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Nine cases of osteonecrosis in elderly patients following arthroscopic meniscectomy
V Pruès-Latour1, J C Bonvin, D Fritschy
1Clinique d'Orthopédie et de Chirurgie de l'Appareil Moteur, Hôpital Cantonal Universitaire, Geneva, Switzerland.
Abstract:
We report nine cases of osteonecrosis of the knee after arthroscopic meniscectomy between 1992 and 1996. In five women and four men aged between 58 and 82 years (mean 69 years), magnetic resonance imaging (MRI) demonstrated a meniscal tear for which arthroscopic meniscectomy was performed. MRI was done between 3 days and 72 weeks after the onset of symptoms. Signs of osteonecrosis were not present on the initial MRI scan. Postoperatively, all patients experienced persistent knee pain and joint effusion. A repeat MRI scan 6-48 weeks after meniscectomy confirmed the diagnosis of osteonecrosis. In eight patients osteonecrosis was located on the medial, in one patient on the lateral femoral condyle. Our report supports the results of recent studies which have related osteonecrosis to arthroscopic meniscectomy. Further studies need to be undertaken to determine the aetiology of the osteonecrosis related to this procedure in the elderly. Until the results of these studies are available, we recommend considering carefully before performing arthroscopic procedures in the elderly.
Insights
Arthroscopic meniscectomy may lead to knee osteonecrosis in elderly patients. Persistent pain and effusion post-surgery, confirmed by MRI, indicate this risk, warranting careful consideration for the procedure in this demographic.
Area of Science:
- Orthopedic Surgery
- Radiology
- Geriatric Medicine
Background:
- Arthroscopic meniscectomy is a common procedure for meniscal tears.
- Osteonecrosis of the knee is a serious condition affecting bone viability.
Observation:
- Nine cases of knee osteonecrosis were identified post-arthroscopic meniscectomy in patients aged 58-82.
- Initial MRI scans did not show osteonecrosis; diagnosis was confirmed on repeat scans post-surgery.
- Persistent knee pain and joint effusion were common postoperative symptoms.
Findings:
- Osteonecrosis occurred on the medial femoral condyle in eight patients and the lateral femoral condyle in one.
- The diagnosis was confirmed 6-48 weeks after arthroscopic meniscectomy.
- The findings support a link between arthroscopic meniscectomy and osteonecrosis in the elderly.
Implications:
- Further research is needed to elucidate the etiology of procedure-related osteonecrosis.
- Clinicians should carefully consider the risks of arthroscopic procedures in elderly patients.
- This study highlights a potential complication of arthroscopic meniscectomy in older adults.