Partial arthroscopic meniscectomy versus total open meniscectomy

Arthroscopic meniscectomy: treatment costs and postoperative function in a historical perspective

We report short-term data from 82 consecutive patients with arthroscopic meniscectomy 1995-1998 in stable knees and without severe cartilage changes. All patients were treated as outpatients, the operating time was, on average, 23 SD12 minutes and 3 of 4 patients were back at work within 1 week. Almost half of the patients still had some knee problems 3 months after surgery, but thereafter a substantial improvement was seen. We also report original data from a consecutive series of patients having arthroscopic meniscectomy 1980-81. In that series, the frequency of total meniscectomies was higher, the operating time longer, but the time to recovery was shorter than in 1995-98. In contrast to 1995-98, most of the patients in 1980-81 were followed by the doctor and had supervised rehabilitation. However, sick leave was similar in the two series. The total costs for an arthroscopic meniscectomy in 1998 was less than half the costs in 1980-81. We conclude that the improved technique for arthroscopic meniscectomy during the last 15-20 years and less supervised rehabilitation have reduced the costs, but not the recovery time.

Meniscal tears of the knee: diagnosis and individualized treatment

Meniscal tears are very common sports injuries. Typical symptoms include pain, catching, and buckling. Signs on physical exam include joint-line tenderness, effusion, and, possibly, a click when the knee is taken through full range of motion. MRI is often needed to confirm tears and differentiate pain from that caused by other injuries such as articular cartilage damage. Treatment comprises physical therapy and rest, partial meniscectomy, or, in special instances, surgical repair. Therapeutic goals, which are often achieved, are to restore a high level of pain-free function and to prevent premature joint degeneration.

Fifteen-year follow-up of arthroscopic partial meniscectomy

From an original pool of 283 patients, 146 patients who had undergone arthroscopic partial meniscectomy an average of 14.7 years before were followed-up. Lysholm score, Tegner activity level, satisfaction index on a scale of 1 to 10, and standing anteroposterior and flexion weight-bearing radiographs of both knees, were obtained. A physical examination was performed on each knee emphasizing motion, swelling, and ligament evaluation. Radiographs were graded for degenerative changes for each knee. Each knee joint space was also measured in millimeters and compared, operative knee with unoperated knee. The unoperated knee had no injuries or surgeries and was used as a control. Patients were 83% male and 17% female; 78% had undergone medial meniscectomies, 19% lateral, and 3% both. There were 88% good and excellent results in anterior cruciate ligament-stable knees. The radiographic grade side-to-side difference showed the operative knee to be only a 0.23 grade worse than the nonoperative knee. Age at the time of meniscectomy was not found to be a factor. Male patients had better radiographic results than female patients, but not better functional scores. Medial meniscus and lateral meniscus results were not significantly different. Knees with a femoral-tibial anatomic alignment of > 0 degree valgus compared with < or = 0 degree and that had undergone medial meniscectomy had significantly better radiographic results. Patients with anterior cruciate ligament tears and meniscectomy did significantly poorer than stable knees with meniscectomy in regards to radiographic grade change, Lysholm, satisfaction index, Tegner level, and medial joint space narrowing.

Early and intensive physiotherapy accelerates recovery postarthroscopic meniscectomy: results of a randomized controlled study

The efficacy of an early, intensive, supervised rehabilitation program to accelerate knee strength recovery in the first 3 weeks postmeniscectomy by arthroscopy was evaluated using a randomized controlled trial design. The maximal voluntary isokinetic strength of 31 men, randomly allocated to either a treatment (EXP) or a control (CTL) group, was measured twice by a blind rater: preoperatively (pretest) and 3 weeks postsurgery (posttest), using a computer-controlled Kin-Com dynamometer (Chattecx Corporation, Chattanooga, TN). Strength deficits of the operated leg at the pretest and posttest were established in percent of the values obtained for the sound leg at the pretest. In the interval between the surgery and the posttest, the patients of the EXP group (n = 15) received nine supervised treatments combined to home exercises whereas patients of the control group (n = 16) had no specific physiotherapy treatment but were given instructions in postsurgical management and prescribed exercises by the orthopedic surgeons. Patients of the EXP group had better knee extensor strength recovery than patients of the CTL group (ANCOVA, p < 0.001). The size of the strength difference (3 weeks postsurgery) between EXP and CTL subgroups (n = 8) matched according to preoperative deficits was as large as 26% and the residual deficits of the untreated patients were two to three times larger than those of the treated patients. The results of this study highlight the importance of instituting an early intensive and supervised rehabilitation program, especially for workers returning to a strenuous job requiring good knee extensor muscle function.

Isolated arthroscopic partial meniscectomy. Functional radiographic evaluation at five years

Fifty patients who underwent isolated arthroscopic partial meniscectomy with a minimum followup of 5 years were analyzed retrospectively. To analyze the factors associated with a satisfactory or an unsatisfactory clinical result, we looked at the patient's age, duration of symptoms, type of meniscal lesion, and articular cartilage abnormalities. The patients were graded with a functional knee score (Lysholm-Gillquist), and activity level before surgery and at followup was determined. The data also included radiographic evaluation of 29 of the 50 patients. Tibiofemoral alignment was measured, and osteoarthritic changes were graded and correlated with the type of meniscal abnormality and functional result. Eighty-two percent of our patients had satisfactory knee function, and the activity level was maintained. The factors associated with a satisfactory result after a partial meniscectomy included age less than 40 years, symptoms less than 12 months duration, type of tear, and chondromalacia less than grade II. Fairbank's changes were present in 50% of the patients, with significant grade III and IV changes identified in 30%. Although the radiographic changes did not necessarily correlate with the functional result, we felt that the changes were significant and indicative of abnormal stress transfer to articular cartilage and bone.

Motor recovery after arthroscopic partial meniscectomy. Analyses of gait and the ascent and descent of stairs

We studied motor recovery as shown by locomotor activities after arthroscopic partial medial meniscectomies in seventeen men who were twenty-five to forty-nine years old. The patients were evaluated before the operation and two, four, and eight weeks after the operation. Control values were obtained from twenty-two healthy men whose ages, weights, and heights were similar to those of the patients who had had a meniscectomy. Motion of the hip, knee, and ankle in the sagittal plane and the electromyographic activities (as measured with surface electrodes) in five muscles were recorded while each subject walked on a level walkway and then ascended and descended stairs at free speeds. The results showed that meniscal tears affect the motor-control mechanisms involved in the submaximum locomotor activities that were studied and that these abnormalities may persist for as long as eight weeks after a meniscectomy.

Discoid medial meniscus: report of a case treated by arthroscopy

A complete discoid medial meniscus with a longitudinal tear was found in a 41-year-old man and treated by arthroscopy. The symptomatology was characterized by a sharp pain corresponding to the medial joint line, slight intrarticular effusion without locking or loss of motion. A review of the literature is described.

Long-term results after conventional total meniscectomy: a point of reference

We have reviewed 167 conventional total meniscectomies with the aim of analyzing the long-term results. One hundred and twenty-five patients came to the hospital for personal view, and the Lysholm test was applied in each case. There was a 14.4% diagnostic error that caused us to remove the meniscus without demonstrable pathology. A systematic introduction of diagnostic arthroscopy has clearly modified this situation. A decision to remove a meniscus should not be based solely on clinical findings; arthroscopic confirmation is necessary. The overall acceptable results (64.5%) revealed that conventional total meniscectomy is not an operation that belongs in the past. We believe it is an alternative to be considered every time diagnostic arthroscopy shows that it is impossible to leave a stable and uniform meniscal rim.

[Open versus arthroscopic meniscectomy: on meniscectomy by arthrotomy]

Articles in the general press, radio and television give the impression that the open operation method for the meniscus is obsolete and passé. With a row of arguments such as ambulant treatment, lower costs, reduced morbidity and shorter operation time etc. attempts are made to demonstrate its advantages. There are comprehensive opinions on each individual point and results from the literature are compared with those of a personal postexamination about open meniscal resection. It can definitely be shown, however, that the postoperative effusion rate by open operation is much lower than with the arthroscopic method. It must be stressed that the arthroscopic operation may cause considerable damage particularly in the cartilage of the joints. It has been determined that for the arthroscopic operation great experience and technical ability is necessary. If these and adequate technical equipment are not guaranteed, then the open method is regarded as the far superior.