In the JournalsPerspective

Several factors may predispose patients to osteoarthritis after arthroscopic partial meniscectomy

Patients who underwent arthroscopic partial meniscectomy had a greater predisposition to osteoarthritis in the tibiofemoral and patellofemoral compartments if they were obese, overweight or had a degenerative tear, according to published results.

Umile Giuseppe Longo, MD, MSc, PhD , and colleagues analyzed the prevalence and progression of knee OA after arthroscopic partial meniscectomy in 57 patients by evaluating KOOS and WOMAC scores, as well as the Kellgren-Lawrence score. Researchers defined radiographic OA as a Kellgren-Lawrence grade of two or worse. Researchers stratified patients according to BMI, type of lesion (degenerative vs. traumatic) and side of meniscectomy (medial, lateral and medial plus lateral).

Results showed the tibiofemoral compartment had a prevalence of knee OA of 62.69%. Researchers found the progression of knee OA ranged from 17.2% preoperatively to 65.95% postoperatively in the medial compartment, from 17.64% preoperatively to 58.82% postoperatively in the lateral compartment and from 5.26% to 42.1% in the patellofemoral compartment. Patients who were obese had a greater progression of OA compared with patients in the normal-weight group. Researchers noted progression of OA was also greater among patients with degenerative vs. traumatic lesions. Results showed patients had a mean KOOS and WOMAC score of 72.01 and 73.84, respectively. Clinical results had a statistically significant correlation with radiographic results, according to results of the Spearman’s test.

“Obesity and degenerative tear represent the most important risk factors to develop osteoarthritis in the tibiofemoral and patellofemoral compartments after arthroscopic meniscectomy,” Longo told Healio.com/Orthopedics. “Therefore, especially in these cases, if it is possible, conservative treatment should be the best way to retard the progression of osteoarthritis.” – by Casey Tingle

Disclosures: Longo reports no relevant financial disclosures. Please see the study for a list of all other authors relevant financial disclosures.

Patients who underwent arthroscopic partial meniscectomy had a greater predisposition to osteoarthritis in the tibiofemoral and patellofemoral compartments if they were obese, overweight or had a degenerative tear, according to published results.

Umile Giuseppe Longo, MD, MSc, PhD , and colleagues analyzed the prevalence and progression of knee OA after arthroscopic partial meniscectomy in 57 patients by evaluating KOOS and WOMAC scores, as well as the Kellgren-Lawrence score. Researchers defined radiographic OA as a Kellgren-Lawrence grade of two or worse. Researchers stratified patients according to BMI, type of lesion (degenerative vs. traumatic) and side of meniscectomy (medial, lateral and medial plus lateral).

Results showed the tibiofemoral compartment had a prevalence of knee OA of 62.69%. Researchers found the progression of knee OA ranged from 17.2% preoperatively to 65.95% postoperatively in the medial compartment, from 17.64% preoperatively to 58.82% postoperatively in the lateral compartment and from 5.26% to 42.1% in the patellofemoral compartment. Patients who were obese had a greater progression of OA compared with patients in the normal-weight group. Researchers noted progression of OA was also greater among patients with degenerative vs. traumatic lesions. Results showed patients had a mean KOOS and WOMAC score of 72.01 and 73.84, respectively. Clinical results had a statistically significant correlation with radiographic results, according to results of the Spearman’s test.

“Obesity and degenerative tear represent the most important risk factors to develop osteoarthritis in the tibiofemoral and patellofemoral compartments after arthroscopic meniscectomy,” Longo told Healio.com/Orthopedics. “Therefore, especially in these cases, if it is possible, conservative treatment should be the best way to retard the progression of osteoarthritis.” – by Casey Tingle

Disclosures: Longo reports no relevant financial disclosures. Please see the study for a list of all other authors relevant financial disclosures.

    Perspective

    The article by Umile Giuseppe Longo, MD, MSc, PhD, and colleagues adds to the growing body of literature assessing the association between arthroscopic partial meniscectomy and subsequent structural disease progression in knee osteoarthritis. The authors found that the prevalence of knee OA (defined as Kellgren-Lawrence grade ≥ 2) in the medial tibiofemoral compartment increased from 17% preoperatively to 66% at follow-up in the surgical knee, while the prevalence increased from 17% to 37% in the contralateral knee, with these data prompting the authors to suggest that knees undergoing arthroscopic partial meniscectomy were more likely to progress to knee OA.

    The question is how to disentangle the increased risk of progression associated with arthroscopic partial meniscectomy from the increased risk of progression associated with the underlying meniscal tear. If both of a patient’s knees in this study had a meniscal tear, and only one had undergone arthroscopic partial meniscectomy, then we would be able to point more definitively to the surgical intervention as the cause of this increased risk. Here though, it is impossible to say whether the tear itself or the arthroscopic partial meniscectomy is the culprit. Studies using a case-control design or focusing on randomized control trials of arthroscopic partial meniscectomy vs. nonoperative therapy could help elucidate this relationship.

    References:

    Collins JE, et al. Arthritis Care Res (Hoboken). 2019;doi:10.1002/acr.23891.

    Herrlin SV, et al. Knee Surg Sports Traumatol Arthrosc. 2013;doi:10.1007/s00167-012-1960-3.

    Roemer FW, et al. Eur Radiol. 2017;doi:10.1007/s00330-016-4361-z.

    • Jamie E. Collins, MD
    • Senior biostatistician
      Orthopedic and Arthritis Center for Outcomes Research
      Brigham and Women’s Hospital
      Assistant professor of orthopedic surgery
      Harvard Medical School
      Boston

    Disclosures: Collins reports she is a consultant for Boston Imaging Core Labs.