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Histologic analysis of postmeniscectomy osteonecrosis
Hiroshi Higuchi1, Yasukazu Kobayashi, Atsushi Kobayashi
1Department of Orthopaedic Surgery, Asakura Sports Rehabilitation Clinic, Maebashi, Gunma, Japan. jaguar156z@yahoo.co.jp
Abstract:
Bone marrow signal changes on magnetic resonance imaging (MRI) after meniscectomy have been reported as evidence of postmeniscectomy osteonecrosis, but this pathology is unclear. We conducted a study to follow-up cases with bone marrow signal changes on MRI after meniscectomy and investigate the pathology of underlying lesions. Of 136 patients with no presurgical evidence of osteonecrosis, 29 had juxta-articular bone marrow signal changes on MRI after arthroscopic meniscectomy and subsequently underwent conservative therapy. In 6 of these 29 patients, clinical symptoms and radiographic changes began deteriorating. Based on the Koshino classification, 4 of the 6 patients had Stage-2 knee osteonecrosis and 2 had Stage-3. Arthroscopic and pathologic examinations were performed. Arthroscopic findings were fibrillation (all 6 cases), fissuring (4), ulceration (2), and eburnation (2). Histologic analysis confirmed subchondral bone fractures in all 6 cases, but osteonecrotic lesions were detected only in 2 cases with obvious radiologic deterioration. Postmeniscectomy osteonecrosis might result from subchondral bone fractures. Fracture healing is worse in patients with comorbidities than in those without it; comorbidities might be a risk factor for osteonecrosis.
Insights
Magnetic resonance imaging (MRI) bone marrow signal changes after meniscectomy may indicate osteonecrosis. Subchondral bone fractures, not always osteonecrosis, are confirmed, with comorbidities potentially increasing risk.
Area of Science:
- Orthopedic Surgery
- Radiology
- Pathology
Background:
- Bone marrow signal changes on MRI post-meniscectomy are often attributed to osteonecrosis.
- The precise pathology underlying these MRI findings remains unclear.
Purpose of the Study:
- To investigate the pathology of bone marrow signal changes observed on MRI after meniscectomy.
- To determine the relationship between these changes and post-meniscectomy osteonecrosis.
Main Methods:
- Follow-up study of 136 patients undergoing arthroscopic meniscectomy.
- Analysis of 29 patients with post-operative juxta-articular bone marrow signal changes on MRI.
- Arthroscopic and histopathological examination of 6 deteriorating cases.
Main Results:
- Subchondral bone fractures were confirmed in all 6 examined cases.
- Osteonecrotic lesions were identified in only 2 cases with significant radiologic deterioration.
- Knee osteonecrosis (Stages 2-3) was diagnosed in these 6 patients.
- Arthroscopic findings included fibrillation, fissuring, ulceration, and eburnation.
Conclusions:
- Post-meniscectomy osteonecrosis may arise from subchondral bone fractures.
- Comorbidities appear to be a risk factor, potentially impairing fracture healing and increasing osteonecrosis risk.
