Arthroscopic Medial Meniscectomy Research Articles

Lipoma arborescence following knee arthroscopy: A case report and literature review

Lipoma arborescence is a rare, reactive disease process which commonly occurs due to chronic inflammation or repeated trauma. A limited number of cases have been documented in the literature and little is known regarding the pathogenesis of this condition. Fortunately, it is a benign condition with no known cases of neoplastic conversion. Here, we present the unique case of a lipoma arborescence occurring in a patient who was one year status post arthroscopic medial meniscectomy.

The ＂tractor trailer＂ sign of traumatic both medial and lateral bucket-handle meniscal tears on the same knee - A case report

Most traumatic bucket handle knee meniscal tear is unilateral, either medial or lateral, and often associated with various degree injury of anterior cruciate ligament (ACL). However, simultaneous injury of both medial and lateral menisci on the same knee is very rare. We reported a case of both medial and lateral traumatic bucket handle meniscal tears on the same knee. The magnetic resonance images (MRIs) could demonstrate both medial and lateral bucket-handle meniscal fragments displaced into the inter-condylar notch. Quadruple sign was noted in three consecutive coronal MRIs, demonstrating four structures in the inter-condylar notch: the ACL, posterior cruciate ligament (PCL) and both the medial and lateral bucket-handle meniscal fragments. The mid oblique sagittal MRIs demonstrated both the displaced medial and lateral bucket-handle meniscal fragments in the inter-condylar notch, appearing like as a ＂tractor trailer.＂ Under arthroscopic examination, the ACL was congested, edematous but grossly intact. Attempted reduction of both medial and lateral displaced bucket handle meniscal fragments failed. Arthroscopic medial and lateral partial meniscectomy was then performed. At a follow-up examination one year later, the knee was relatively stable with no instability. The range of motion was full and free. No local pain and tenderness was noted. The patient was instructed to avoid heavy work to prevent early osteoarthritis.

Variable outcomes of medial meniscectomy in middle aged and older patients after 2 to 8 years

Objectives:To review midterm results of arthroscopic medial meniscectomy in patients over the age of 40.Methods: Retrospective observational series.All 354 patients over 40 years of age (after exclusion criteria) who underwent medial meniscectomy by a single surgeon for clinical and MRI correlated medial meniscal tears, having failed conservative treatment, between 2009 and 2014 were sent a questionnaire. Completed questionnaires from 179 patients at an average follow up of 52 ± 15 months (range, 20-79) were analysed.Results:The average time to maximum recovery was longer than expected at 5.6 ± 6 months (range 0.5-36). 74% (133) felt they were largely or completely relieved of symptoms, but, as predicted from past experience, 5% (8) were worse post-operatively. Symptoms became worse in the follow-up period in another 26% (47). 11% (20) had further surgery (15 to TKR). 9% (17) preferred to have left the knee alone in retrospect. Final WOMET and Tegner-Lysholm scores showed overall fair results (36% excellent, 17% good, 22% fair, 25% poor.)Conclusion:Medial meniscectomy in the middle aged and elderly remains controversial, with some claiming that it is no better than placebo, and possibly harmful. This data should provide guidance in counselling patients regarding the risks, and likelihood of benefit, from such surgery, and has led to the authors using more rigorous selection criteria. Prospective studies are needed.

The effect of percutaneous release of the medial collateral ligament in arthroscopic medial meniscectomy on functional outcome

BackgroundPie crusting (PC) of the medial collateral ligament (MCL) in the knee has been used empirically to achieve more space in the medial compartment during knee arthroscopy. However, there are no reported studies analyzing the functional results of the application of the PC technique to the MCL in patients undergoing arthroscopic meniscectomy of the medial meniscus, and to determine the rate of iatrogenic injury and associated morbidity. Description of techniqueThe patient was in a supine position with a tourniquet and a side post. Percutaneous controlled release of the posterior part of the MCL was performed using an intramuscular needle, and a mild valgus force was applied while viewing with the arthroscope of the controlled progressive gain in medial compartment space. Patients and methodsA retrospective clinical study of 140 patients undergoing arthroscopic meniscectomy with or without MCL PC was conducted. Tegner and Lysholm tests and visual analogue scales were used to assess pain and functional results. ResultsThe patients in the group with meniscectomy and PC had higher scores on the Lysholm scale, less pain at rest after two months, and achieved significantly better pain control during physical activity at six months. No complication, residual instability, or iatrogenic injury to the cartilage were observed in the meniscectomy plus PC group. ConclusionThe MCL PC technique for medial meniscectomy is a safe and effective way to reduce iatrogenic injury to the cartilage and does not affect knee stability. Decompression of the medial compartment results in better functional outcomes at two months and lesser pain during physical activity at six months.

Early postoperative cartilage evaluation by magnetic resonance imaging using T2 mapping after arthroscopic partial medial meniscectomy

PurposeThis study was performed to quantitatively evaluate postoperative changes in cartilage by T2 mapping after arthroscopic partial medial meniscectomy. Material and MethodsThe study enrolled 17 patients with 20 knees that underwent arthroscopic partial medial meniscectomy. MRI was performed preoperatively and at six months postoperatively, with subjects evaluated by T2 mapping of the central part of the medial condyle of the femur in the sagittal plane. Regions of interest (ROIs) were set at 10 points between the point of intersection of the anatomical axis of the femur and the articular surface of the medial condyle and posterior area approximately 90 degrees to the anatomical axis. Pre- and postoperative T2 values at each ROI were evaluated. ResultsPostoperative T2 values were significantly longer than preoperative values at approximately 20, 30, 40, and 50 degrees to the anatomical axis of the femur. The maximum change between pre- and postoperative T2 values was +6.65% at 30 degrees to the anatomical axis. ConclusionsMechanical stress at positions approximately 20, 30, 40, and 50 degrees relative to the anatomical axis of the femur increased soon after arthroscopic medial meniscectomy. These findings indicate the start of degeneration, via disorganization of collagen arrays, of the articular cartilage and increased water content.

Correlation between body mass index and chondral lesions in isolated medial meniscus tears.

Background:Chondral lesions of the knee are commonly found during arthroscopic partial meniscectomy. The literature advises against arthroscopic medial meniscectomy in the presence of advanced chondral derangement because of unfavorable outcome. Recent studies have shown an association between obesity and chondropathy in patients with meniscal tears. The aim of this study was to assess whether body mass index (BMI) correlates with the severity of chondral lesions in patients with isolated medial meniscus tears (i.e. without ligamentous or lateral meniscal injury).Materials and Methods:837 knee arthroscopies were performed in a regional referral center of arthroscopic surgery between January 2011 and December 2012. Of these 168 (109 males, 59 females) patients with no axial knee deformity and no radiological signs of osteoarthritis who have had arthroscopic debridement for isolated torn medial meniscus were included in the study. The correlation between different demographic factors and the level of chondral damage reported at surgery was evaluated. The mean age of patient was 50 years (range 13-82 years) and an average BMI was 28.2 kg/m2 (range17.5-42.5 kg/m2).Results:Overall, regression analysis showed both age and BMI to be linearly correlated to chondral score (r = 0.53, P < 0.04); however, there were no advanced chondral lesions found in patients younger than 40 years of age and all severe lesions were at age 50 years or more. Therefore, further analysis was performed for age subgroups: patients were grouped as younger than 40, between the age of 40 and 50 (middle age) and older than 50 years. The BMI was linearly correlated to the severity of chondral score exclusively in the middle aged group (i.e. 40-50 years old). There was no correlation between activity level and chondral damage. Women had worse chondral lesions than men in all age groups.Conclusion:Higher BMI in middle aged patients with isolated medial meniscus tears and unremarkable radiographs may predict more advanced chondral lesions at arthroscopy.

Ultrasound-guided adductor canal block for arthroscopic medial meniscectomy: a randomized, double-blind trial

The saphenous nerve block using a landmark-based approach has shown promise in reducing postoperative pain in patients undergoing arthroscopic medial meniscectomy. We hypothesized that performing an ultrasound-guided adductor canal saphenous block as part of a multimodal analgesic regimen would result in improved analgesia after arthroscopic medial meniscectomy. Fifty patients presenting for ambulatory arthroscopic medial meniscectomy under general anesthesia were prospectively randomized to receive an ultrasound-guided adductor canal block with 0.5% ropivacaine or a sham subcutaneous injection of sterile saline. Our primary outcome was resting pain scores (numerical rating scale; NRS) upon arrival to the postanesthesia care unit (PACU). Secondary outcomes included NRS at six hours, 12 hr, 18 hr, and 24 hr; postoperative nausea; and postoperative opioid consumption. There was a statistically significant difference in mean NRS pain scores upon arrival to the PACU (P = 0.03): block group NRS = 1.71 (95% confidence interval [CI] 0.73 to 2.68) vs sham group NRS = 3.25 (95% CI 2.27 to 4.23). Cumulative opioid consumption (represented in oral morphine equivalents) over 24 hr was 71.8 mg (95% CI 56.5 to 87.2) in the sham group vs 44.9 mg (95% CI 29.5 to 60.2) in the block group (P = 0.016). An ultrasound-guided block at the adductor canal as part of a combined multimodal analgesic regimen significantly reduces resting pain scores in the PACU following arthroscopic medial meniscectomy. Furthermore, 24-hr postoperative opioid consumption and pain scores were also reduced.

Does varus alignment increase after medial meniscectomy?

In patients who underwent arthroscopic meniscectomy for medial meniscus tears, the authors wished to ascertain (1) whether varus alignment in the lower extremity would increase after an operation and (2) if so, what the related factors would be. Among 181 patients from 20 to 60 years of age who underwent arthroscopic medial meniscectomy for medial meniscus tears between 2002 and 2005, 56 patients followed for a minimum period of 5 years were enroled for this study. Alignment in the lower extremity was measured preoperatively and again at the last follow-up. Change in varus alignment (the difference between preoperative alignment and alignment at the last follow-up) was analyzed in relation to sex, age, body mass index (BMI), resection amount (partial vs. total), preoperative alignment, and follow-up duration, using multiple linear regression analysis. Varus deformity increased by 1.7° ± 1.5° from a preoperative mean of 2.4° ± 2.4° to a mean of 4.1° ± 3.0° at the last follow-up, which was statistically significant (p = 0.000). From multiple linear regression analysis, only the resection amount (partial meniscectomy or total meniscectomy) was found to be significantly related to the change in varus alignment (p = 0.002). Other factors including sex, age, BMI, preoperative alignment, presence of cartilage injury and follow-up duration were not significantly related to the change in varus alignment after the operation. Arthroscopic meniscectomy performed in patients with medial meniscus tears aggravated varus alignment in the lower extremity at the last follow-up. In addition, the increase in varus deformity was significantly higher among patients with total meniscectomy than among those with partial meniscectomy. Retrospective comparative study, level III.

Percutaneous medial collateral ligament release in arthroscopic medial meniscectomy in tight knees

Visualization and surgery of tears in the posterior medial meniscus are difficult in tight knees. Iatrogenic chondral lesions might cause serious morbidity, and residual tears may result in inadequate symptom relief. We evaluated the clinical and radiological results of superficial medial collateral ligament (MCL) release during arthroscopic medial meniscectomy in tight knees. Eighteen patients [median age: 43 years (22-59); median follow-up: 8.3 months (6-12)] who underwent arthroscopic meniscectomy were included in the study. Patients with ligamentous injuries, severe chondral damage or meniscal repairs were excluded. Preoperatively, anteroposterior knee radiographs were obtained with 11-kg valgus stress using a specialized instrument. During the operation, if opening of the medial knee in 30° flexion under 11-kg valgus stress was inadequate, controlled release of the posterior portion of the MCL was performed using a 16-gauge needle. Intraoperative valgus stress was monitored using a specially designed lateral support with mounted load cell. MCL injury was evaluated both with magnetic resonance imaging (MRI) and valgus stress radiographs, which were obtained in the 1st week and 3rd and 6th months postoperatively to monitor healing of the elongated MCL. In all patients, meniscectomy could be performed with adequate visualization of the posterior medial meniscus and without iatrogenic chondral injury. The median medial joint space width on valgus stress radiographs was 7.1 mm preoperatively and 9.1, 8.0 and 7.2 mm in the 1st week, and 3rd and 6th months, respectively (p < 0.0001). On MRI, the injured structure was the posterior two-thirds of the MCL. Median Lysholm score, which was 42 points before the operation, had increased to 94 points at the final follow-up (p = 0.0002). Controlled release of the MCL in tight knees allowed easier handling in posterior medial meniscus tears and a better understanding of tear configurations, avoiding iatrogenic chondral lesions. The MCL injury healed uneventfully. IV.

Relationship between cartilage glycosaminoglycan content (assessed with dGEMRIC) and OA risk factors in meniscectomized patients

To study the relationship between cartilage integrity, assessed with [delayed Gadolinium-Enhanced Magnetic Resonance Imaging of Cartilage (dGEMRIC)] and epidemiologic risk factors for knee osteoarthritis (OA) in meniscectomized patients. Body mass index (BMI) was calculated in 45 patients (16 women), mean age 46, who underwent an arthroscopic medial meniscectomy 1-6 years earlier. The cartilage glycosaminoglycan (GAG) content was estimated by dGEMRIC Index and tests of isokinetic muscle strength and functional performance (one-leg hop test) were conducted. BMI ranged from 20.0 to 34.3 (mean: 26.5). The dGEMRIC Index was 14.4% lower in the medial index compartment (374+/-61 ms, mean+/-SD) than in the lateral reference compartment (437+/-59 ms, mean+/-SD) (P<0.001). The dGEMRIC Index of the medial diseased compartment correlated positively with both knee flexor (r=0.50, P=0.001) and knee extensor strength (r=0.47, P=0.001) relative to body weight and with the one-leg hop test (r=0.42, P=0.004). Furthermore, a negative correlation was found between the dGEMRIC Index of the medial compartment and BMI (r=-0.35, P=0.019). No significant correlations were found in the lateral reference compartment. The lower dGEMRIC Index of the medial compartment suggests decreased cartilage GAG content after medial meniscectomy, indicating an early stage OA. Furthermore, results suggest that overweight is a factor that deteriorates cartilage, whereas strong and co-ordinated thigh muscles may have a protective effect on the cartilage integrity.

Subchondral Fracture Following Arthroscopic Knee Surgery

Osteonecrosis has been reported as a rare complication of arthroscopic knee surgery, with the diagnosis based on radiographic findings associated with recurrent or worsening clinical symptoms. The term osteonecrosis has been applied to this clinical entity despite a lack of pathologic evidence to support the diagnosis. The purpose of this study was to document the pathologic changes involved in this rare process. Patients who had undergone an arthroscopic procedure followed by a total knee replacement within two years were eligible for the study. Inclusion criteria included pre-arthroscopy magnetic resonance imaging findings consistent with a meniscal tear with otherwise normal bone morphology followed by a provisional diagnosis of post-arthroscopy osteonecrosis based on subsequent imaging studies. Patients were excluded if a laser-assisted device had been utilized during the arthroscopy. Seven patients (eight knees) with an average age of sixty-four years met the criteria and were included in the study group. All patients had undergone an arthroscopic medial meniscectomy, and two also had had a chondroplasty, with use of a mechanical shaver. Seven of the post-arthroscopy lesions involved the medial femoral condyle, and one lesion involved the medial tibial plateau. Pathologic analysis revealed a subchondral fracture with callus formation, indicated by the presence of woven bone, in all cases. Four patients had essentially intact articular cartilage overlying the lesion, which was characterized by disruption of the trabecular architecture indicative of subchondral bone fracture. The other four patients had an isolated osteochondral defect with reparative tissue within the base of the defect. Only two knees had localized evidence of osteonecrosis, which appeared to be secondary to the fracture. This study provides pathologic evidence supporting the concept that subchondral fracture, and not osteonecrosis, is the major event in this rare complication following arthroscopy. Further investigation into the etiology of this condition is warranted.

Results of Arthroscopic Medial Meniscectomy in Patients With Grade IV Osteoarthritis of the Medial Compartment

To determine the clinical results of arthroscopic medial meniscectomy in patients with Outerbridge grade IV osteoarthritis who underwent an arthroscopic medial meniscectomy. From March 1998 to December 2001, 617 patients underwent arthroscopic medial meniscectomy; 68 patients had Outerbridge grade IV osteoarthritis and were examined in this study. The mean age of the 68 patients was 63.3 years (range, 51 to 77). The study was comprised of 5 males (7.3%) and 63 females (92.7%). The mean follow-up period was 52 months (range, 37-83 months). Clinical assessment was performed retrospectively using the arthroscopic surgery database, medical records, and telephone interviews. Assessment included visual analog pain scale (VAS) scores, Lysholm scores, and whether further surgery was required (e.g., total knee arthroplasty or high tibial osteotomy). Of the study population, 17 (25%) patients showed Outerbridge grade IV changes on the femoral condyle, 24 (35%) on the tibial condyle, and 27 (40%) on both the tibial and femoral condyle. The mean VAS decreased from 7.1 presurgery to 2.9 postsurgery (P < .05), and the mean Lysholm score increased from 65.7 presurgery to 82.9 postsurgery (P < .05). Four patients underwent further surgery, which was a total knee arthroplasty in all cases. The mean time to further surgery was 49.8 months (range, 20-75 months). Meniscal tear symptoms in patients with grade IV osteoarthritis can be improved using arthroscopic medial meniscectomy. Level IV, therapeutic case series.

半月板切除後にとう痛を伴いＭＲＩで早期に骨髄信号異常を呈した一例

We report a case of bone marrow signal change in the medial tibial condyle (MTC) on MRI shortly after arthroscopic medial meniscectomy. A 52-year-old man visited our hospital complaining of pain on the medial side of the left knee for a one-month duration without specific trauma. Anteroposterior radiograph showed no bony lesion. MRI, however, suggested a medial meniscal tear. There was no abnormal change in the bone marrow of the MTC. The diagnosis was medial meniscus injury and we performed arthroscopic medial meiscectomy. At the time of surgery, there was no apparent chondral damage at the MTC. He was temporally relieved of his pain, however three weeks later he experienced postoperative pain at a more acute level than initially. MRI suggested bone marrow edema in the medial tibial condyle. After retuning to the hospital, the patient was issued a cast for three weeks and seven weeks later he was relieved of his pain and symptoms. We can conclude this case to be subchondral microfracture caused by weight bearing after meniscectomy based on the results of MRI and findings during clinical course.

Medial meniscectomy in patients over the age of fifty: a six year follow-up study.

Meniscectomy in the older patient remains a controversial topic. The aim of our study is to assess the mid-term outcome of arthroscopic partial medial meniscectomy in patients over fifty years of age and attempt to retrospectively identify symptoms and/or findings on examination which can differentiate between non-degenerative medial meniscal tears versus degenerative meniscal changes. Thirty-two patients over the age of fifty who had undergone arthroscopic medial partial meniscectomy, were reviewed. The average age was 60 (51-74 yrs) and the average follow-up was six years (3-7 yrs). Based upon the intra-operative findings, patients were divided into two groups: (1) non-degenerative meniscal tears (NDM; n = 12) and (2) degenerative meniscal changes (DM; n = 20). Our outcome measurements were with the HSS knee score, a satisfaction score, and weight-bearing X-rays. In the NDM group, eleven patients were rated excellent or good, and one was rated poor. In the DM group, three patients were rated as excellent or good, eight as fair, and nine as poor. The HSS score was 97 +/- 4.6 for the NDM group and 85 +/- 9.5 for the DM group. The average satisfaction score was 9.2 +/- 0.7 (very satisfied) for the NDM group and 5.8 +/- 2.6 (fairly satisfied) for the DM group. There was no significant difference between the NDM and the DM groups with regards to pre-operative symptoms and signs, except for the McMurray sign, which was found to be positive in 83% of NDM cases versus 25% of DM cases (sensitivity = 83%). Using only these data, the McMurray sign was 67% specific for NDM. Arthroscopic medial meniscectomy in older patients provides 90% good results six years after a non-degenerative meniscal tear, but only 20% of good results after a degenerative meniscal tear. However, based on this study, neither symptoms nor physical examination are able to differentiate between traumatic meniscal tears and degenerative meniscal changes in older patients. A positive McMurray's sign favors the diagnosis of a traumatic tear. However, a specificity of this test of only 67% as shown in our data questions its utility in clinical decision-making.

Subchondral microfracture of the knee without osteonecrosis after arthroscopic medial meniscectomy

We report a case of an osteonecrosis-like lesion of the knee that developed shortly after an arthroscopic medial meniscectomy. Clinical presentation, physical findings, and imaging of the knee including magnetic resonance imaging were similar to those of the cases that have been reported as osteonecrosis after meniscectomy. However, histologic analysis of the lesion revealed that there was no osteonecrosis but rather a subchondral microfracture with active callus formation.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 18, No 5 (May-June), 2002: pp 538–541

The natural history of the knee following arthroscopic medial meniscectomy

We examined the natural history of arthroscopic medial meniscectomy in knees with an isolated meniscal injury by reviewing 317 of 894 cases following medial meniscectomy. At the time of the initial surgery none of the knees had been operated on, and there was no evidence of ligament injury. The patients were reviewed clinically and radiologically after a mean of 11.5 years (range 10-15). The knee was considered "normal" or "nearly normal" by 91% of patients. In 218 patients the contralateral knee was asymptomatic without history of operation or significant injury and could be used as control for comparison. Radiology showed 22.4% greater excess prevalence of joint space narrowing in the operated compared to the control knee. The factors predisposing to a poor radiological result were age above 35 years, the presence of medial compartment cartilage degeneration at the time of the first arthroscopy, resection of the posterior one-third of the meniscus, and meniscal rim resection. Preoperative participation in sport was a predictor of a better outcome.

変形性膝関節症に対する高分子量ヒアルロン酸ナトリウム（ＳＰＨ）の使用経験 特に関節鏡所見について

The result of intraarticular injection of high molecular weight sodium hyaluronate in the knee joint were reviewed. Twelve knees in 12 patients were divided into two groups: Group A consisted of 10 patients with osteoarthritis in the medial compartment of the knee and arthroscopic medial partial meniscectomy had been performed. Group B consisted of 2 patients who had osteoarthritis in the medial compartment of the knee and lateral partial meniscectomy had been performed. After meniscectomy all patients received intraarticular injection of high molecular weight sodium hyaluronate into the knee joint for at least 5 months. After this therapy all knees were arthroscoped again. Improvement was obserbed in both groups.These results suggest that high molecular weight sodium hyaluronate is effective for improvement of degenerative joint cartilage.