Treatment options for the symptomatic post-meniscectomy knee
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To provide a current review on the evidence for management of the symptomatic meniscus-deficient knee.
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.
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.
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
KeywordsKnee Meniscus Injury Lesion Resection Repair Allograft Scaffold Osteoarthritis
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).
This article does not contain any studies with human participants or animals performed by any of the authors.
- 5.Chahla J, Cinque ME, Godin JA, Sanchez G, Lebus GF, Whalen JM, Price MD, Kennedy NI, Moatshe G, LaPrade RF, Provencher MT (2018) Meniscectomy and resultant articular cartilage lesions of the knee among prospective national football league players: an imaging and performance analysis. Am J Sports Med 46(1):200–207CrossRefPubMedGoogle Scholar
- 9.Cristiani R, Ronnblad E, Engstrom B, Forssblad M, Stalman A (2018) Medial meniscus resection increases and medial meniscus repair preserves anterior knee laxity: a cohort study of 4497 patients with primary anterior cruciate ligament reconstruction. Am J Sports Med 46(2):357–362CrossRefPubMedGoogle Scholar
- 11.Drobnic M, Martincic D, Merkac J, Radosavljevic D (2016) Survival rates of various ACI grafts and concomitant procedures. A prospective single-center study over 15 years. In: 13th ICRS World Congress. International Cartilage Repair Society, SorrentoGoogle Scholar
- 23.Harris JD, Hussey K, Saltzman BM, McCormick FM, Wilson H, Abrams GD, Cole BJ (2014) Cartilage repair with or without meniscal transplantation and osteotomy for lateral compartment chondral defects of the knee: case series with minimum 2-year follow-up. Orthop J Sports Med 2(10):2325967114551528CrossRefPubMedPubMedCentralGoogle Scholar
- 49.Rausch Osthoff AK, Niedermann K, Braun J, Adams J, Brodin N, Dagfinrud H, Duruoz T, Esbensen BA, Gunther KP, Hurkmans E, Juhl CB, Kennedy N, Kiltz U, Knittle K, Nurmohamed M, Pais S, Severijns G, Swinnen TW, Pitsillidou IA, Warburton L, Yankov Z, Vliet Vlieland TPM (2018) 2018 EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis. Ann Rheum Dis 77(9):1251–1260CrossRefPubMedGoogle Scholar
- 50.Rongen JJ, Rovers MM, van Tienen TG, Buma P, Hannink G (2017) Increased risk for knee replacement surgery after arthroscopic surgery for degenerative meniscal tears: a multi-center longitudinal observational study using data from the osteoarthritis initiative. Osteoarthr Cartil 25(1):23–29CrossRefPubMedGoogle Scholar
- 57.Smith NA, Parsons N, Wright D, Hutchinson C, Metcalfe A, Thompson P, Costa ML, Spalding T (2018) A pilot randomized trial of meniscal allograft transplantation versus personalized physiotherapy for patients with a symptomatic meniscal deficient knee compartment. Bone Jt J 100-B(1):56–63CrossRefGoogle Scholar
- 60.Trojani C, Sbihi A, Djian P, Potel JF, Hulet C, Jouve F, Bussiere C, Ehkirch FP, Burdin G, Dubrana F, Beaufils P, Franceschi JP, Chassaing V, Colombet P, Neyret P (2011) Causes for failure of ACL reconstruction and influence of meniscectomies after revision. Knee Surg Sports Traumatol Arthrosc 19(2):196–201CrossRefPubMedGoogle Scholar
- 68.Zhang W, Moskowitz RW, Nuki G, Abramson S, Altman RD, Arden N, Bierma-Zeinstra S, Brandt KD, Croft P, Doherty M, Dougados M, Hochberg M, Hunter DJ, Kwoh K, Lohmander LS, Tugwell P (2008) OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthr Cartil 16(2):137–162CrossRefPubMedGoogle Scholar
- 69.Zur G, Linder-Ganz E, Elsner JJ, Shani J, Brenner O, Agar G, Hershman EB, Arnoczky SP, Guilak F, Shterling A (2011) Chondroprotective effects of a polycarbonate-urethane meniscal implant: histopathological results in a sheep model. Knee Surg Sports Traumatol Arthrosc 19(2):255–263CrossRefPubMedGoogle Scholar