Patellofemoral and tibiofemoral articular cartilage and subchondral bone health following arthroscopic partial medial meniscectomy

  • Yuanyuan Wang
  • Alasdair R. Dempsey
  • David G. Lloyd
  • Peter M. Mills
  • Tim Wrigley
  • Kim L. Bennell
  • Ben Metcalf
  • Fahad Hanna
  • Flavia M. Cicuttini



To examine articular cartilage and subchondral bone changes in tibiofemoral and patellofemoral joints following partial medial meniscectomy.


For this cross-sectional study, 158 patients aged 30–55 years, without evidence of knee osteoarthritis at arthroscopic partial medial meniscectomy (APMM), and 38 controls were recruited. MRI was performed once on the operated knee for each subcohort of 3 months, 2 or 4 years post-surgery, and the randomly assigned knee of the controls. Cartilage volume, cartilage defects, and bone size were assessed using validated methods.


Compared with controls, APMM patients had more prevalent cartilage defects in medial tibiofemoral (OR = 3.17, 95%CI 1.24–8.11) and patellofemoral (OR = 13.76, 95%CI 1.52–124.80) compartments, and increased medial tibial plateau bone area (B = 143.8, 95%CI 57.4–230.2). Time from APMM was positively associated with cartilage defect prevalence in medial tibiofemoral (OR = 1.02, 95%CI 1.00–1.03) and patellofemoral (OR = 1.04, 95%CI 1.01–1.07) compartments, and medial tibial plateau area (B = 2.5, 95%CI 0.8–4.3), but negatively associated with lateral tibial cartilage volume (B = −4.9, 95%CI −8.4 to −1.5). The association of APMM and time from APMM with patellar cartilage defects was independent of tibial cartilage volume.


Partial medial meniscectomy is associated with adverse effects on articular cartilage and subchondral bone, which are associated with subsequent osteoarthritis, in both tibiofemoral and patellofemoral compartments.

Level of evidence



Meniscectomy Cartilage Subchondral bone Magnetic resonance imaging Osteoarthritis 


  1. 1.
    Aglietti P, Buzzi R, Bassi PB, Pisaneschi A (1986) Results of arthroscopic meniscectomy. Ital J Orthop Traumatol 12(3):315–325PubMedGoogle Scholar
  2. 2.
    Amin S, Baker K, Niu J, Clancy M, Goggins J, Guermazi A, Grigoryan M, Hunter DJ, Felson DT (2009) Quadriceps strength and the risk of cartilage loss and symptom progression in knee osteoarthritis. Arthritis Rheum 60(1):189–198PubMedCrossRefGoogle Scholar
  3. 3.
    Appleyard RC, Ghosh P, Swain MV (1999) Biomechanical, histological and immunohistological studies of patellar cartilage in an ovine model of osteoarthritis induced by lateral meniscectomy. Osteoarthr Cartil 7(3):281–294PubMedCrossRefGoogle Scholar
  4. 4.
    Bernstein J (2000) Meniscal tears of the knee: diagnosis and individualized treatment. Phys Sportsmed 28(3):83–90PubMedGoogle Scholar
  5. 5.
    Bolano LE, Grana WA (1993) Isolated arthroscopic partial meniscectomy. Functional radiographic evaluation at five years. Am J Sports Med 21(3):432–437Google Scholar
  6. 6.
    Bourne RB, Finlay JB, Papadopoulos P, Andreae P (1984) The effect of medial meniscectomy on strain distribution in the proximal part of the tibia. J Bone Joint Surg Am 66(9):1431–1437PubMedGoogle Scholar
  7. 7.
    Burr DB (1998) The importance of subchondral bone in osteoarthrosis. Curr Opin Rheumatol 10(3):256–262PubMedCrossRefGoogle Scholar
  8. 8.
    Chatain F, Adeleine P, Chambat P, Neyret P (2003) A comparative study of medial versus lateral arthroscopic partial meniscectomy on stable knees: 10-year minimum follow-up. Arthroscopy 19(8):842–849PubMedCrossRefGoogle Scholar
  9. 9.
    Cicuttini FM, Forbes A, Yuanyuan W, Rush G, Stuckey SL (2002) Rate of knee cartilage loss after partial meniscectomy. J Rheumatol 29(9):1954–1956PubMedGoogle Scholar
  10. 10.
    Conaghan PG, Felson D, Gold G, Lohmander S, Totterman S, Altman R (2006) MRI and non-cartilaginous structures in knee osteoarthritis. Osteoarthr Cartil 14(Suppl A):A87–A94Google Scholar
  11. 11.
    Ding C, Cicuttini F, Jones G (2007) Tibial subchondral bone size and knee cartilage defects: relevance to knee osteoarthritis. Osteoarthr Cartil 15(5):479–486PubMedCrossRefGoogle Scholar
  12. 12.
    Ding C, Cicuttini F, Scott F, Boon C, Jones G (2005) Association of prevalent and incident knee cartilage defects with loss of tibial and patellar cartilage: a longitudinal study. Arthritis Rheum 52(12):3918–3927PubMedCrossRefGoogle Scholar
  13. 13.
    Ding C, Cicuttini F, Scott F, Cooley H, Jones G (2005) Knee structural alteration and BMI: a cross-sectional study. Obes Res 13(2):350–361PubMedCrossRefGoogle Scholar
  14. 14.
    Ding C, Garnero P, Cicuttini F, Scott F, Cooley H, Jones G (2005) Knee cartilage defects: association with early radiographic osteoarthritis, decreased cartilage volume, increased joint surface area and type II collagen breakdown. Osteoarthr Cartil 13(3):198–205PubMedCrossRefGoogle Scholar
  15. 15.
    Eckstein F, Cicuttini F, Raynauld JP, Waterton JC, Peterfy C (2006) Magnetic resonance imaging (MRI) of articular cartilage in knee osteoarthritis (OA): morphological assessment. Osteoarthr Cartil 14(Suppl A):A46–A75Google Scholar
  16. 16.
    Elahi S, Cahue S, Felson DT, Engelman L, Sharma L (2000) The association between varus-valgus alignment and patellofemoral osteoarthritis. Arthritis Rheum 43(8):1874–1880PubMedCrossRefGoogle Scholar
  17. 17.
    Englund M, Lohmander LS (2005) Patellofemoral osteoarthritis coexistent with tibiofemoral osteoarthritis in a meniscectomy population. Ann Rheum Dis 64(12):1721–1726PubMedCrossRefGoogle Scholar
  18. 18.
    Englund M, Roos EM, Lohmander LS (2003) Impact of type of meniscal tear on radiographic and symptomatic knee osteoarthritis: a sixteen-year followup of meniscectomy with matched controls. Arthritis Rheum 48(8):2178–2187PubMedCrossRefGoogle Scholar
  19. 19.
    Ericsson YB, Roos EM, Dahlberg L (2006) Muscle strength, functional performance, and self-reported outcomes four years after arthroscopic partial meniscectomy in middle-aged patients. Arthritis Rheum 55(6):946–952PubMedCrossRefGoogle Scholar
  20. 20.
    Gomoll AH, Madry H, Knutsen G, van Dijk N, Seil R, Brittberg M, Kon E (2010) The subchondral bone in articular cartilage repair: current problems in the surgical management. Knee Surg Sports Traumatol Arthrosc 18(4):434–447PubMedCrossRefGoogle Scholar
  21. 21.
    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 15(4):393–401PubMedCrossRefGoogle Scholar
  22. 22.
    Jackson BD, Teichtahl AJ, Morris ME, Wluka AE, Davis SR, Cicuttini FM (2004) The effect of the knee adduction moment on tibial cartilage volume and bone size in healthy women. Rheumatology (Oxford) 43(3):311–314CrossRefGoogle Scholar
  23. 23.
    Jones G, Ding C, Scott F, Glisson M, Cicuttini F (2004) Early radiographic osteoarthritis is associated with substantial changes in cartilage volume and tibial bone surface area in both males and females. Osteoarthr Cartil 12(2):169–174PubMedCrossRefGoogle Scholar
  24. 24.
    Jones G, Glisson M, Hynes K, Cicuttini F (2000) Sex and site differences in cartilage development: a possible explanation for variations in knee osteoarthritis in later life. Arthritis Rheum 43(11):2543–2549PubMedCrossRefGoogle Scholar
  25. 25.
    Jones RE, Smith EC, Reisch JS (1978) Effects of medial meniscectomy in patients older than forty years. J Bone Joint Surg Am 60(6):783–786PubMedGoogle Scholar
  26. 26.
    Lee SJ, Aadalen KJ, Malaviya P, Lorenz EP, Hayden JK, Farr J, Kang RW, Cole BJ (2006) Tibiofemoral contact mechanics after serial medial meniscectomies in the human cadaveric knee. Am J Sports Med 34(8):1334–1344PubMedCrossRefGoogle Scholar
  27. 27.
    Maletius W, Messner K (1996) The effect of partial meniscectomy on the long-term prognosis of knees with localized, severe chondral damage. A twelve- to fifteen-year followup. Am J Sports Med 24(3):258–262Google Scholar
  28. 28.
    Menetrey J, Unno-Veith F, Madry H, Van Breuseghem I (2010) Epidemiology and imaging of the subchondral bone in articular cartilage repair. Knee Surg Sports Traumatol Arthrosc 18(4):463–471PubMedCrossRefGoogle Scholar
  29. 29.
    Mills PM, Wang Y, Cicuttini FM, Stoffel K, Stachowiak GW, Podsiadlo P, Lloyd DG (2008) Tibio-femoral cartilage defects 3–5 years following arthroscopic partial medial meniscectomy. Osteoarthr Cartil 16(12):1526–1531PubMedCrossRefGoogle Scholar
  30. 30.
    Miyazaki T, Wada M, Kawahara H, Sato M, Baba H, Shimada S (2002) Dynamic load at baseline can predict radiographic disease progression in medial compartment knee osteoarthritis. Ann Rheum Dis 61(7):617–622PubMedCrossRefGoogle Scholar
  31. 31.
    Petersen MM, Olsen C, Lauritzen JB, Lund B, Hede A (1996) Late changes in bone mineral density of the proximal tibia following total or partial medial meniscectomy. A randomized study. J Orthop Res 14(1):16–21Google Scholar
  32. 32.
    Radin EL, Burr DB, Caterson B, Fyhrie D, Brown TD, Boyd RD (1991) Mechanical determinants of osteoarthrosis. Semin Arthritis Rheum 21(3 Suppl 2):12–21Google Scholar
  33. 33.
    Radin EL, Paul IL, Rose RM (1972) Role of mechanical factors in pathogenesis of primary osteoarthritis. Lancet 1(7749):519–522PubMedCrossRefGoogle Scholar
  34. 34.
    Rangger C, Klestil T, Gloetzer W, Kemmler G, Benedetto KP (1995) Osteoarthritis after arthroscopic partial meniscectomy. Am J Sports Med 23(2):240–244PubMedCrossRefGoogle Scholar
  35. 35.
    Rockborn P, Gillquist J (1996) Long-term results after arthroscopic meniscectomy. The role of preexisting cartilage fibrillation in a 13 year follow-up of 60 patients. Int J Sports Med 17(8):608–613Google Scholar
  36. 36.
    Roos H, Lauren M, Adalberth T, Roos EM, Jonsson K, Lohmander LS (1998) Knee osteoarthritis after meniscectomy: prevalence of radiographic changes after twenty-one years, compared with matched controls. Arthritis Rheum 41(4):687–693PubMedCrossRefGoogle Scholar
  37. 37.
    Sturnieks DL, Besier TF, Hamer PW, Ackland TR, Mills PM, Stachowiak GW, Podsiadlo P, Lloyd DG (2008) Knee strength and knee adduction moments following arthroscopic partial meniscectomy. Med Sci Sports Exerc 40(6):991–997PubMedCrossRefGoogle Scholar
  38. 38.
    Sturnieks DL, Besier TF, Mills PM, Ackland TR, Maguire KF, Stachowiak GW, Podsiadlo P, Lloyd DG (2008) Knee joint biomechanics following arthroscopic partial meniscectomy. J Orthop Res 26(8):1075–1080PubMedCrossRefGoogle Scholar
  39. 39.
    von Lewinski G, Stukenborg-Colsman C, Ostermeier S, Hurschler C (2006) Experimental measurement of tibiofemoral contact area in a meniscectomized ovine model using a resistive pressure measuring sensor. Ann Biomed Eng 34(10):1607–1614CrossRefGoogle Scholar
  40. 40.
    Wang Y, Ding C, Wluka AE, Davis S, Ebeling PR, Jones G, Cicuttini FM (2006) Factors affecting progression of knee cartilage defects in normal subjects over 2 years. Rheumatology 45(1):79–84PubMedCrossRefGoogle Scholar
  41. 41.
    Wang Y, Wluka AE, Cicuttini FM (2005) The determinants of change in tibial plateau bone area in osteoarthritic knees: a cohort study. Arthritis Res Ther 7(3):R687–R693PubMedCrossRefGoogle Scholar
  42. 42.
    Williams RJ III, Warner KK, Petrigliano FA, Potter HG, Hatch J, Cordasco FA (2007) MRI evaluation of isolated arthroscopic partial meniscectomy patients at a minimum five-year follow-up. Hss J 3(1):35–43PubMedCrossRefGoogle Scholar
  43. 43.
    Wluka AE, Davis SR, Bailey M, Stuckey SL, Cicuttini FM (2001) Users of oestrogen replacement therapy have more knee cartilage than non-users. Ann Rheum Dis 60(4):332–336PubMedCrossRefGoogle Scholar
  44. 44.
    Wluka AE, Ding C, Jones G, Cicuttini FM (2005) The clinical correlates of articular cartilage defects in symptomatic knee osteoarthritis: a prospective study. Rheumatology (Oxford) 44(10):1311–1316CrossRefGoogle Scholar
  45. 45.
    Wolski M, Stachowiak GW, Dempsey AR, Mills PM, Cicuttini FM, Wang YY, Stoffel KK, Lloyd DG, Podsiadlo P (2011) Trabecular bone texture detected by plain radiography and variance orientation transform method is different between knees with and without cartilage defects. J Orthop Res 29(8):1161–1167PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Yuanyuan Wang
    • 1
  • Alasdair R. Dempsey
    • 2
    • 3
    • 4
  • David G. Lloyd
    • 2
    • 3
    • 4
  • Peter M. Mills
    • 2
    • 3
    • 4
  • Tim Wrigley
    • 5
  • Kim L. Bennell
    • 5
  • Ben Metcalf
    • 5
  • Fahad Hanna
    • 1
  • Flavia M. Cicuttini
    • 1
  1. 1.Department of Epidemiology and Preventive MedicineSchool of Public Health and Preventive Medicine, Monash UniversityMelbourneAustralia
  2. 2.School of Sport Science, Exercise and Health, University of Western AustraliaPerthAustralia
  3. 3.Musculoskeletal Research Program, Griffith Health Institute, Clinical Science 1 (G02), Griffith UniversitySouthportAustralia
  4. 4.School of Physiotherapy and Exercise Science, Griffith UniversityGold CoastAustralia
  5. 5.Centre for Health, Exercise and Sports Medicine, School of Physiotherapy, University of MelbourneMelbourneAustralia

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