Post‑arthroscopic osteonecrosis of the knee: A case report and literature review

Abstract

Post-arthroscopic osteonecrosis is a rare complication of arthroscopic surgery. The present study reported on a case of knee osteonecrosis after arthroscopic surgery. The patient, an 81-year-old male, presented with left knee pain and limited range of motion without any history of trauma. MRI revealed medial meniscus tear. Medial partial meniscectomy was performed using arthroscopy. The pain was found to be relieved due to the operation. However, there was an aggravation of pain after two months post-operatively. X-ray revealed that the subchondral bone in the medial femoral condyle (MFC) had collapsed. MRI revealed a large area of bone marrow edema in the MFC with cartilage delamination and subchondral flattening. Considering the age of the patient and the large area of bone necrosis, total knee arthroplasty was performed. At the 1-year follow-up, the Knee Society Knee Score improved from 44 points pre-operatively to 90 points and the Knee Society Functional Score was elevated from 35 to 90 points. Patient-reported outcome measures were assessed in the form of the Oxford Knee Score, which was 16. Furthermore, previous case reports of post-arthroscopic osteonecrosis were reviewed and the clinical and radiographic features, as well as the treatment, were summarized. If the patient complains of persistent and worsening pain after arthroscopy, particularly in elderly osteoporotic patients with meniscal tears or chondral lesions, the possibility of post-arthroscopic knee osteonecrosis should be considered. Diagnosis and treatment at the early stages are likely to be beneficial for the outcome.

Knee osteonecrosis after SARS-CoV-2 infection: a systematic case-based review

“…Sixteen days after the procedure the patient was positive for SARS-CoV-2. Several authors have previously hypothesized that the arthroscopic procedure could cause osteonecrosis, and called it post-operative or post arthroscopy ON [40,41]. In the author's case report, the two possible causes of osteonecrosis were meniscal tear or arthroscopy.…”

Delayed Avascular Necrosis of the Talus Following Arthroscopic Os Trigonum Excision

“…The pathophysiology is still not fully understood but studies have suggested that it could be due to heat generated to the subchondral bone from radiofrequency probes or more likely from the increased biomechanical load causing insufficiency fractures within the femoral condyle after partial meniscectomy within the compartment. 6,19 There have also been some case reports of AVN after arthroscopic anterior cruciate ligament reconstruction 10 or patellar osteonecrosis after arthroscopy presumably due to excessive disruption of the anterior fat pad. 3 Osteonecrosis of the femoral head with arthroscopy has been rarely seen and reported.…”

Aseptische Osteonekrose des medialen Femurkondylus bei einem Patienten mit akuter SARS-CoV-2 Infektion

“…Das gelegentliche Auftreten eines primär radiologisch nicht sichtbaren Knochenmarködems nach Kniegelenkarthroskopie ist bekannt und wurde erstmals von Brahme et al. 1991 beschrieben [ 4 , 5 ]. Das Ausmaß der Nekrose macht dies jedoch im aktuellen Fall eher unwahrscheinlich.…”