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Treatment options for the symptomatic post-meniscectomy 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.

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References

  1. Allen PR, Denham RA, Swan AV (1984) Late degenerative changes after meniscectomy. Factors affecting the knee after operation. J Bone Jt Surg Br 66(5):666–671

    Article  CAS  Google Scholar 

  2. Baratz ME, Fu FH, Mengato R (1986) Meniscal tears: the effect of meniscectomy and of repair on intraarticular contact areas and stress in the human knee. A preliminary report. Am J Sports Med 14(4):270–275

    Article  CAS  PubMed  Google Scholar 

  3. Beaufils P, Becker R, Kopf S, Matthieu O, Pujol N (2017) The knee meniscus: management of traumatic tears and degenerative lesions. EFORT Open Rev 2(5):195–203

    Article  PubMed  PubMed Central  Google Scholar 

  4. Brophy RH, Gray BL, Nunley RM, Barrack RL, Clohisy JC (2014) Total knee arthroplasty after previous knee surgery: expected interval and the effect on patient age. J Bone Jt Surg Am 96(10):801–805

    Article  Google Scholar 

  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):200–207

    Article  PubMed  Google Scholar 

  6. Chatain F, Adeleine P, Chambat P, Neyret P, Societe Francaise dA (2003) A comparative study of medial versus lateral arthroscopic partial meniscectomy on stable knees: 10-year minimum follow-up. Arthroscopy 19(8):842–849

    Article  CAS  PubMed  Google Scholar 

  7. Chew E, Prakash R, Khan W (2017) Mesenchymal stem cells in human meniscal regeneration: A systematic review. Ann Med Surg (Lond) 24:3–7

    Article  Google Scholar 

  8. Covall DJ, Wasilewski SA (1992) Roentgenographic changes after arthroscopic meniscectomy: five-year follow-up in patients more than 45 years old. Arthroscopy 8(2):242–246

    Article  CAS  PubMed  Google 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):357–362

    Article  PubMed  Google Scholar 

  10. De Coninck T, Elsner JJ, Linder-Ganz E, Cromheecke M, Shemesh M, Huysse W, Verdonk R, Verstraete K, Verdonk P (2014) In-vivo evaluation of the kinematic behavior of an artificial medial meniscus implant: a pilot study using open-MRI. Clin Biomech (Bristol Avon) 29(8):898–905

    Article  Google 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, Sorrento

  12. Eichinger M, Schocke M, Hoser C, Fink C, Mayr R, Rosenberger RE (2016) Changes in articular cartilage following arthroscopic partial medial meniscectomy. Knee Surg Sports Traumatol Arthrosc 24(5):1440–1447

    Article  PubMed  Google Scholar 

  13. Elsner JJ, Portnoy S, Zur G, Guilak F, Shterling A, Linder-Ganz E (2010) Design of a free-floating polycarbonate-urethane meniscal implant using finite element modeling and experimental validation. J Biomech Eng 132(9):095001

    Article  PubMed  Google Scholar 

  14. Farr J, Rawal A, Marberry KM (2007) Concomitant meniscal allograft transplantation and autologous chondrocyte implantation: minimum 2-year follow-up. Am J Sports Med 35(9):1459–1466

    Article  PubMed  Google Scholar 

  15. Filardo G, Andriolo L, Kon E, de Caro F, Marcacci M (2015) Meniscal scaffolds: results and indications. A systematic literature review. Int Orthop 39(1):35–46

    Article  PubMed  Google Scholar 

  16. Filardo G, Di Matteo B, Tentoni F, Cavicchioli A, Di Martino A, Lo Presti M, Iacono F, Kon E, Marcacci M (2016) No effects of early viscosupplementation after arthroscopic partial meniscectomy: a randomized controlled trial. Am J Sports Med 44(12):3119–3125

    Article  PubMed  Google Scholar 

  17. Filardo G, Kon E, Perdisa F, Sessa A, Di Martino A, Busacca M, Zaffagnini S, Marcacci M (2017) Polyurethane-based cell-free scaffold for the treatment of painful partial meniscus loss. Knee Surg Sports Traumatol Arthrosc 25(2):459–467

    Article  CAS  PubMed  Google Scholar 

  18. Gelber PE, Isart A, Erquicia JI, Pelfort X, Tey-Pons M, Monllau JC (2015) Partial meniscus substitution with a polyurethane scaffold does not improve outcome after an open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 23(1):334–339

    Article  PubMed  Google Scholar 

  19. Getgood A, LaPrade RF, Verdonk P, Gersoff W, Cole B, Spalding T, Group I (2017) International Meniscus Reconstruction Experts Forum (IMREF) 2015 consensus statement on the practice of meniscal allograft transplantation. Am J Sports Med 45(5):1195–1205

    Article  PubMed  Google Scholar 

  20. Gnannt R, Chhabra A, Theodoropoulos JS, Hodler J, Andreisek G (2011) MR imaging of the postoperative knee. J Magn Reson Imaging 34(5):1007–1021

    Article  PubMed  Google Scholar 

  21. Greis PE, Bardana DD, Holmstrom MC, Burks RT (2002) Meniscal injury: I. Basic science and evaluation. J Am Acad Orthop Surg 10(3):168–176

    Article  PubMed  Google Scholar 

  22. Harris JD, Cavo M, Brophy R, Siston R, Flanigan D (2011) Biological knee reconstruction: a systematic review of combined meniscal allograft transplantation and cartilage repair or restoration. Arthroscopy 27(3):409–418

    Article  PubMed  Google 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):2325967114551528

    Article  PubMed  PubMed Central  Google Scholar 

  24. Harris JD, McNeilan R, Siston RA, Flanigan DC (2013) Survival and clinical outcome of isolated high tibial osteotomy and combined biological knee reconstruction. Knee 20(3):154–161

    Article  PubMed  Google Scholar 

  25. Haviv B, Bronak S, Kosashvili Y, Thein R (2016) Arthroscopic meniscectomy of traumatic versus atraumatic tears in middle aged patients: is there a difference? Arch Orthop Trauma Surg 136(9):1297–1301

    Article  PubMed  Google Scholar 

  26. Hede A, Larsen E, Sandberg H (1992) The long term outcome of open total and partial meniscectomy related to the quantity and site of the meniscus removed. Int Orthop 16(2):122–125

    Article  CAS  PubMed  Google Scholar 

  27. Jorgensen U, Sonne-Holm S, Lauridsen F, Rosenklint A (1987) Long-term follow-up of meniscectomy in athletes. A prospective longitudinal study. J Bone Joint Surg Br 69(1):80–83

    Article  CAS  PubMed  Google Scholar 

  28. Kazi HA, Abdel-Rahman W, Brady PA, Cameron JC (2015) Meniscal allograft with or without osteotomy: a 15-year follow-up study. Knee Surg Sports Traumatol Arthrosc 23(1):303–309

    Article  PubMed  Google Scholar 

  29. Kim JG, Lee SY, Chay S, Lim HC, Bae JH (2016) Arthroscopic meniscectomy for medial meniscus horizontal cleavage tears in patients under age 45. Knee Surg Relat Res 28(3):225–232

    Article  PubMed  PubMed Central  Google Scholar 

  30. Kim JG, Lee YS, Bae TS, Ha JK, Lee DH, Kim YJ, Ra HJ (2013) Tibiofemoral contact mechanics following posterior root of medial meniscus tear, repair, meniscectomy, and allograft transplantation. Knee Surg Sports Traumatol Arthrosc 21(9):2121–2125

    Article  PubMed  Google Scholar 

  31. Kim JM, Bin SI, Lee BS, Kim NK, Song JH, Choi JW, Lee CR (2017) Long-term survival analysis of meniscus allograft transplantation with bone fixation. Arthroscopy 33(2):387–393

    Article  PubMed  Google Scholar 

  32. Kim SG, Nagao M, Kamata K, Maeda K, Nozawa M (2013) Return to sport after arthroscopic meniscectomy on stable knees. BMC Sports Sci Med Rehabil 5(1):23

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Koh JL, Yi SJ, Ren Y, Zimmerman TA, Zhang LQ (2016) Tibiofemoral contact mechanics with horizontal cleavage tear and resection of the medial meniscus in the human knee. J Bone Jt Surg Am 98(21):1829–1836

    Article  Google Scholar 

  34. Kon E, Filardo G, Drobnic M, Madry H, Jelic M, van Dijk N, Della Villa S (2012) Non-surgical management of early knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 20(3):436–449

    Article  PubMed  Google Scholar 

  35. Krych AJ, Johnson NR, Mohan R, Dahm DL, Levy BA, Stuart MJ (2018) Partial meniscectomy provides no benefit for symptomatic degenerative medial meniscus posterior root tears. Knee Surg Sports Traumatol Arthrosc 26(4):1117–1122

    PubMed  Google Scholar 

  36. Lee BS, Bin SI, Kim JM (2016) Articular cartilage degenerates after subtotal/total lateral meniscectomy but radiographic arthrosis progression is reduced after meniscal transplantation. Am J Sports Med 44(1):159–165

    Article  PubMed  Google Scholar 

  37. Lee DH, Lee CR, Jeon JH, Kim KA, Bin SI (2015) Graft extrusion in both the coronal and sagittal planes is greater after medial compared with lateral meniscus allograft transplantation but is unrelated to early clinical outcomes. Am J Sports Med 43(1):213–219

    Article  PubMed  Google Scholar 

  38. Lee HI, Park D, Cho J (2018) Clinical and radiological results with second-look arthroscopic findings after open wedge high tibial osteotomy without arthroscopic procedures for medial meniscal root tears. Knee Surg Relat Res 30(1):34–41

    Article  PubMed  PubMed Central  Google Scholar 

  39. McDermott ID, Amis AA (2006) The consequences of meniscectomy. J Bone Jt Surg Br 88(12):1549–1556

    Article  CAS  Google Scholar 

  40. Nawabi DH, Cro S, Hamid IP, Williams A (2014) Return to play after lateral meniscectomy compared with medial meniscectomy in elite professional soccer players. Am J Sports Med 42(9):2193–2198

    Article  PubMed  Google Scholar 

  41. Nha KW, Lee YS, Hwang DH, Kwon JH, Chae DJ, Park YJ, Kim JI (2013) Second-look arthroscopic findings after open-wedge high tibia osteotomy focusing on the posterior root tears of the medial meniscus. Arthroscopy 29(2):226–231

    Article  PubMed  Google Scholar 

  42. Noyes FR, Barber-Westin SD (2012) Treatment of meniscus tears during anterior cruciate ligament reconstruction. Arthroscopy 28(1):123–130

    Article  PubMed  Google Scholar 

  43. Noyes FR, Barber-Westin SD (2016) Long-term survivorship and function of meniscus transplantation. Am J Sports Med 44(9):2330–2338

    Article  PubMed  Google Scholar 

  44. Ode GE, Van Thiel GS, McArthur SA, Dishkin-Paset J, Leurgans SE, Shewman EF, Wang VM, Cole BJ (2012) Effects of serial sectioning and repair of radial tears in the lateral meniscus. Am J Sports Med 40(8):1863–1870

    Article  PubMed  Google Scholar 

  45. Paxton ES, Stock MV, Brophy RH (2011) Meniscal repair versus partial meniscectomy: a systematic review comparing reoperation rates and clinical outcomes. Arthroscopy 27(9):1275–1288

    Article  PubMed  Google Scholar 

  46. Piedade SR, Pinaroli A, Servien E, Neyret P (2013) TKA outcomes after prior bone and soft tissue knee surgery. Knee Surg Sports Traumatol Arthrosc 21(12):2737–2743

    Article  PubMed  Google Scholar 

  47. Prakash J, Song EK, Lim HA, Shin YJ, Jin C, Seon JK (2018) High tibial osteotomy accelerates lateral compartment osteoarthritis in discoid meniscus patients. Knee Surg Sports Traumatol Arthrosc 26(6):1845–1850

    Article  PubMed  Google Scholar 

  48. Rao AJ, Erickson BJ, Cvetanovich GL, Yanke AB, Bach BR Jr, Cole BJ (2015) The meniscus-deficient knee: biomechanics, evaluation, and treatment options. Orthop J Sports Med 3(10):2325967115611386

    Article  PubMed  PubMed Central  Google 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):1251–1260

    Article  PubMed  Google 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):23–29

    Article  CAS  PubMed  Google Scholar 

  51. Rue JP, Yanke AB, Busam ML, McNickle AG, Cole BJ (2008) Prospective evaluation of concurrent meniscus transplantation and articular cartilage repair: minimum 2-year follow-up. Am J Sports Med 36(9):1770–1778

    Article  PubMed  Google Scholar 

  52. Schimmer RC, Brulhart KB, Duff C, Glinz W (1998) Arthroscopic partial meniscectomy: a 12-year follow-up and two-step evaluation of the long-term course. Arthroscopy 14(2):136–142

    Article  CAS  PubMed  Google Scholar 

  53. Shelbourne KD, Dickens JF (2007) Joint space narrowing after partial medial meniscectomy in the anterior cruciate ligament-intact knee. J Am Acad Orthop Surg 15(9):519–524

    Article  PubMed  Google Scholar 

  54. Shin YS, Lee HN, Sim HB, Kim HJ, Lee DH (2018) Polyurethane meniscal scaffolds lead to better clinical outcomes but worse articular cartilage status and greater absolute meniscal extrusion. Knee Surg Sports Traumatol Arthrosc 26(8):2227–2238

    Article  PubMed  Google Scholar 

  55. Smith NA, MacKay N, Costa M, Spalding T (2015) Meniscal allograft transplantation in a symptomatic meniscal deficient knee: a systematic review. Knee Surg Sports Traumatol Arthrosc 23(1):270–279

    Article  PubMed  Google Scholar 

  56. Smith NA, Parkinson B, Hutchinson CE, Costa ML, Spalding T (2016) Is meniscal allograft transplantation chondroprotective? A systematic review of radiological outcomes. Knee Surg Sports Traumatol Arthrosc 24(9):2923–2935

    Article  PubMed  Google 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):56–63

    Article  CAS  Google Scholar 

  58. Souza RB, Wu SJ, Morse LJ, Subburaj K, Allen CR, Feeley BT (2015) Cartilage MRI relaxation times after arthroscopic partial medial meniscectomy reveal localized degeneration. Knee Surg Sports Traumatol Arthrosc 23(1):188–197

    Article  PubMed  Google Scholar 

  59. Tetsworth K, Paley D (1994) Malalignment and degenerative arthropathy. Orthop Clin North Am 25(3):367–377

    CAS  PubMed  Google 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):196–201

    Article  PubMed  Google Scholar 

  61. Van Thiel GS, Frank RM, Gupta A, Ghodadra N, Shewman EF, Wang VM, Bach BR, Verma NN, Cole BJ, Provencher MT (2011) Biomechanical evaluation of a high tibial osteotomy with a meniscal transplant. J Knee Surg 24(1):45–53

    Article  PubMed  Google Scholar 

  62. Verdonk PC, Demurie A, Almqvist KF, Veys EM, Verbruggen G, Verdonk R (2005) Transplantation of viable meniscal allograft. Survivorship analysis and clinical outcome of one hundred cases. J Bone Jt Surg Am 87(4):715–724

    Article  Google Scholar 

  63. Verma NN, Kolb E, Cole BJ, Berkson MB, Garretson R, Farr J, Fregly B (2008) The effects of medial meniscal transplantation techniques on intra-articular contact pressures. J Knee Surg 21(1):20–26

    Article  PubMed  Google Scholar 

  64. Williams RJ 3rd, 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):35–43

    Article  PubMed  Google Scholar 

  65. Xu C, Zhao J (2015) A meta-analysis comparing meniscal repair with meniscectomy in the treatment of meniscal tears: the more meniscus, the better outcome? Knee Surg Sports Traumatol Arthrosc 23(1):164–170

    Article  PubMed  Google Scholar 

  66. Zaffagnini S, Grassi A, Marcheggiani Muccioli GM, Bonanzinga T, Nitri M, Raggi F, Ravazzolo G, Marcacci M (2015) MRI evaluation of a collagen meniscus implant: a systematic review. Knee Surg Sports Traumatol Arthrosc 23(11):3228–3237

    Article  PubMed  Google Scholar 

  67. Zhang JY, Fabricant PD, Ishmael CR, Wang JC, Petrigliano FA, Jones KJ (2016) Utilization of platelet-rich plasma for musculoskeletal injuries: an analysis of current treatment trends in the United States. Orthop J Sports Med 4(12):2325967116676241

    Article  PubMed  PubMed Central  Google 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):137–162

    Article  CAS  PubMed  Google 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):255–263

    Article  PubMed  Google Scholar 

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Correspondence to Matej Drobnič.

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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).

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Drobnič, M., Ercin, E., Gamelas, J. et al. Treatment options for the symptomatic post-meniscectomy knee. Knee Surg Sports Traumatol Arthrosc 27, 1817–1824 (2019). https://doi.org/10.1007/s00167-019-05424-3

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Keywords

  • Knee
  • Meniscus
  • Injury
  • Lesion
  • Resection
  • Repair
  • Allograft
  • Scaffold
  • Osteoarthritis