J Korean Orthop Assoc.  2008 Feb;43(1):86-92. 10.4055/jkoa.2008.43.1.86.

A Study on the Development of Degenerative Osteoarthritis after Arthroscopic Total Menisectomy

• Jeong BO
• Yoon KH
• Bae DK
• Lee DH

• KMID: 2106421
• DOI: http://doi.org/10.4055/jkoa.2008.43.1.86

Abstract

PURPOSE: This study compared the clinical and radiological incidence of osteoarthritis after a total meniscectomy.
MATERIALS AND METHODS
Seventy eight patients, who underwent a total meniscectomy, were evaluated after a minimum follow up of five years. The operations were a medial meniscectomy (group I) in 16 cases, a lateral meniscectomy (group II) in 17 cases, a discoid meniscus (group III) in 29 cases and medial meniscectomy with an anterior cruciate ligament reconstruction (group IV) in 16 cases. The development of degenerative osteoarthritis was analyzed using the Kaplan-Meyer survivorship.
RESULTS
At postoperative 5 years and 7 years, degenerative osteoarthritis developed in 17% and 36% of patients, respectively. The incidence ofdegenerative osteoarthritis at postoperative 5 years and 7 years in groups I, II, III and IV was 9% and 18%, 14% and 29%, 25% and 46%, and 28% and 55%, respectively. The difference was statistically significant.
CONCLUSION
The meniscus deficient knee joint which varies according to the patterns of a meniscal injury, had a higher incidence of degenerative osteoarthritis. Careful attention should be paid to the treatment of meniscal tears.

Keyword

Knee; Degenerative osteoarthritis; Meniscal injury; Total meniscectomy

MeSH Terms

Anterior Cruciate Ligament Reconstruction
Follow-Up Studies
Humans
Incidence
Knee
Knee Joint
Osteoarthritis

Figure

• 

  Fig. 1 An anteroposterior radiograph, which was obtained eight years after the meniscectomy, showed a ridge along the margin of the lateral femoral condyle (arrow) in the left knee.

• 

  Fig. 2 Overall development of degenerative osteoarthritis after a total meniscecomy estimated by Kaplan-Meyer survivorship analysis.

• 

  Fig. 3 Different pattern of degenerative osteoarthritis according to groups after a total meniscectomy. Discrimination in the rate of arthritic change was observed. *Group I medial meniscectomy; Group II lateral meniscectomy; Group III meniscectomy on discoid meniscus; Group IV medial meniscectomy with ACL reconstruction.

• 

  Fig. 4 (A) Group II had a tendency to show degenerative change earlier than in Group I after a total meniscectomy (p<0.05, log rank test). (B) The same comparison of Group II with III. Group III had a tendency to show degenerative changes earlier than Group II (p<0.05). (C) Same comparison of Group III with IV. Group IV had a tendency to show degenerative change earlier than Group III (p<0.05).

Reference

1. Ahlbäck S. Osteoarthrosis of the knee. A radiographic investigation. Acta Radiol Diagn (Stockh). 1968. 277:Suppl. 7–72.

2. Aichroth PM, Patel DV, Marx CL. Congenital discoid lateral meniscus in children. A follow-up study and evolution of management. J Bone Joint Surg Br. 1991. 73:932–936.

3. Allen CR, Wong EK, Livesay GA, Sakane M, Fu FH, Woo SL. Importance of the medial meniscus in the anterior cruciate ligament-deficient knee. J Orthop Res. 2000. 18:109–115.

4. Baratz ME, Fu FH, Mengato R. Meniscal tears: the effect of meniscectomy and of repair on intraarticular contact areas and stress in the human knee. A preliminary report. Am J Sports Med. 1986. 14:270–275.

5. Cannon WD Jr. McGinty JB, Caspari RB, Jackson RW, Poehling GG, editors. Arthroscopic meniscal repair. Operative arthroscopy. 1999. 2nd ed. Philadelphia: Lippincott-Raven Inc;299–315.

6. Cole BJ, Carter TR, Rodeo SA. Allograft meniscal transplantation: background, techniques, and results. Instr Course Lect. 2003. 52:383–396.

7. Cooper DE, Arnoczky SP, Warren RF. Arthroscopic meniscal repair. Clin Sports Med. 1990. 9:589–607.

8. Dienst M, Burks RT, Greis PE. Anatomy and biomechanics of the anterior cruciate ligament. Orthop Clin North Am. 2002. 33:605–620.

9. Fairbank TJ. Knee joint changes after meniscectomy. J Bone Joint Surg Br. 1948. 30:664–670.

10. Fukubayashi T, Kurosawa H. The contact area and pressure distribution pattern of the knee. A study of normal and osteoarthrotic knee joints. Acta Orthop Scand. 1980. 51:871–879.

11. Hede A, Larsen E, Sandberg H. Partial versus total meniscectomy. A prospective, randomised study with longterm follow-up. J Bone Joint Surg Br. 1992. 74:118–121.

12. Ikeuchi H. Arthroscopic treatment of the discoid lateral meniscus. Technique and long-term results. Clin Orthop Relat Res. 1982. 167:19–28.

13. Jorgensen U, Sonne-Holm S, Lauridsen F, Rosenklint A. Long-term follow-up of meniscectomy in athletes. A prospective longitudinal study. J Bone Joint Surg Br. 1987. 69:80–83.

14. Kaplan EB. Discoid lateral meniscus of the knee joint; nature, mechanism, and operative treatment. J Bone Joint Surg Am. 1957. 39:77–87.

15. King D. The function of semilunar cartilage. J Bone Joint Surg Am. 1936. 18:1069–1076.

16. Lysholm J, Gillquist J. Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med. 1982. 10:150–154.

17. Milachowski KA, Weismeier K, Wirth CJ. Homologous meniscus transplantation. Experimental and clinical results. Int Orthop. 1989. 13:1–11.

18. Noyes FR, Schipplein OD, Andriacchi TP, Saddemi SR, Weise M. The anterior cruciate ligament-deficient knee with varus alignment. An analysis of gait adaptations and dynamic joint loadings. Am J Sports Med. 1992. 20:707–716.

19. Paletta GA Jr, Levine DS, O'Brien SJ, Wickiewicz TL, Warren RF. Patterns of meniscal injury associated with acute anterior cruciate ligament injury in skiers. Am J Sports Med. 1992. 20:542–547.

20. Rodeo SA. Meniscal allografts--where do we stand? Am J Sports Med. 2001. 29:246–261.

21. Shoemaker SC, Markolf KL. The role of the meniscus in the anterior-posterior stability of the loaded anterior cruciate-deficient knee. Effects of partial versus total excision. J Bone Joint Surg Am. 1986. 68:71–79.

22. Washington ER 3rd, Root L, Liener UC. Discoid lateral meniscus in children. Long-term follow-up after excision. J Bone Joint Surg Am. 1995. 77:1357–1361.