Osteonecrosis of the knee after arthroscopic surgery: diagnosis with MR imaging.

Abstract

Spontaneous osteonecrosis about the knee typically is a disease of the elderly characterized by an acute onset of pain. The exact cause of this condition has long been debated, although a causative relationship between meniscal tears and spontaneous osteonecrosis about the knee has been postulated. Seven patients with knee pain, meniscal tears, and chondromalacia without initial evidence of osteonecrosis at magnetic resonance (MR) imaging underwent arthroscopic surgery with meniscal recontouring or repair and cartilage shaving. These patients returned within 2-14 months with recurrent pain in the treated knee. MR imaging then demonstrated abnormalities consistent with osteonecrosis. Osteonecrosis of the femoral condyle or tibial plateau may be a late sequela of meniscal injury in association with chondromalacia and arthroscopic surgery. This diagnosis should be suspected in patients with recurrent knee pain after arthroscopic repair of meniscal tears. The precise relationship of this pattern of osteonecrosis to that previously described as spontaneous requires further investigation.

Idiopathic osteonecrosis of the medial tibial plateau

“…Fat suppression in T2-weighted images presents a typical zone of high signal intensity (bone marrow edema) with a low signal intensity area in the lesion's center. These findings are similar to femoral condyle necrosis [1,2,5].…”

“…The histological findings of Narváez et al [14] suggest that the etiology of spontaneous osteonecrosis results from an insufficient subchondral fracture in an osteoporotic bone [8]. Spontaneous necrosis of the knee is also described as an arthroscopy complication [2,5,18].…”

Articular Cartilage and Subchondral Bone

“…The etiology remains unclear, but the localized vascular insuffi ciency may explain subchondral osteonecrosis due to disruption of the nutrition supply to the cartilage above [ 33 ]. Spontaneous osteonecrosis of the knee has been also described as a complication after arthroscopic repair of the meniscal tears, and the lesion may be a late sequela of meniscal injury in association with cartilage defects and arthroscopic surgery [ 34 ]. Secondary osteonecrosis is caused by a number of well-recognized predisposing factors for osteonecrosis (e.g., systemic lupus erythematosus, steroid use, pancreatitis, alcoholism, HIV infection and renal transplants) or may be secondary to an old trauma [ 35 ].…”

Nine cases of osteonecrosis in elderly patients following arthroscopic meniscectomy

“…Recent publications report osteonecrosis of the knee following arthroscopic surgery. Muscolo et al [23] reported eight cases, Brahme et al [5] seven cases and Santori et al [28] two cases. Three articles describe several cases of osteonecrosis after laser-assisted arthroscopic surgery [10,12,27].…”