[Correlation of long-term clinical and radiological results after meniscectomies]

Although surgical treatment of meniscus injuries has made great progress, meniscectomy remains the most frequently indicated intervention. The aim of this retrospective study was to evaluate the long-term radiological results of isolated subtotal and total meniscectomies and compare them with the clinical results.

The assessed group included 22 men and 8 women at an average age of 35 years; nine and 21 knees, respectively, were treated by isolated subtotal and total meniscectomy in the period from 1987 to 1989. The lateral meniscus was operated on in six knees and the medial meniscus in 24 knees. Patients with other injuries to the knee joint or with a systemic disease were not evaluated. The average follow-up was 16 years. The results were compared with the other, non-treated knee.

The results were assessed by means of the Lysholm scoring system which takes into account limping, support requirement, walking distances, instability, edema, stair ascent and descent, ability to squat and pain. Radiographic osteoarthritis of the knee was classified by the Kellgren and Lawrence system. A grade greater or equal to 2 was taken for a clear sign of arthritis. In addition, the anatomical axis of the lower extremity was evaluated. Anteroposterior projection of both knees under load was made in a standing position on long films and lateral projection was obtained separately on short films.

The average Lysholm scores were 87 points (range, 41-100) and 91 points (range, 67-100) in the treated and non-treated knees, respectively. The outcome of meniscectomy was excellent in 14 (47 %), good in eight (27 %), satisfactory in five (16 %) and poor in three (10 %) knees. In 12 patients (40 %) the state of the treated knee was evaluated as being equal to that of the non-treated knee and in eight patients (27 %) it was even better. Osteoarthritis of the affected compartment was found in eight treated knees and that of the corresponding compartment on the opposite side in four knees. Grade 2 Kellgren- Lawrence radiographic changes were present in four, grade 3 in two and grade 4 in two knees treated by meniscectomy. The anatomic femoro-tibial angle differed between the treated and non-treated side, by 4 degrees on average (range, 2 degrees to 10 degrees ), in 13 (43 %) patients.

Johnson et al. found at follow-up for about 17 years that osteoarthritis developed more often in the treated than in healthy contralateral knees (40 % as against 6 %). Tapper and Hoover reported that 45 % of men and 10 % of women were without subjective complaints at 10 to 30 years of follow up. In the relevant Czech literature, only Pasa et al. have recently paid attention to the development of lesions in knees treated by meniscectomy, but they have largely evaluated changes occurring after partial arthroscopic meniscectomies.

The present study showed that osteoarthritis after subtotal or total meniscectomy developed in 27 % of the patients at an average follow-up of 16 years. In less than half of the patients, a deviation of the anatomical axis occurred in the treated lower extremity, as compared with the other healthy side. Lysholm scores worse in the treated than the non-treated knee were found in one third of the patients.However, a deviated knee joint axis and/or osteoarthritic lesions did not always correlate with deteriorated clinical findings.