Osteonecrosis after contact neodymium:yttrium aluminum garnet arthroscopic laser meniscectomy

The purpose of this report is to describe two cases of osteonecrosis that occurred after arthroscopic meniscectomy with a contact neodymium:yttrium aluminum garnet laser system. The patients developed increasing knee pain and disability 5 months and 6 months after laser meniscectomy. MR imaging showed subchondral osteonecrosis in the femoral condyle and tibial plateau immediately adjacent to the site of laser meniscectomy in both patients. One patient required a total knee replacement to alleviate knee symptoms, and the other patient required a tibial osteotomy and surgical elevation of collapsed tibial articular surface.

To our knowledge, this complication of laser arthroscopic meniscectomy has not been reported in the radiology literature. The clinical and MR imaging features of this important complication are described and possible causative mechanisms are discussed.