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Subchondral microfracture of the knee without osteonecrosis after arthroscopic medial meniscectomy
Norimasa Nakamura1, Shuji Horibe, Shigeko Nakamura
1Department of Orthopaedic Sports Medicine, Osaka Rosai Hospital, Osaka, Japan. nori@orh.go.jp
Abstract:
We report a case of an osteonecrosis-like lesion of the knee that developed shortly after an arthroscopic medial meniscectomy. Clinical presentation, physical findings, and imaging of the knee including magnetic resonance imaging were similar to those of the cases that have been reported as osteonecrosis after meniscectomy. However, histologic analysis of the lesion revealed that there was no osteonecrosis but rather a subchondral microfracture with active callus formation.
Insights
A knee lesion after arthroscopic medial meniscectomy mimicked osteonecrosis but was actually a subchondral microfracture. Histologic analysis confirmed healing bone, not bone death, following the knee surgery.
Area of Science:
- Orthopedic Surgery
- Sports Medicine
- Musculoskeletal Imaging
Background:
- Arthroscopic medial meniscectomy is a common procedure for knee injuries.
- Post-operative osteonecrosis of the knee is a rare but serious complication.
- Clinical and imaging findings can overlap between osteonecrosis and other knee pathologies.
Observation:
- A patient developed a knee lesion shortly after arthroscopic medial meniscectomy.
- Clinical presentation and magnetic resonance imaging (MRI) findings were suggestive of osteonecrosis.
- The lesion presented with pain and restricted movement, similar to reported osteonecrosis cases.
Findings:
- Histologic examination revealed subchondral microfracture with active callus formation.
- The lesion was definitively diagnosed as a healing bone injury, not osteonecrosis.
- Microfracture indicates a bone stress injury rather than avascular necrosis.
Implications:
- This case highlights the importance of histologic analysis in diagnosing post-arthroscopic knee lesions.
- It suggests that some osteonecrosis-like presentations after meniscectomy may represent treatable bone microfractures.
- Accurate diagnosis is crucial for appropriate management and patient outcomes in post-operative knee complications.