Patellofemoral and tibiofemoral articular cartilage and subchondral bone health following arthroscopic partial medial meniscectomy

Wang Y, Dempsey AR, Lloyd DG, Mills PM, Wrigley T, Bennell KL, Metcalf B, Hanna F, & Cicuttini FM (2011). Knee Surgery, Sports Traumatology, Arthroscopy. PMID: 21946943 (Link will take you to the abstract)

Partial meniscectomy is commonly performed in symptomatic knees.  It is a minimally invasive surgery that requires a relatively short recovery time, resulting in less missed activity.  Meniscectomy is a recognized risk factor for the development of tibiofemoral osteoarthritis (OA).  However, it remains unclear whether risk of patellofemoral OA is elevated as well.  The purpose of this cross-sectional study was to evaluate the patellofemoral and tibiofemoral cartilage using magnetic resonance (MR) imaging in patients who had an isolated partial medial meniscectomy and compare them to controls. A total of 196 patients met all inclusion criteria for the study (e.g., no knee OA, > 33% of medial meniscus was resected), and were divided into 4 groups based on time from partial medial meniscectomy: 54 patients three-months, 63 patients two-years, and 41 patients four years post partial medial meniscectomy as well as 38 controls.  Average age for all groups ranged from 42 to 46 years old.  MR imaging was used to assess cartilage defects and quantify articular cartilage as well as underlying bone.  Prevalence of medial tibiofemoral and patella cartilage defects were significantly greater in knees with a history of partial medial meniscectomy compared to controls.  The prevalence of cartilage defects was also positively correlated with time from partial medial meniscectomy surgery.   A history of partial medial meniscectomy was also associated with greater medial tibial plateau bone area (a finding that may reflect early joint degeneration). There were no other MR imaging findings associated with a history of partial medial meniscectomy.  
As clinicians, this study demonstrates that partial medial meniscectomy places patients at an increased risk for early tibiofemoral and patellofemoral joint degenerative changes within five years of surgery.  The average age of the population is older than the athletes that we typically work with in high school or college settings, but the risk may still remain.  It may be interesting to see a similar study in a younger population as well as a study that follows patients over time.  Has anyone dealt with any athletes that have developed a cartilage defect in the same knee where they previously had a partial meniscectomy?  It is also interesting to note that this study utilized MR imaging instead of x-rays, which are the current standard for diagnosing OA.  X-rays for OA are not sensitive enough to detect early joint degenerative changes.  More and more studies are using MR imaging to assess early joint degeneration, changes in a joint after trauma, and disease progression of OA knees. These studies will help us better understand early changes that lead to obvious signs and symptoms of OA. There may be something that we can do as clinicians in these early stages to slow or prevent early degenerative changes, rather than waiting until it is too late.  As clinicians, we often try to address altered knee biomechanics after surgery by designing rehabilitation programs.  When we develop these programs it is important to remember to address the patellofemoral and tibiofemoral joints. What are your experiences with patellofemoral pain after partial medial meniscectomy?
Written by: Nicole Cattano
Reviewed by: Jeffrey Driban

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