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Arthroscopic partial meniscectomy: MR imaging for prediction of outcome in middle-aged and elderly patients
Richard Kijowski1, Michael A Woods, Timothy A McGuine
1Department of Radiology, Orthopedic Surgery, and Family Medicine, University of Wisconsin Hospital, Clinical Science Center-E3/311, 600 Highland Ave, Madison, WI 53792-3252, USA. r.kijowski@hosp.wisc.edu
Purpose:
To determine whether preoperative magnetic resonance (MR) imaging could help identify factors associated with poor clinical outcome after arthroscopic partial meniscectomy (APM) in middle-aged and elderly patients with meniscal tears.
Materials And Methods:
The prospective, institutional review board-approved, HIPAA-compliant study was performed with informed consent in 53 men and 47 women (average ages, 54.5 and 56.6 years, respectively). Patients underwent knee MR imaging before APM; clinical symptoms were evaluated preoperatively and 1 year postoperatively with International Knee Documentation Committee (IKDC) questionnaire. Overall severity of knee joint degeneration and severity of each feature of joint degeneration were assessed with Boston Leads Osteoarthritis Knee (BLOK) scoring system. Tear length was measured, and type of meniscal tear was classified. Spearman correlation coefficients and relative risks showed the relationship between clinical outcome after APM (difference between preoperative and postoperative IKDC scores) and severity of joint degeneration.
Results:
Seventy-four patients with isolated medial APM had a significant (P < .05) inverse correlation between clinical outcome and severity of cartilage loss and bone marrow edema in the medial femoral condyle and medial tibial plateau. Fifteen patients with isolated lateral APM had a significant (P < .05) inverse correlation between clinical outcome and severity of cartilage loss in the lateral femoral condyle and lateral tibial plateau and bone marrow edema in the lateral femoral condyle. One hundred patients with APM had a significant (P < .05) inverse correlation between clinical outcome and severity of meniscal extrusion, total BLOK score, and meniscal tear length. A significantly (P < .05) increased relative risk that a patient would not definitely improve after APM was observed if a meniscal root tear was present.
Conclusion:
Poorer clinical outcome after APM was associated with greater severity of cartilage loss and bone marrow edema in the same compartment as the meniscal tear, greater severity of meniscal extrusion, greater overall severity of joint degeneration, a meniscal root tear, and a longer meniscal tear at preoperative MR imaging.
Insights
Preoperative magnetic resonance imaging can identify factors linked to poor outcomes after arthroscopic partial meniscectomy. Greater cartilage damage, extrusion, and meniscal root tears predict worse results in older patients.
Area of Science:
- Orthopedic surgery
- Radiology
- Biomedical imaging
Background:
- Arthroscopic partial meniscectomy (APM) is a common procedure for meniscal tears.
- Identifying factors predicting poor outcomes is crucial for patient selection and managing expectations.
Purpose of the Study:
- To investigate if preoperative magnetic resonance (MR) imaging can predict clinical outcomes after APM in middle-aged and elderly patients.
- To identify specific imaging features associated with poor outcomes following APM.
Main Methods:
- Prospective study of 100 patients (men and women) undergoing APM.
- Preoperative knee MR imaging and clinical evaluation using the International Knee Documentation Committee (IKDC) questionnaire.
- Assessment of joint degeneration severity using the Boston Leads Osteoarthritis Knee (BLOK) scoring system, including cartilage loss, bone marrow edema, meniscal extrusion, and tear characteristics.
Main Results:
- Poorer clinical outcomes correlated with increased cartilage loss and bone marrow edema in the affected compartment.
- Meniscal extrusion, overall joint degeneration severity (BLOK score), and longer meniscal tear length were associated with worse outcomes.
- Meniscal root tears significantly increased the relative risk of not improving after APM.
Conclusions:
- Preoperative MR imaging reveals key factors predicting outcomes after APM.
- Severity of cartilage degeneration, meniscal extrusion, meniscal root tears, and tear length are significant predictors of poor clinical results.