Meniscectomy & Osteoarthritis: A Mean 40-Year Follow-Up

Abstract

Summary Patients who underwent total meniscectomy prior to their 19th birthday under the auspices of a single surgeon were reviewed clinically, radiographically and with PROMs. Abstract Data A mean 40-year follow-up outcomes of 53 patients who underwent open total meniscectomy prior to their 19th birthday, who had no other intra-articular pathology identified at the time, under the auspices of a single surgeon are presented. As part of a longitudinal follow-up the cohort of patients who underwent radiographic evaluation at the 30-year follow-up were identified and invited for clinical and radiographic evaluation as well as subjective review by 2 separate patient reported outcome measures (PROMs). The data were analysed with SPSS 17.0 (SPSS Inc., Chicago) statistical package where a p value of less than 0.05 was deemed o be statistically significant. Data were examined for normality using the Shapiro-Wilk test. Parametric data was analysed with paired t-test, and for non-parametric data the Wilcoxon signed-rank test and the Mann-Whitney U test were used. Correlations were scrutinised with the Kendall’s tau coefficient. Results 13.2% of patients have had a total knee arthroplasty (TKA) at the time of follow-up. An increased rate of osteoarthritis (OA) between the operated and non-operated knees was observed, indicating a >4-fold relative risk (RR) at 40 years post-operatively. A statistically significant difference was observed between the operated and non-operated knee in terms of range of motion (ROM) and tibiofemoral (TFJ) OA. All patients were deemed symptomatic as per KOOS score. The Kendall’s tau coefficient demonstrated a moderate but statistically significant inverse correlation between the Ahlback radiographic score and the IKDC, KOOS Sport and ADL scores (p=0.009, p=0.044, p=0.010 respectively) only. There was also a statistically significant negative correlation between radiographic OA scores and ROM (t = -0.61). Conclusion This is the longest mean follow-up reported in the English literature to date and it clearly demonstrates that total meniscectomy in adolescent patients is a cause of symptomatic knee osteoarthritis later in life, with a resultant 132-fold increase of arthroplasty rate in comparison to their geographical and age-matched peers.