Total meniscectomy in adolescents

Abstract

We continued a prospective longitudinal follow-up study of 53 remaining patients who underwent open total meniscectomy as adolescents and who at that time had no other intra-articular pathology of the knee. Their clinical, radiological and patient-reported outcomes are described at a mean follow-up of 40 years (33 to 50). The cohort of patients who had undergone radiological evaluation previously after 30 years were invited for clinical examination, radiological evaluation and review using two patient-reported outcome measures. A total of seven patients (13.2%) had already undergone total knee replacement at the time of follow-up. A significant difference was observed between the operated and non-operated knee in terms of range of movement and osteoarthritis of the tibiofemoral joint, indicating a greater than fourfold relative risk of osteoarthritis at 40 years post-operatively. All patients were symptomatic as defined by the Knee Injury and Osteoarthritis Outcome Score. This study represents the longest follow-up to date and it can be concluded that meniscectomy leads to symptomatic osteoarthritis of the knee later in life, with a resultant 132-fold increase in the rate of total knee replacement in comparison to their geographical and age-matched peers.

Outcomes After Anterior Cruciate Ligament Reconstruction Using the Norwegian Knee Ligament Registry of 4691 Patients

“…4 Previous studies have also indicated that meniscal resections result in significantly decreased subjective outcomes scores and activity levels and increased numbers of total knee replacements and osteoarthritic progression at follow-ups ranging from 8 to 40 years. 2,4,13,18,19 However, for both the MM and LM resection groups in our current study, no significant differences were seen, indicating that perhaps the reported poor outcomes after meniscal resection are not immediately seen at 2-year follow-up.…”

Epidemiology of Posttraumatic Osteoarthritis

“…40 Yet these same data reveal that patients who did go on to develop PTOA within 2 years were more likely to have sustained medial meniscectomy (OR ¼ 3.03; 95% CI ¼ 1.4, 6.5), complex meniscal tears (OR ¼ 5.0; 95% CI ¼ 1, 25), or radial tears of the meniscus (OR ¼ 5.92; 95% CI ¼ 1.7, 7.5). 40 Pengas et al 41 followed patients for an average of 40 years after meniscectomy, observing a relative risk of PTOA development of 4.5 (95% CI…”

Meniscal pathology - the evidence for treatment

“…Overwhelming evidence has demonstrated the poor long-term outcomes from total menisectomy, and this procedure should be considered a procedure of yesteryear [4-6]. All APM, meniscal repair and physical therapy have been shown to be associated with symptom improvement, although there are conflicting data regarding the comparative superiority of the surgical versus the conservative approach.…”

“…Recently, a prospective longitudinal 40-year follow-up study examined people who underwent open total menisectomy as adolescents for isolated meniscal pathology. The results showed that total menisectomy increased the risk of symptomatic knee OA in later life, with a resultant 132-fold increase in the rate of knee replacement compared with geographical and age-matched controls [6]. …”