[3] Most acute tears are commoner in younger patients, with the medial meniscus affected at a 2:1 ratio with the lateral side. Metcalf, and R.W. 84(7): p. 937-45. The functional and clinical outcomes do not necessarily match the radiological outcomes in most of the studies. Balato G, Ascione T, Iorio P, De Franco C, De Matteo V, D'Addona A, Tammaro N, Pellegrino A. BMC Infect Dis. Chatain, F., et al., The natural history of the knee following arthroscopic medial meniscectomy. Proper observation allows for resection of only unstable meniscal fragments. Meniscus is the C-shaped cartilage located in the knee that lubricates the knee joint, acts as shock-absorber, and controls the flexion and extension of joint. Osteonecrosis of the knee following arthroscopic laser meniscectomy. These radiological signs were indicative of early osteoarthritic changes in the knee. Posterior meniscal root avulsions occasionally may be missed after treating the more obvious multidirectional tears of the body and posterior horn. The purpose of this Prevention and treatment information (HHS). Total meniscectomy was the more time consuming and there were intraoperative technical problems in 16 patients, the most common being rupture of the meniscus during extraction. These events can be related to the arthroscopic set-up, the instrumentation, or the meniscal resection itself. Technical Complications. The acute tears are described as per their orientation and extent along the meniscus. [5](Fig. These events can be related to the arthroscopic set-up, the instrumentation, or the meniscal resection itself. Signal-intensity changes in an intact meniscal remnant in a 35-year-old man following partial medial meniscectomy. In this instance, we extracted the data relative to arthroscopic partial meniscectomy, and used them in our analysis. 2019 Oct 24;19(1):887. doi: 10.1186/s12879-019-4556-4. The menisci of the knee joint are fibrocartilagenous semilunar tissues that perform a critical function of stabilising the joint and aiding in efficient load transfer as a shock absorber. Partial meniscectomy. Arthroscopic partial meniscectomy can be complicated by excessive resection, damage to articular cartilage, neurovascular injury, persistent drainage from portals, and infection; the procedure can be rendered more difficult, and the outcome less certain, if the surgeon fails to recognize concomitant injuries, malpositions the portals, or misidentifies the components of a meniscus tear. The technique of partial meniscectomy is performed arthroscopically. The effects of meniscectomy on the stability and pressures inside the knee joint were studied using pressure sensitive films in cadavers. • Wed, May 22nd, 2019. The purpose of this study was to evaluate the complications of arthroscopic partial meniscectomy, especially in the early stages of experience with a review of literature. (1.78% and 1.48% for medial and lateral meniscectomy) , . Hughston, J.C., A simple meniscectomy. 203–236. McDermott, I.D. Englund, M. and L.S. Subscribe for print copy of AJA. The American Academy of Orthopedic Surgeons (AAOS) states that infection is a risk of meniscal surgery 1.In the case of a meniscal transplant surgery, the risk of contracting HIV from a meniscal transplant is one in 1.6 million 1.Other possible sources of infection include the patient’s skin, surgical tool or other objects in the operating room. Ni J, Shi Z, Fan L, Guo N, Wang H, Dang X, Li D. BMC Musculoskelet Disord. Proper observation allows for resection of…, An arthroscopic view shows safe instrumentation. Author: Shantanu Sudhakar Patil[1], Sachin Ramchandra Tapasvi[1], Anshu Shekhar[1]. Only 50-68% of Partial Meniscectomy Patients Satisfied. Fairbank, T.J., Knee joint changes after meniscectomy. FOIA Lohmander, Risk factors for symptomatic knee osteoarthritis fifteen to twenty-two years after meniscectomy. Background: Complications of arthroscopic meniscectomy in the older population have not been established.. Purpose: To determine the risk and relative risk of developing pyogenic arthritis (PA), a deep vein thrombosis (DVT), and pulmonary embolism (PE) in an older population of patients who have undergone arthroscopic meniscectomy.. Study Design: Case series; Level of evidence, 4. A finite element study quantifying the amount of resected meniscus to peak pressures showed that with as little as 20% resection of meniscus, a detrimental increase of forces is seen which may hasten the osteoarthritic changes. J Bone Joint Surg Br, 2002. With our growing understanding of the anatomy , vasculature, biomechanics and the biology of the meniscus, and with improved arthroscopic techniques and instrumentation, the goal of management of meniscal tears has shifted towards achieving repair. 4. If you have a partial or total meniscectomy, you can expect your recovery to take about a month. and A.A. Amis, The consequences of meniscectomy. Petty, C.A. Multiple clinical and radiological studies have documented these sequelae, but the correlation between the symptoms of the patient and severity of these changes is not always seen in the results. Hede A, Larsen E, Sandberg H. The long term outcome of open total and partial meniscectomy related to the quantity and site of the meniscus removed. Ahn JH(1), Oh I. Though meniscus repair is being increasingly performed to preserve knee function, not all tears are amenable to repair and partial meniscectomy in such cases is an acceptable treatment option. Learn More. Arthroscopy, 1988. 2015 Oct 16;112(42):705-13. doi: 10.3238/arztebl.2015.0705. Recovery time from a partial meniscectomy (partial removal of the meniscus knee cartilage) is quicker than recovery from a meniscus repair. 15. The Orthopaedic Speciality Clinic, 16 Status Chambers, 1221/A Wrangler Paranjpe Road, Pune 411004 51(3): p. 517-26 passim. 17(8): p. 608-13. patients who had a partial meniscectomy had a shorter hospital stay and spent less time using crutches. Kim, and I.H. The multiple imaging modalities add to data which is not uniform for evaluation. Some of the enumerated complications include instrument failure or breakage, injuries to nerves and blood vessels, accidental damage to chondral surfaces and ligament injury. Arthroscopic partial medial or lateral meniscectomy, loose body removal or debridement protocol: The intent of this protocol is to provide the clinician with a guideline of the post- ... post-operative complications. 7. Considering the relatively high number of partial lateral meniscectomy performed, we cannot understand why this complication is so rare. 30b(4): p. 664-70. 4(3): p. 215-21. It is uncommon these days to perform a total resection, with partial meniscectomy being the more widely reported procedure. J Athl Train, 2012. Arthroscopic partial meniscectomy can be complicated by excessive resection, damage to articular cartilage, neurovascular injury, persistent drainage from portals, and infection; the procedure can be rendered more difficult, and the outcome less certain, if the surgeon fails to recognize concomitant injuries, malpositions the portals, or misidentifies the components of a meniscus tear. [11], [21]. A radial tear disrupts the continuity of the circularly oriented fibrils and thus prevents the hoop strains from forming, causing dysfunction of the meniscus. Chondral lesions can cause similar symptoms as that of a meniscal tear and meniscectomy may not fully alleviate the patients’ complaints, thus leading to poor outcomes. Lubowitz, Does arthroscopic partial meniscectomy always cause arthritis? Once a meniscal tear is identified and deemed unsuitable for repair, a meniscectomy is the recommended surgical option. Infection risk has been found to be 0.2% to 0.4% and is associated with longer operative time, greater number of procedures performed, longer tourniquet time, and history of prior surgeries. It is probably safe to conclude that a minimally invasive procedure with attention to sparing bulk of meniscal tissue seems to reduce the subsequent incidence of arthritic changes, as compared with open invasive and radical procedures.. 1. Complications are rare. However, [19, 20]While there is consensus about patients with increased BMI predisposing to a higher risk of OA post meniscectomy, the exact level of BMI that placed the patient at risk is not conclusive. Tapper, E.M. and N.W. The Medial and Lateral meniscal cartilages are gasket like cushions in the knee. Although x-rays may show some mild changes of arthritis 12 to 15 years later, patients generally do not experience any persistent or increased symptoms in their knee. Fu, and R. Mengato, Meniscal tears: the effect of meniscectomy and of repair on intraarticular contact areas and stress in the human knee. Shantanu Sudhakar Patil, Sachin Ramchandra Tapasvi, Anshu Shekhar. Anat Embryol (Berl), 1998. Technical Complications. 22. Bethesda, MD 20894, Copyright For this reason, tears of the inner portion of the meniscus, which does not have a blood supply, almost always have to be resected. Complications of Partial Meniscectomy Though meniscus repair is being increasin gly performed to preserve knee function, not all tears are amenable to rep air and. However, they can include: Infection; Deep vein thrombosis; Swelling; Stiffness; We take all necessary measures to … Abstract. jha@smc.samsung.co.kr After surgery, rehabilitation exercises may help to restore knee mobility, strength and improve range of motion. There is a direct relationship between the amount of meniscus tissue that is surgically removed and the load distribution across the knee. Unable to load your collection due to an error, Unable to load your delegates due to an error. [6] The articular cartilage responds unfavourably to the higher loads, with disruption of the proteoglycan matrix, causing swelling and inflammation throughout the joint. 1990 May-Jun;128(3):295-300. Osteoarthritis Cartilage, 2011. We will take a look at the outcomes and complications of arthroscopic meniscectomy in this article. These can be classified as those related to knee arthroscopy in general and those associated specifically with arthroscopic partial meniscectomy. Healthy Menisci convert the The modified cross-suture technique for unilateral pulled-out anchor during all-inside meniscal repair. [17] Consequences of meniscectomy in an unstable knee are worsened by the combination of higher contact forces inducing early pathological changes due to the elevated shear stresses within the articular cartilage. Park, In vitro study of contact area and pressure distribution in the human knee after partial and total meniscectomy. Knee septic arthritis caused by α-hemolytic Streptococcus in a patient with a recent history of knee arthroscopy: a case report. 20. Conf Proc IEEE Eng Med Biol Soc, 2006. Author information: (1)Department of Orthopedic Surgery, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea. Arthroscopic partial meniscectomy can be complicated by excessive resection, damage to articular cartilage, neurovascular injury, persistent drainage from portals, and infection; the procedure can be rendered more difficult, and the outcome less certain, if the surgeon fails to recognize concomitant injuries, malpositions the portals, or misidentifies the components of a meniscus tear. Karpinski K, Müller-Rath R, Niemeyer P, Angele P, Petersen W. Knee Surg Sports Traumatol Arthrosc. 24. Accessibility Moreover, a meniscal tear rarely presents in isolation and the concomitant ligament or articular injuries play a role in subsequent degeneration and development of Osteoarthritis. This is more prominent on the lateral side where a convex lateral femoral condyle articulates on a flat or convex tibial plateau. The radiological changes in the knee joint following medial meniscectomy are well documented. Complications following partial meniscectomy surgery are rare. Clipboard, Search History, and several other advanced features are temporarily unavailable. Only 50-68% of Partial Meniscectomy Patients Satisfied. 88(12): p. 1549-56. 50(9): p. 2811-9. Radial tears of the posteromedial compartment are the most frequently seen tears and vertical longitudinal tears are most often associated with acute ACL injury. The next meniscus tear happened many years later, in my 30s, after a seemingly innocent move. Careers. 2013 Feb 25;14:71. doi: 10.1186/1471-2474-14-71. Degenerative tears have a varied pattern and are complex in their morphology.[4]. Why is it done? Volume 1 | Issue 2 | Aug – Nov 2016 | Page 53-55. Arthroscopic partial meniscectomy can be complicated by excessive resection, damage to articular cartilage, neurovascular injury, persistent drainage from portals, and infection; the procedure can be rendered more difficult, and the outcome less certain, if the surgeon fails to recognize concomitant injuries, malpositions the portals, or misidentifies the components of a meniscus tear. Arthroscopic partial meniscectomy of a medial meniscus bucket-handle tear using the posteromedial portal. Incomplete removal of the torn pieces can cause persistent pain along with coexistent knee pathology. Patients with a lateral meniscectomy have a much higher functional deterioration and increased instability than the medial meniscectomy patients[11,3,16]. Hare KB, Lohmander LS, Christensen R, Roos EM. Papalia, R., et al., Meniscectomy as a risk factor for knee osteoarthritis: a systematic review. An arthroscopic view shows a complex meniscal tear not amenable to repair. Resecting more than it is necessary of the meniscus, thus affecting the loading capacity of the knee 13(6): p. 673-9. However, like any surgical procedure, it can be rendered more difficult by misdiagnoses or technical errors, and compromised by complications. BMC Musculoskelet Disord. They have a blood supply on the outer third, with the inner portion of the meniscus not having any blood supply. A partial meniscectomy is when a surgeon trims out or removes the torn portion of meniscus leaving behind as much stable, healthy meniscus as possible. Petersen, W. and B. Tillmann, Collagenous fibril texture of the human knee joint menisci. Positioned between the femur and tibia, they distribute the weight transferred from the larger femur above to the smaller tibia below. Elizabeth Hofheinz, M.P.H., M.Ed. 10. Am J Sports Med, 2010. Metcalf, R.W., Arthroscopic meniscal surgery., in Operative Arthroscopy., M. JB, Editor. The functions of the meniscus were recognised much earlier [2] and eventually the potential harms of its excision were gaining attention. [15] This needs to be borne in mind while determining the extent of the meniscectomy. The poor outcomes following partial meniscectomy are due to the shrinking of contact areas and rise in peak stresses. They are usually classified as vertical longitudinal, oblique, circumferential, complex, transverse or radial, and horizontal cleavage tears. Ihn, J.C., S.J. This lack of homogenous data and lack of standardization of methodological issues, makes it difficult to conclude if the findings represent true differences or are simply artefact related to measurement bias or other errors. However, the evidence that meniscectomy in this group leads to higher rate of radiographic OA is not conclusive. 1: p. 2098-101. Of course, there’s always a chance of infection, bleeding, injury to ligaments, injury to the meniscus, blood clots, and nerve damage, but these complications can be minimized under the care of an experienced orthopedic surgeon. A meniscectomy is typically performed when you have a torn meniscus , which is a common knee injury. In addition, the inner portion is much thinner than the thicker outer portion, which attaches to the joint lining. Complications of a meniscus tear include: Persistent knee pain Inability to move the knee normally Predisposition to developing osteoarthritis Background: Complications of arthroscopic meniscectomy in the older population have not been established.. Purpose: To determine the risk and relative risk of developing pyogenic arthritis (PA), a deep vein thrombosis (DVT), and pulmonary embolism (PE) in an older population of patients who have undergone arthroscopic meniscectomy.. Study Design: Case series; Level of evidence, 4. The menisci are made of fibrocartilage and act as shock absorbers for the joint. Salata in a meta-analysis showed the significantly higher risk of developing radiographic OA in the patients undergoing total meniscectomy as compared to the partial meniscectomy. Salzmann GM, Preiss S, Harder LP, Naal FD. 19. 9. If a clinician requires assistance in the progression of a Metcalf, Fifteen-year follow-up of arthroscopic partial meniscectomy. Please enable it to take advantage of the complete set of features! A torn meniscus is an extremely common knee injury, which usually occurs due to a sports injury or degenerative changes in older adults. The tear of the meniscus is one of the most common injuries of … For example, a smaller 2.7-mm biter (rather than the standard 3.4-mm biter) can provide safer access to the meniscus without damaging the articular cartilage while resecting the meniscus. 99: p. 89-106. Elizabeth Hofheinz, M.P.H., M.Ed. Clin Biomech (Bristol, Avon), 1996. Rozbruch SR, Wickiewicz TL, DiCarlo EF, Potter HG. 9(1): p. 15-18. J Bone Joint Surg Br, 1948. The cross section of the meniscus reveals three distinct layers: a superficial thin layer on both tibial and femoral surfaces; a lamellar layer below this with the fibrils arranged in a radial manner and a main central region where the fibrils are orientated in a circular manner. The Effect of Partial Meniscectomy on Future Knee Function Meniscal tears are the most common injury to the knee joint and meniscectomy is one of the most commonly performed orthopedic procedures in the United States. A preliminary report. 21. 2020 Jul 22;21(1):480. doi: 10.1186/s12891-020-03502-z. Description of Partial Meniscectomy. BibTex; Full citation; Publisher: 'Springer Science and Business Media LLC' DOI identifier: 10.1007/s11999-012-2735-3. The medial collateral ligament may get injured due to excessive valgus forces while attempting access to the medial compartment. In years past, the meniscus was thought to … Systematic…, An arthroscopic view shows a partial meniscectomy. The study analyzed the results of arthroscopic partial medial meniscectomy in 213 patients in a 24-month period, from 2006, to 2008. 197(4): p. 317-24. Complications From Arthroscopic Knee Surgery. Infections are uncommon complications of this procedure with an incidence rate of 0,01% - 3,4%. The direction of the meniscus tears is explained by the orientation of collagen fibrils within the structure. ( A ) An arthroscopic view shows an unstable articular cartilage fragment on…, An arthroscopic view shows a complex meniscal tear not amenable to repair. Partial meniscectomy helps in restoring or maintaining knee stability and offers faster and complete recovery. The poor outcomes following partial meniscectomy are due to the shrinking of contact areas and rise in peak stresses. In th… Maximum shear stress in the articular cartilage is seen with 65% partial meniscectomy[14]. 20(2): p. 58-61. The Treatment of Non-Traumatic Meniscus Lesions. Rapid chondrolysis after partial arthroscopic lateral meniscectomy has been seldom reported in literature. 1). Phase I: Day 1 to 2 Weeks. Complications In Brief: Arthroscopic Partial Meniscectomy Complications In Brief: Arthroscopic Partial Meniscectomy Kinsella, Stuart; Carey, James 2012-12-11 00:00:00 Clinical Orthopaedics Clin Orthop Relat Res (2013) 471:1427–1432 ® and Related Research DOI 10.1007/s11999-012-2735-3 A Publication of The Association of Bone and Joint Surgeons® IN BRIEF Complications In … South Florida’s Top Orthopaedic Specialists and Surgeons We'd love to hear from you Good grief—it hurt! Small, N.C., Complications in arthroscopic surgery performed by experienced arthroscopists. This translates to poorer outcomes with lateral meniscectomy as compared to medial as reported in multiple studies. Pin 400604, Tel- 02225834545 (office time 10-5 pm, Mon-Fri), Email: editor.asian.arthroscopy@gmail.com, Payment Option (Article Processing Charges). Brace • Knee immobilizer • TED hose to be worn until ambulation has returned to normal pre-surgery level or two weeks • Crutches: weight bearing as tolerated. While there is no way to predict if a patient will develop later arthritis after a partial meniscectomy or how quickly, it is a potential concern. They are as follows: Remove all mobile fragments; Avoid sudden changes in rim contour; a perfectly smooth rim is unnecessary as some remodelling may occur; re-evaluate the tear often with a probe; Avoid damage to the meniscus-capsular junction to avoid the loss of hoop stresses; Use both manual and motorized instruments to maximize efficiency and when uncertain if an area should be resected, err on the side of leaving more meniscus intact rather than compromising biomechanical properties[9]. The overall complication rate varies from 0.5% to 1.7% with meniscectomy. 6. Partial meniscectomy is a minimally invasive and relatively quick procedure; however, intraoperative complications can occur. The menisci, once considered expendable remnants have been conclusively proven to be of extreme vitality in the biomechanics and biology of the knee joint. The medial and lateral tibio-femoral articulations are anatomically different and the absence of menisci which afford a degree of congruity can lead to increased point loading and higher contact pressures. [12] There exists a direct correlation with the meniscal tissue left behind and peak contact stress on the tibial surfaces following partial resections[13]. 3. Instrument failure rates have dropped from 18.1% to 2.9% over the years, due to improvement in surgical techniques, better designs as well as better skill levels of the surgeons[22]. Meniscectomy was thought to be a benign procedure and as late as 1975 [1] the importance of doing a complete removal was being reiterated. The menisci are C-shaped pieces of tough cartilage that rest on either side of the knee, between the thigh bone and shin bone. 23. Partial meniscectomy is a minimally invasive and relatively quick procedure; however, intraoperative complications can occur. 18. Sequelae of articular cartilage changes following Meniscectomy, http://asianarthroscopy.com/wp-content/uploads/2016/02/AJA-WORD-300x94.png, © Copyright - Indian Orthopaedic Research Group -, Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Partial meniscectomy is the surgical removal of a portion of a torn meniscus.

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