Arthroscopic Partial Meniscectomy for Painful Degenerative Meniscal Tears in the Presence of Knee Osteoarthritis in Patients Older than 50 Years of Age: Predictors of an Early (1 to 5 Years) Total Knee Replacement

Document Type: RESEARCH PAPER

Authors

1 Department of Orthopaedic Surgery, La Paz University Hospital-IdiPaz, Madrid, Spain

2 Department of Orthopaedic Surgery, La Paz University Hospital-IdiPaz, Madrid, Spain.

Abstract

 
Background: The role of arthroscopic partial meniscectomy (APM) for painful degenerative meniscal tears (PDMT) is currently controversial.
To define the rate of early (1 to 5 years) conversion to total knee replacement (TKR) and their predictors after APM for PDMT in patients with knee osteoarthritis and more than 50 years of age.
Methods: Retrospective cohort study of patients more than 50 years of age with the diagnosis of PDMT, treated by means of APM. Patients were classified in two groups: Patients that required an early (between 1 and 5 years after APM) TKR (TKR group) after its failure and patients that did not require a TKR (non-TKR group). Patient demographics, general characteristics, Kellgren & Lawrence (KL) classification, Outerbridge classification, and other characteristics were analyzed. Postoperative variables were also analyzed: pain, use of walking aids and use of intra-articular injections (hyaluronic acid or corticosteroids) at 3, 6, and 12 months of follow-up.
Results: A total of 356 patients (356 APMs) were included. Forty-nine patients (13.7%) required an early (1.8 years on average) TKR and 307 did not. The main predictor of early TKR was the grade of the KL classification. After APM, the presence of pain and the need of walking aids also were predictors of an early TKR.
Conclusion: In patients older than 50 years with PDMT, APM should be cautiously indicated in case of KL grade of 1 or more. Postoperative pain and prolonged need of walking aids were also predictors of an early (mean 1.8 years) TKR.
Level of evidence: IV

Keywords

Main Subjects


1. Alipour M, Tabari M. Effect of dexmedetomidine on
postoperative pain in knee arthroscopic surgery; a
randomized controlled clinical trial. Arch Bone Jt
Surg. 2014; 2(1):52.
2. Nahravani M, Tekye SM, Alipour M, Makhmalbaf
H, Aghaee MA. Analgesia following arthroscopy–a
comparison of intra-articular bupivacaine and/or
midazolam and or fentanyl. Arch Bone Jt Surg. 2017;
5(1):28.
3. Howell R, Kumar NS, Patel N, Tom J. Degenerative
meniscus: pathogenesis, diagnosis, and treatment
options. World J Orthop. 2014; 5(5):597-602.
4. Katz JN, Brophy RH, Chaisson CE, de Chaves L, Cole BJ,
Dahm DL, et al. Surgery versus physical therapy for a
meniscal tear and osteoarthritis. N Engl J Med. 2013;
368(18):1675-84.
5. Skedros JG, Knight AN, Thomas SC, Paluso AM, Bertin
KC. Dilemma of high rate of conversion from knee
arthroscopy to total knee arthroplasty. Am J Orthop
(Belle Mead NJ). 2014; 43(7):E153-8.
6. Thorlund JB, Juhl CB, Roos EM, Lohmander LS.
Arthroscopic surgery for degenerative knee:
systematic review and meta-analysis of benefits and
harms. Br J Sports Med. 2015; 49(19):1229-35.
7. Bollen SR. Is arthroscopy of the knee completely
useless? Meta-analysis--a reviewer’s nightmare. Bone Joint J. 2015; 97-B(12):1591–2.

8. Bailey O, Gronkowski K, Leach WJ. Effect of body
mass index and osteoarthritis on outcomes following
arthroscopic meniscectomy: a prospective nationwide
study. Knee. 2015; 22(2):95-9.
9. Meniscus consensus. ESSKA. Available at: URL: www.
esska/org/education/projects; 2017.
10. Monk P, Garfjeld Roberts P, Palmer AJ, Bayliss L,
Mafi R, Beard D, et al. The urgent need for evidence
in arthroscopic meniscal surgery. Am J Sports Med.
2016; 45(4):965-73.
11. Kise NJ, Risberg MA, Stensrud S, Ranstam J,
Engebretsen L, Roos EM. Exercise therapy versus
arthroscopic partial meniscectomy for degenerative
meniscal tear in middle aged patients: randomised
controlled trial with two year follow-up. BMJ. 2016;
354:i3740.
12. Kellgren JH, Lawrence JS. Radiological assessment
of osteo-arthrosis. Ann Rheum Dis. 1957; 16(4):
494-502.
13. Outerbridge RE. The etiology of chondromalacia
patellae. J Bone Joint Surg Br. 1961; 43-B:752-7.
14. Sihvonen R, Englund M, Turkiewicz A, Järvinen TL.
Mechanical symptoms as an indication for knee
arthroscopy in patients with degenerative meniscus
tear: a prospective cohort study. Osteoarthritis
Cartilage. 2016; 24(8):1367-75.
15. Moseley JB, O’Malley K, Petersen NJ, Menke TJ,
Brody BA, Kuykendall DH, et al. A controlled trial of
arthroscopic surgery for osteoarthritis of the knee. N
Engl J Med. 2002; 347(2):81-8.
16. Herrlin S, Hållander M, Wange P, Weidenhielm L,
Werner S. Arthroscopic or conservative treatment
of degenerative medial meniscal tears: a prospective
randomised trial. Knee Surg Sports Traumatol
Arthrosc. 2007; 15(4):393-401.
17. Kirkley A, Birmingham TB, Litchfield RB, Giffin JR,
Willits KR, Wong CJ, et al. A randomized trial of
arthroscopic surgery for osteoarthritis of the knee. N
Engl J Med. 2008; 359(11):1097-107.
18. Sihvonen R, Englund M, Turkiewicz A, Järvinen TL;
Finnish Degenerative Meniscal Lesion Study Group.
Mechanical symptoms and arthroscopic partial
meniscectomy in patients with degenerative meniscus
tear: a secondary analysis of a randomized trial. Ann
Intern Med. 2016; 164(7):449-55.
19. Yim JH, Seon JK, Song EK, Choi JI, Kim MC, Lee KB,
et al. A comparative study of meniscectomy and
nonoperative treatment for degenerative horizontal
tears of the medial meniscus. Am J Sports Med. 2013;
41(7):1565-70.
20. Englund M, Roemer FW, Hayashi D, Crema MD,
Guermazi A. Meniscus pathology, osteoarthritis and
the treatment controversy. Nat Rev Rheumatol. 2012;
8(7):412-9.
21. Herrlin SV, Wange PO, Lapidus G, Hållander M,
Werner S, Weidenhielm L. Is arthroscopic surgery
beneficial in treating non traumatic, degenerative
medial meniscal tears? A five year follow-up. Knee
Surg Sports Traumatol Arthrosc. 2013; 21(2):358-64.
22. Khan M, Evaniew N, Bedi A, Ayeni OR, Bhandari M.
Arthroscopic surgery for degenerative tears of the
meniscus: a systematic review and meta-analysis.
CMAJ. 2014; 186(14):1057-64.
23. Petersen W, Achtnich A, Lattermann C, Kopf S. The
treatment of non-traumatic meniscus lesions. Dtsch
Arztebl Int. 2015; 112(42):705-13.
24. Demange MK, Gobbi RG, Camanho GL. “Fatigue
meniscal tears”: a description of the lesion and the
results of arthroscopic partial meniscectomy. Int
Orthop. 2016; 40(2):399-405.
25. Roemer FW, Kwoh CK, Hannon MJ, Hunter DJ, Eckstein
F, Grago J, et al. Partial meniscectomy is associated with
increased risk of incident radiographic osteoarthritis
and worsening cartilage damage in the following year.
Eur Radiol. 2017; 27(1):404-13.