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Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 27, Issue 6, pp 1817–1824 | Cite as

Treatment options for the symptomatic post-meniscectomy knee

  • Matej DrobničEmail author
  • Ersin Ercin
  • Joao Gamelas
  • Emmanuel T. Papacostas
  • Konrad Slynarski
  • Urszula Zdanowicz
  • Tim Spalding
  • Peter Verdonk
KNEE

Abstract

Purpose

To provide a current review on the evidence for management of the symptomatic meniscus-deficient knee.

Methods

A literature review was performed detailing the natural history and origin of symptoms in a meniscus-deficient knee, in addition to strategies for non-surgical management, meniscus scaffolds, meniscus allograft transplantation (MAT), isolated cartilage repair, unloading osteotomies, meniscus prosthesis, and joint replacements which were revealed as treatment possibilities.

Results

Meniscus deficiency was recognized to lead to an early onset knee osteoarthritis (OA). A subset of patients develop post-meniscectomy syndrome: dull and nagging pain after a short pain-free interval subsequently to meniscectomy, which can be accompanied by transient effusions. Evidence for non-surgical management of post-meniscectomy knee pain is lacking. Two available meniscus scaffolds, indicated for symptomatic segmental meniscus deficiency, show pain relief at mid-term follow-up, and effect on joint preservation is unclear. MAT represents a durable solution for sub/total meniscus deficiency (80% survival at 10 years), but it is still considered a temporary solution for post-meniscectomy pain. MAT may also reduce the progression of OA. Isolated cartilage repair without a meniscus reconstruction is commonly performed, but better results were reported with preserved or reconstructed menisci. Osteotomies are used in the combination of misaligned knee and meniscus reconstruction or as pain solution for irreversible unilateral knee structural changes following a meniscectomy. Polycarbonate-urethane medial meniscus prosthesis is currently undergoing clinical trial. Joint replacements should be limited to later stages of post-meniscectomy OA.

Conclusions

Post-meniscectomy pain syndrome and post-meniscectomy knee OA are common findings after meniscus resection. Short-term pain relief is provided by non-surgical management, mid-term pain relief by meniscus scaffolds, and long-term relief by MAT, though each has differing indications. In later stages, osteotomies and joint replacements are indicated.

Level of evidence

IV.

Keywords

Knee Meniscus Injury Lesion Resection Repair Allograft Scaffold Osteoarthritis 

Notes

Funding

No external funding was used.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no direct conflict of interest to the published work. Two of the authors declare clinical consultancy (PV - Smith Nephew, Conmed, Active Implants, Depuy Synthes; MD - Arthrex, Finceramica, Cartiheal).

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019

Authors and Affiliations

  1. 1.Department of Orthopedic SurgeryUniversity Medical Centre LjubljanaLjubljanaSlovenia
  2. 2.Chair of Orthopedics, Medical FacultyUniversity of LjubljanaLjubljanaSlovenia
  3. 3.Department of Orthopaedics and TraumatologyBakirkoy Dr Sadi Konuk Training and Research HospitalIstanbulTurkey
  4. 4.Department of Orthopaedics and TraumatologyLusíadas Hospital, NOVA Medical SchoolLisbonPortugal
  5. 5.The MIS Orthopaedic Center and PAOK FC Medical DepartmentThessalonikiGreece
  6. 6.Lekmed Hospital for Special SurgeryWarsawPoland
  7. 7.Carolina Medical CenterWarsawPoland
  8. 8.McGowan Institute for Regenerative MedicineUniversity of PittsburghPittsburghUSA
  9. 9.University Hospital Coventry and Warwickshire NHS TrustCoventryUK
  10. 10.Antwerp Orthopaedic CenterAZ Monica HospitalsAntwerpBelgium
  11. 11.Antwerp University HospitalEdegemBelgium

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