MRI Evaluation of Isolated Arthroscopic Partial Meniscectomy Patients at a Minimum Five Year Followup


Riley J. Williams III, MD

Associate Attending Orthopedic Surgeon, Hospital for Special Surgery
Director of the Institute for Cartilage Repair, Hospital for Special Surgery
Associate Professor of Orthopedic Surgery, Weill Cornell Medical College

Hollis G. Potter, MD

Chairman, Division of Magnetic Resonance Imaging
Attending Radiologist, Hospital for Special Surgery
Professor of Radiology, Weill College of Medicine of Cornell University

Frank A. Cordasco, MD, MS

Attending Orthopaedic Surgeon, Hospital for Special Surgery
Professor of Orthopaedic Surgery, Weill Cornell Medical College
Surgical Director, Ambulatory Surgery Center, Hospital for Special Surgery
Co-Medical Director, Leon Root Motion Analysis Laboratory, Hospital for Special Surgery

Frank A. Petrigliano, MD
Sports Medicine and Shoulder Service

Kristen K. Warner, MD
Sports Medicine and Shoulder Service

Joshua Hatch, MD
Sports Medicine and Shoulder Service

Abstract
Background:
  The risk of radiographic knee degeneration following partial or total meniscectomy is well documented, but no prior study has employed cartilage-sensitive MRI technology to assess degenerative changes following meniscectomy. 
Hypothesis:  Arthroscopic partial meniscectomy results in early articular cartilage wear and subchondral bony degeneration, even in the absence of clinical symptoms, and these findings can be evaluated with cartilage-sensitive MRI.

Study Design:  Retrospective cohort

Methods:  Twenty-nine patients (ages: 15-40) who had undergone isolated arthroscopic partial medial or lateral meniscectomy with at least five year follow-up were evaluated.  All patients had arthroscopically normal articular cartilage at the time of initial meniscectomy.  Seventeen patients (18 knees) underwent partial medial meniscectomy (MM) and 12 patients underwent partial lateral meniscectomy (LM) with mean follow-up of 8.4 and 7.1 years, respectively.  Follow-up evaluation included physical examination, outcome questionnaires, and cartilage-sensitive MRI examination with modified Outerbridge grading of articular surfaces.

Results:  Outerbridge grades II-IV were noted in 64% of medial compartment joint surfaces in Group MM knees versus 33% of lateral compartment joint surfaces in Group LM knees.  Abnormal cartilage surfaces (grades II-IV), subchondral sclerosis, and condylar squaring were all significantly more frequent after medial meniscectomy (p<0.05).  Groups MM and LM had no significant differences among outcome scores, which remained excellent in both groups.  A significant negative correlation was found between the severity of cartilage wear and functional scoring in the MM group, suggesting that functional disability lags behind early MRI evidence of degeneration.

Conclusions:  Despite optimal preoperative prognostic factors and excellent functional outcomes, MRI evidence of early articular cartilage degeneration was present in both partial medial and lateral meniscectomy patients at a minimum five-year follow-up.  Results support the use of cartilage sensitive MRI as a non-invasive screening technique to evaluate cartilage changes following arthroscopic partial meniscectomy and may help to counsel the high-risk patient in regard to post-operative activity.

This article appears in HSS Journal: Volume 3, Number 1.
View the full article at springerlink.com.


About the HSS Journal
HSS Journal, an academic peer-reviewed journal, is published twice a year, February and September, and features articles by internal faculty and HSS alumni that present current research and clinical work in the field of musculoskeletal medicine performed at HSS, including research articles, surgical procedures, and case reports.

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