Postarthroscopy Osteonecrosis of the Knee: Current Concepts

Abstract

Knee osteonecrosis is a severe disease rapidly leading to end-stage osteoarthritis, which was classified into three categories: spontaneous, secondary, and postarthroscopy. To understand postarthroscopy osteonecrosis of the knee, all the three types of knee osteonecrosis have to be deepened. This article reviewed spontaneous and secondary osteonecroses of the knee, with special focus upon postarthroscopy osteonecrosis, which is a rare form, affecting patients operated for arthroscopic knee surgery, most commonly for meniscectomy. Due to its rarity, patients and surgeons are often unprepared for this complication. A correct diagnosis is essential for appropriate treatment, and also to determine if a preexisting osteonecrosis was present, avoiding medicolegal sequelae, although many authors agree that osteonecrosis (both spontaneous and postarthroscopy) represent unpreventable and unpredictable conditions. In spontaneous osteonecrosis, the treatment is defined according to the size and the degree of the lesion, whereas in postarthroscopy osteonecrosis, the size of the lesion has no prognostic value, and therefore, the choice of the correct treatment is based more on the timing of the diagnosis. A diagnostic and therapeutic algorithm was outlined on the basis of the actual knowledge.

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

“…Secondary osteonecrosis has a multifactorial etiology, including trauma, chemotherapy, alcohol abuse and corticosteroid treatment. The patients are typically <45 years old and occurrence is more common in females than in males (26). Most cases of secondary osteonecrosis are bilateral and secondary osteonecrosis may also involve other joints (26).…”

“…The patients are typically <45 years old and occurrence is more common in females than in males (26). Most cases of secondary osteonecrosis are bilateral and secondary osteonecrosis may also involve other joints (26). Spontaneous osteonecrosis is idiopathic and it may be caused by chronic mechanical stress or a weight-bearing articular surface subjected to altered stresses as the result of subchondral fracture, or the progression of osteoarthritis.…”

“…Post-arthroscopic osteonecrosis is associated with subchondral collapse with altered knee mechanics. Patients of any age may be affected and it occurs without sex bias (26,27). For secondary and spontaneous osteonecrosis, bone edema may be observed soon after the onset of symptoms.…”

Pathophysiologie und aktuelle Behandlungskonzepte bei ausgewählten Osteonekrosen

“…Initial bestehen akut einsetzende anteromedial gelegene Gonalgien mit einem klinischem Befund mit Streckdefizit oder Erguss, der einer Innenmensikusläsion äh-nelt [24]. Sekundäre Osteonekrose treten bei eher jüngeren Patienten unter 45 Jahren mit bekannten Risikofaktoren (90 % Alkohol, Glukokortikoide) auf [25,26], während die post-arthroskopischen Osteonekrosen hauptsächlich nach einer Meniskektomie auftreten [26]. Während SONK in 94 % im medialen Femurkondylus lokalisiert ist [27], können die sekundäre und post-arthroskopische Osteonekrose auch im lateralen Kniekompartiment bzw.…”

“…Wichtig ist zudem, dass die Abgrenzung zwischen primär nicht diagnostizierten SONK und postarthroskopischer Osteonekrose schwierig sein kann. Bei einer MRT-Diagnostik innerhalb der ersten 6 Wochen nach Symptomentstehung besteht ein diagnostisches Fenster, sodass im Fall eine Meniskektomie und postoperativ bestehenden Schmerzen in Kombination mit einem neuaufgetretenem ossärem Ödem die Ätiologie nicht eindeutig zugeordnet werden kann [26].…”