findings underscore the potential importance of timely recognition and surgical treatment of MMPRTs in young patients.