Preoperative Meniscal Extrusion Predicts Unsatisfactory Clinical Outcomes and Progression of Osteoarthritis after Isolated Partial Medial Meniscectomy: A 5-Year Follow-Up Study

João V. Novaretti; Diego C. Astur; Elton L.B. Cavalcante; Camila C. Kaleka; Joicemar T. Amaro; Moisés Cohen

doi:10.1055/s-0040-1715109

The Journal of Knee Surgery, Table of Contents

J Knee Surg 2022; 35(04): 393-400
DOI: 10.1055/s-0040-1715109

Original Article

Preoperative Meniscal Extrusion Predicts Unsatisfactory Clinical Outcomes and Progression of Osteoarthritis after Isolated Partial Medial Meniscectomy: A 5-Year Follow-Up Study

Authors

João V. Novaretti

¹Department of Orthopaedics and Traumatology, Orthopaedics and Traumatology Sports Center (CETE), Paulista School of Medicine (EPM), Federal University of São Paulo, São Paulo, Brazil
Diego C. Astur

¹Department of Orthopaedics and Traumatology, Orthopaedics and Traumatology Sports Center (CETE), Paulista School of Medicine (EPM), Federal University of São Paulo, São Paulo, Brazil
Elton L.B. Cavalcante

²Cohen Institute, São Paulo, Brazil
Camila C. Kaleka

²Cohen Institute, São Paulo, Brazil
Joicemar T. Amaro

²Cohen Institute, São Paulo, Brazil
Moisés Cohen

¹Department of Orthopaedics and Traumatology, Orthopaedics and Traumatology Sports Center (CETE), Paulista School of Medicine (EPM), Federal University of São Paulo, São Paulo, Brazil

Abstract

The objective of this study was to examine the association between preoperative meniscal extrusion of patients undergoing partial medial meniscectomy with clinical outcomes and progression of osteoarthritis and to determine the extent of meniscal extrusion associated with unsatisfactory clinical outcomes and progression of osteoarthritis. Ninety-five patients who underwent partial medial meniscectomy with a minimum follow-up of 5 years were retrospectively reviewed. Preoperative meniscal extrusion was evaluated with magnetic resonance imaging. Patients were assessed preoperatively and postoperatively with Lysholm and International Knee Documentation Committee (IKDC) subjective scores for clinical outcomes and with IKDC radiographic scale for osteoarthritis. An ANOVA (Analysis of Variance) was used to analyze the variations in meniscal extrusion and the clinical and radiological outcomes. A regression analysis was performed to identify factors that affect preoperative medial meniscus extrusion and that influence results after partial meniscectomy. An optimal cutoff value for meniscal extrusion associated with unsatisfactory clinical outcomes and progression of osteoarthritis was established. Significance was set at p < 0.05. The mean ± SD preoperative and postoperative Lysholm scores were 59.6 ± 15.5 versus 83.8 ± 13.1 (p < 0.001) and the mean preoperative and postoperative IKDC subjective scores were 59.4 ± 16.8 versus 82.0 ± 15.8 (p < 0.001). Meniscal extrusion greater than 2.2 mm (sensitivity, 84%; specificity, 81%) and 2.8 mm (sensitivity, 73%; specificity, 85%) was associated with unsatisfactory (poor/fair) Lysholm and IKDC subjective scores, respectively. The progression of osteoarthritis, characterized as a change of at least one category on the IKDC radiographic scale, occurred when meniscal extrusion was greater than 2.2 mm (sensitivity, 63%; specificity, 75%). Patients with higher body mass index (BMI) had significantly greater meniscal extrusion that patients with normal BMI (p < 0.001). The medial meniscus was more extruded in patients with horizontal and root tears. In conclusion, patients with preoperative meniscal extrusion of 2.2 mm or greater had unsatisfactory clinical outcomes and progression of osteoarthritis after partial medial meniscectomy at a minimum of 5 years follow-up. Higher BMI and horizontal and root tears were associated with greater preoperative meniscal extrusion.

Keywords

meniscal extrusion - partial meniscectomy - clinical outcomes - progression to osteoarthritis

Full Text

References

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