Skip to main content

Advertisement

SpringerLink
Log in

“Fatigue meniscal tears”: a description of the lesion and the results of arthroscopic partial meniscectomy

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

The purpose of this study was to describe the clinical outcomes of partial meniscectomy in patients with “fatigue meniscal tear”, which presents as a non-traumatic tear with abrupt onset of symptoms of a radial tear in the transition between the middle and posterior thirds of the meniscus.

Methods

We prospectively followed 71 patients with “fatigue meniscal tear” (41 women and 30 men, mean age of 63 years, SD 6.9 years) recruited among 497 patients with isolated medial meniscal lesions treated between January 2006 and June 2011. Inclusion criteria were spontaneous abrupt onset knee pain, minor or no trauma, no radiographic or MRI osteoarthritis, no bone oedema, pre-operative magnetic resonance image of medial meniscus tear, and arthroscopic evaluation demonstrating radial or vertical flap tear in the body to posterior horn junction of the medial meniscus. We followed all patients for a minimum of two years and reviewed their clinical symptoms, physical exam, functional outcome, and patient satisfaction at last follow-up.

Results

The average follow-up was 4.2 years, with a minimum follow-up of two years. Among the 71 patients, there were 59 (83.1 %) good or excellent results and 12 (16.9 %) poor results. These 12 patients demanded further treatment because of persistent pain, with three of the patients developing subchondral bone fracture. All patient complaints and poor outcomes could be identified in the initial six months after surgery. There was no gender difference in the subgroup analysis.

Conclusion

Our findings indicate that patients with “fatigue meniscal tear” benefit from arthroscopic partial meniscectomy, with only 16.9 % reporting unfavourable results.

Level of Evidence: IV, Cohort study or case series

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Abrams GD, Frank RM, Gupta AK, Harris JD, McCormick FM, Cole BJ (2013) Trends in meniscus repair and meniscectomy in the United States, 2005–2011. Am J Sports Med 41:2333–2339. doi:10.1177/0363546513495641

    Article  PubMed  Google Scholar 

  2. Englund M, Guermazi A, Gale D, Hunter DJ, Aliabadi P, Clancy M, Felson DT (2008) Incidental meniscal findings on knee MRI in middle-aged and elderly persons. N Engl J Med 359:1108–1115. doi:10.1056/NEJMoa0800777

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  3. Anderson AF, Irrgang JJ, Dunn W, Beaufils P, Cohen M, Cole BJ, Coolican M, Ferretti M, Glenn RE Jr, Johnson R, Neyret P, Ochi M, Panarella L, Siebold R, Spindler KP, Ait Si Selmi T, Verdonk P, Verdonk R, Yasuda K, Kowalchuk DA (2011) Interobserver reliability of the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) classification of meniscal tears. Am J Sports Med 39:926–932. doi:10.1177/0363546511400533

    Article  PubMed  Google Scholar 

  4. Kamimura M, Umehara J, Takahashi A, Aizawa T, Itoi E (2014) Medial meniscus tear morphology and related clinical symptoms in patients with medial knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc Off J ESSKA. doi:10.1007/s00167-014-2939-z

    Google Scholar 

  5. Camanho GL, Hernandez AJ, Bitar AC, Demange MK, Camanho LF (2006) Results of meniscectomy for treatment of isolated meniscal injuries: correlation between results and etiology of injury. Clinics 61:133–138

    Article  PubMed  Google Scholar 

  6. Peterfy CG, Guermazi A, Zaim S, Tirman PFJ, Miaux Y, White D, Kothari M, Lu Y, Fye K, Zhao S, Genant HK (2004) Whole-organ magnetic resonance imaging score (WORMS) of the knee in osteoarthritis. Osteoarthr Cartil 12:177–190. doi:10.1016/J.Joca.2003.11.003

    Article  CAS  PubMed  Google Scholar 

  7. Sihvonen R, Paavola M, Malmivaara A, Itala A, Joukainen A, Nurmi H, Kalske J, Jarvinen TL, Finnish Degenerative Meniscal Lesion Study G (2013) Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear. N Engl J Med 369:2515–2524. doi:10.1056/NEJMoa1305189

    Article  CAS  PubMed  Google Scholar 

  8. Lubowitz JH, Provencher MT, Rossi MJ (2014) Could the New England Journal of Medicine be biased against arthroscopic knee surgery? Part 2. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc North Am Int Arthrosc Assoc 30:654–655. doi:10.1016/j.arthro.2014.04.007

    Article  Google Scholar 

  9. Rossi MJ, D'Agostino RB Jr, Provencher MT, Lubowitz JH (2014) Could the New England Journal of Medicine be biased against arthroscopic knee surgery? Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc North Am Int Arthrosc Assoc 30:536–537. doi:10.1016/j.arthro.2014.02.013

    Article  Google Scholar 

  10. Herrlin S, Hallander M, Wange P, Weidenhielm L, Werner S (2007) Arthroscopic or conservative treatment of degenerative medial meniscal tears: a prospective randomised trial. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 15:393–401. doi:10.1007/s00167-006-0243-2

    Article  Google Scholar 

  11. Katz JN, Brophy RH, Chaisson CE, de Chaves L, Cole BJ, Dahm DL, Donnell-Fink LA, Guermazi A, Haas AK, Jones MH, Levy BA, Mandl LA, Martin SD, Marx RG, Miniaci A, Matava MJ, Palmisano J, Reinke EK, Richardson BE, Rome BN, Safran-Norton CE, Skoniecki DJ, Solomon DH, Smith MV, Spindler KP, Stuart MJ, Wright J, Wright RW, Losina E (2013) Surgery versus physical therapy for a meniscal tear and osteoarthritis. N Engl J Med 368:1675–1684. doi:10.1056/NEJMoa1301408

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  12. Yim JH, Seon JK, Song EK, Choi JI, Kim MC, Lee KB, Seo HY (2013) A comparative study of meniscectomy and nonoperative treatment for degenerative horizontal tears of the medial meniscus. Am J Sports Med 41:1565–1570. doi:10.1177/0363546513488518

    Article  PubMed  Google Scholar 

  13. Gauffin H, Tagesson S, Meunier A, Magnusson H, Kvist J (2014) Knee arthroscopic surgery is beneficial to middle-aged patients with meniscal symptoms: a prospective, randomised, single-blinded study. Osteoarthr Cartil OARS Osteoarthr Res Soc. doi:10.1016/j.joca.2014.07.017

    Google Scholar 

  14. Demange MK, Fregni F (2011) Limits to clinical trials in surgical areas. Clinics 66:159–161

    Article  PubMed Central  PubMed  Google Scholar 

  15. Hunter DJ, Zhang YQ, Tu X, Lavalley M, Niu JB, Amin S, Guermazi A, Genant H, Gale D, Felson DT (2006) Change in joint space width: hyaline articular cartilage loss or alteration in meniscus? Arthritis Rheum 54:2488–2495. doi:10.1002/art.22016

    Article  CAS  PubMed  Google Scholar 

  16. Fairbank TJ (1948) Knee joint changes after meniscectomy. J Bone Joint Surg Br 30B:664–670

    CAS  PubMed  Google Scholar 

  17. Pengas IP, Assiotis A, Nash W, Hatcher J, Banks J, McNicholas MJ (2012) Total meniscectomy in adolescents: a 40-year follow-up. J Bone Joint Surg Br 94:1649–1654. doi:10.1302/0301-620X.94B12.30562

    Article  CAS  PubMed  Google Scholar 

  18. Lee DH, Lee BS, Kim JM, Yang KS, Cha EJ, Park JH, Bin SI (2011) Predictors of degenerative medial meniscus extrusion: radial component and knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 19:222–229. doi:10.1007/s00167-010-1274-2

    Article  Google Scholar 

  19. Badlani JT, Borrero C, Golla S, Harner CD, Irrgang JJ (2013) The effects of meniscus injury on the development of knee osteoarthritis: data from the osteoarthritis initiative. Am J Sports Med 41:1238–1244. doi:10.1177/0363546513490276

    Article  PubMed  Google Scholar 

  20. Wenger A, Wirth W, Hudelmaier M, Noebauer-Huhmann I, Trattnig S, Bloecker K, Frobell RB, Kwoh CK, Eckstein F, Englund M (2013) Meniscus body position, size, and shape in persons with and persons without radiographic knee osteoarthritis: quantitative analyses of knee magnetic resonance images from the osteoarthritis initiative. Arthritis Rheum 65:1804–1811. doi:10.1002/art.37947

    Article  PubMed  Google Scholar 

  21. Englund M, Guermazi A, Roemer FW, Aliabadi P, Yang M, Lewis CE, Torner J, Nevitt MC, Sack B, Felson DT (2009) Meniscal tear in knees without surgery and the development of radiographic osteoarthritis among middle-aged and elderly persons: The Multicenter Osteoarthritis Study. Arthritis Rheum 60:831–839. doi:10.1002/art.24383

    Article  PubMed Central  PubMed  Google Scholar 

  22. Yamamoto T, Bullough PG (2000) Spontaneous osteonecrosis of the knee: the result of subchondral insufficiency fracture. J Bone Joint Surg Am 82:858–866

    Article  CAS  PubMed  Google Scholar 

  23. Norman A, Baker ND (1978) Spontaneous osteonecrosis of the knee and medial meniscal tears. Radiology 129:653–656. doi:10.1148/129.3.653

    Article  CAS  PubMed  Google Scholar 

  24. Sung JH, Ha JK, Lee DW, Seo WY, Kim JG (2013) Meniscal extrusion and spontaneous osteonecrosis with root tear of medial meniscus: comparison with horizontal tear. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc North Am Int Arthrosc Assoc 29:726–732. doi:10.1016/j.arthro.2012.11.016

    Article  Google Scholar 

  25. Robertson DD, Armfield DR, Towers JD, Irrgang JJ, Maloney WJ, Harner CD (2009) Meniscal root injury and spontaneous osteonecrosis of the knee: an observation. J Bone Joint Surg Br 91:190–195. doi:10.1302/0301-620X.91B2.21097

    Article  CAS  PubMed  Google Scholar 

  26. Yao L, Stanczak J, Boutin RD (2004) Presumptive subarticular stress reactions of the knee: MRI detection and association with meniscal tear patterns. Skelet Radiol 33:260–264. doi:10.1007/s00256-004-0751-4

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Institute of Orthopaedic Surgery - Hospital das Clínicas, Faculty of Medicine, University of São Paulo, Rua Ouvidio Pires de Campos, 333, Cerqueira Cesar, São Paulo, SP, Brazil

    Marco Kawamura Demange, Riccardo Gomes Gobbi & Gilberto Luis Camanho

Authors
  1. Marco Kawamura Demange
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Riccardo Gomes Gobbi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gilberto Luis Camanho
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marco Kawamura Demange.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Demange, M.K., Gobbi, R.G. & Camanho, G.L. “Fatigue meniscal tears”: a description of the lesion and the results of arthroscopic partial meniscectomy. International Orthopaedics (SICOT) 40, 399–405 (2016). https://doi.org/10.1007/s00264-015-3010-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-015-3010-5

Keywords

Search

Navigation