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Lateral meniscus with tears or with histologic calcification does not increase the risk of lateral osteoarthritis after medial unicompartmental arthroplasty

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Abstract

Purpose

Meniscal tears or histological meniscal calcifications (in the absence of radiological chondrocalcinosis) are frequent in osteoarthritis. Whether lateral meniscal lesions influence clinical outcomes after medial unicompartmental knee arthroplasty (UKA) is unknown.

Methods

We analyzed 130 patients (130 knees) with medial unicompartmental knee arthroplasties between 2005 and 2015. These 130 knees had full articular cartilage thickness in the lateral compartment and no radiological chondrocalcinosis on preoperative radiographs. The lateral meniscus was analyzed with preoperative MRI and a biopsy of the anterior horn at the time of surgery. Synovial fluid was collected and analyzed for calcium pyrophosphate dihydrate crystal deposition (CPPD crystals). Lateral meniscal tears were untreated when detected on MRI or during surgery, with the hypothesis that these tears on the opposite compartment would remain asymptomatic in medial UKA. At average 10-year follow-up, patients were evaluated with clinical and radiographic outcome, with a focus on the risk of joint space narrowing of the lateral femorotibial compartment.

Results

CPPD crystals were present in the synovial fluid of 70 knees. Lateral meniscal tears were seen on MRI in 34 (49%) normal meniscuses of the 60 knees without CPPD crystals and in six other knees without histological meniscal calcification despite CPPD crystals. Histological calcification was present on 61 lateral meniscuses with 53 meniscal tears. The results showed no significant differences in the clinical outcomes between knees with lateral meniscal tears or lateral meniscal histological chondrocalcinosis or both lesions and those without these conditions. Additionally, radiographic progression of osteoarthritis in the opposite femorotibial compartment of the knee was not more frequent in patients with these meniscal issues. The ten year cumulative survival rates, measured by the need for total knee arthroplasty, were 91% for knees without meniscal lesions and 92% for knees with these lesions.

Conclusion

On this basis, treatment of meniscal tears of the lateral compartment and routine aspiration of the knee to assess for birefringent crystals in the planning of medial UKA do not appear necessary.

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Data availability

University of Paris on demand.

Code availability

None.

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Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, University Paris East (UPEC), Créteil, France

    Philippe Hernigou & Sami Karam

  2. Department of Orthopaedic Surgery, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China

    Nianfei Zhang, Wanshou Guo & Juncheng Ge

  3. Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China

    Nianfei Zhang, Wanshou Guo, Juncheng Ge, Changquan Liu & Qidong Zhang

  4. China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China

    Changquan Liu

  5. Department of Orthopedic Surgery, EpiCURA Hospital, 7331, Baudour, Belgium

    Jacques Hernigou

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  1. Philippe Hernigou
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  2. Sami Karam
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Contributions

Data collection: PH, SK, and JH; redaction: PH; lecture and corrections: NZ, WG, JG, QZ, and JH.

Corresponding author

Correspondence to Philippe Hernigou.

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Hernigou, P., Karam, S., Zhang, N. et al. Lateral meniscus with tears or with histologic calcification does not increase the risk of lateral osteoarthritis after medial unicompartmental arthroplasty. International Orthopaedics (SICOT) 47, 2477–2485 (2023). https://doi.org/10.1007/s00264-023-05907-6

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