Arthroscopic, open partial, and total meniscectomy. A comparative study

Northmore-Ball,; Dandy, David J.; Rw, Jackson

doi:10.1302/0301-620x.65b4.6874710

Cited by 164 publications

(58 citation statements)

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“…Substantial function of the residual meniscus in shock absorption and load transmission would thus remain. However, the evidence for improved long-term outcome after partial meniscal resection is limited (2,8,(24)(25)(26). To our knowledge, the present study is the first, using a large number of subjects, to show that partial meniscal resection induces less radiographic OA over time than does total meniscectomy.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for symptomatic knee osteoarthritis fifteen to twenty‐two years after meniscectomy

Englund¹,

Lohmander²

2004

Arthritis & Rheumatism

489

438

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Objective. To evaluate the influence of age, sex, body mass index (BMI), extent of meniscal resection, cartilage status, and knee load on the development of radiographically evident osteoarthritis (OA) of the knee and knee symptoms after meniscal resection.Methods. We evaluated 317 patients with no cruciate ligament injury (mean ؎ SD age 54 ؎ 11 years) who had undergone meniscal resection 15-22 years earlier (followup rate 70%), with radiographic and clinical examination. The Knee injury and Osteoarthritis Outcome Score was used to quantify knee-related symptoms. Sixty-eight unoperated subjects identified from national population records were included as a reference group.Results. Symptomatic radiographic OA (corresponding to Kellgren/Lawrence grade >2) was present in 83 of 305 operated knees (27%) and 7 of 68 control knees (10%) (relative risk 2.6, 95% confidence interval [95% CI] 1.3-6.1). Patients who had undergone total meniscectomy and subjects with obesity (BMI >30) had a greater likelihood of tibiofemoral radiographic OA than those who had undergone partial meniscal resection and those with a BMI <25, respectively. Furthermore, degenerative meniscal tear, intraoperative cartilage changes, and lateral meniscectomy were associated with radiographic OA more frequently than were longitudinal tear, absence of cartilage changes, and medial meniscectomy, respectively. Symptomatic tibiofemoral or patellofemoral radiographic OA was associated with obesity, female sex, and degenerative meniscal tear.Conclusion. Contributing risk factors for OA development after meniscal resection are similar to risk factors for common knee OA. Systemic factors and local biomechanical factors interact. Obesity, female sex, and preexisting early-stage OA are features associated with poor self-reported and radiographic outcome. Partial meniscal resection is associated with less radiographic OA over time than is total meniscectomy.

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Section: Discussionmentioning

confidence: 99%

Risk factors for symptomatic knee osteoarthritis fifteen to twenty‐two years after meniscectomy

Englund¹,

Lohmander²

2004

Arthritis & Rheumatism

489

438

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“…As suggested by reports from Tapper and Hoover and some other investigators the preservation of an intact peripheral rim of the meniscus may produce better long-term results (Tapper and Hoover 1969, Northmore-Ball et al 1983, Chatain et al 2001, Andersson-Molina et al 2002. If a substantial portion of the circumferentially oriented matrix fi bers is intact, hoop tension may still develop, which counteracts meniscal extrusion when the knee is loaded.…”

Section: Partial Meniscectomy-less Radiographic Changesmentioning

confidence: 93%

Meniscal tear - a feature of osteoarthritis

Englund¹

2004

SORT

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Meniscectomy is recognized as an important risk factor for the development of knee osteoarthritis (OA), a disease that traditionally has been considered as a simple "wear and tear" phenomenon. However, despite numerous reports, little evidence has been presented that a limited meniscal resection, compared with a more extensive resection, reduces the risk of OA by preserving meniscal function. Why? This thesis provides one possible answer to that question.Patients, who had undergone isolated meniscal resection in 1973, 1978, or between 1983 and 1985 at Lund University Hospital, Sweden, were reviewed clinically and radiographically 15-22 years after the surgical procedure.Of the subjects (n = 317) almost 50% had developed radiographic OA in their operated knee, but just over half of these patients were symptomatic. An additional 20% of the patients had knee symptoms, but did not have radiographic knee OA. These results confi rm a limited correlation between radiographic features of the disorder and symptoms.A degenerative type of meniscal tear and obesity were the factors most strongly associated with both radiographic knee OA and symptomatic radiographic knee OA.Partial meniscal resection induced less radiographic changes related to knee OA compared with total meniscectomy, but the patient-relevant outcomes remained essentially the same.If radiographic hand OA was present there was an increased likelihood of the patient also having knee OA following meniscectomy. This fi nding was independent of age, and therefore an inherited susceptibility to the disease contributes to the risk of knee OA after meniscal tear. Genetic and environmental risk factors interact in OA development.A degenerative meniscal lesion is often associated with early-stage knee OA, a disorder also involving the meniscal tissue. The tear may thus represent the fi rst "signal" feature of OA. The challenge for the health professional is to discriminate between symptoms caused by a meniscal tear and those caused by OA. Meniscal resection may not benefi t the patient with early-stage knee OA. The intervention merely removes evidence of the disorder, while the OA joint degradation proceeds.

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“…Over the past several decades, surgical methods have shifted to use of arthroscopic technique and minimal resections of damaged meniscal tissue, with the intent to reduce the risk of subsequent OA by preserving as much of the meniscal function as possible. Short-term benefits such as shortened hospital stay and recovery time have been proven for limited meniscus resection, as opposed to more extensive surgery, but so far improved long-term outcome has not been convincingly documented (7)(8)(9)(10)(11)(12)(13). The radiologic and clinical outcomes reported in previous studies vary considerably, probably due to heterogeneous groups of patients with respect to extent of injury, ligament status, range of followup times, and to high dropout rates, small samples, or lack of appropriate controls (13).…”

mentioning

confidence: 99%

Impact of type of meniscal tear on radiographic and symptomatic knee osteoarthritis: A sixteen‐year followup of meniscectomy with matched controls

Englund¹,

Roos²,

Lohmander³

2003

Arthritis & Rheumatism

541

515

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Objective. To investigate long-term radiographic and patient-relevant outcome of isolated limited meniscectomy with regard to type of meniscal tear and extent of surgical resection.Methods. We studied 155 patients with intact cruciate ligaments (mean ؎ SD age 54 ؎ 12 years) who had undergone meniscectomy an average of 16 ؎ 1 years earlier. The patients were examined using standardized radiography and validated self-administered questionnaires. The Knee Injury and Osteoarthritis Outcome Score (KOOS) was used to quantify knee-related symptoms, and the definition of a symptomatic knee was determined. We used 68 control subjects matched for age, sex, and body mass index to calculate the relative risks (RRs).Results. Radiographic tibiofemoral osteoarthritis (OA) (Kellgren/Lawrence grade >2) was present in 66 index knees (43%), of which 39 (59%) were considered to be symptomatic according to the KOOS. In total, 77 patients (50%) had a symptomatic index knee. In a multivariate model, degenerative meniscal tears were associated with both radiographic OA (P ‫؍‬ 0.030) and combined radiographic and symptomatic OA (P < 0.015). The RRs for combined radiographic and symptomatic OA after degenerative and traumatic types of meniscal tear were 7.0 (95% confidence interval [95% CI] 2.1-23.5) and 2.7 (95% CI 0.9-7.7), respectively, compared with matched controls.Conclusion. An isolated meniscal tear treated by limited meniscectomy is associated with a high risk of radiographic and symptomatic tibiofemoral OA at 16-year followup. Factors associated with worse outcome were degenerative meniscal lesions and extensive resections. We suggest that degenerative meniscal tears may be associated with incipient OA, and that the meniscal tear signals the first symptom of the disease.

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Arthroscopic, open partial, and total meniscectomy. A comparative study

Cited by 164 publications

References 0 publications

Risk factors for symptomatic knee osteoarthritis fifteen to twenty‐two years after meniscectomy

Risk factors for symptomatic knee osteoarthritis fifteen to twenty‐two years after meniscectomy

Meniscal tear - a feature of osteoarthritis

Impact of type of meniscal tear on radiographic and symptomatic knee osteoarthritis: A sixteen‐year followup of meniscectomy with matched controls

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