Sports Medicine

, Volume 23, Issue 1, pp 61–68 | Cite as

Partial Meniscectomy and Osteoarthritis

Implications for Treatment of Athletes
  • Christoph Rangger
  • Anton Kathrein
  • Thomas Klestil
  • Wulf Glötzer
Injury Clinic

Summary

The biphasic ultrastructure of the meniscus and of articular cartilage provides their function in the complex biomechanics of the knee joint including load distribution, shock absorption, viscoelasticity, a smooth low friction gliding surface and resilience to compression. Meniscectomy may lead to destruction of cartilage and to osteoarthritis of the knee joint. Osteoarthritic changes after meniscectomy have been reported in up to 89% of patients.

Retrospective analysis after open or arthroscopically assisted meniscectomy revealed restriction in sports to be between 2 and 50% and cessation of sports to be between 2 and 25%. Generally, patients with degenerative changes at the time of surgery are reported to have lower knee joint function and to resume sports activities later.

Pharmalogical measures to treat osteoarthritis following previous meniscectomy include pain medication and intra-articular drug administration. Additionally, range of motion and strengthening exercises and moderate athletic activities are recommended. When surgery is considered, correctional osteomies and uni-compartmental or total knee arthroplasty depending on the degree of osteoarthritis are preferred.

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References

  1. 1.
    Walker PS, Erkman MJ. The role of the menisci in force transmission across the knee. Clin Orthop 1975; 109: 184–92PubMedCrossRefGoogle Scholar
  2. 2.
    Krause WR, Pope MH, Johnson RJ, et al. Mechanical changes in the knee after meniscectomy. J Bone Joint Surg Am 1976; 58-A: 599–604Google Scholar
  3. 3.
    Markolf KL, Mensch JS, Amstutz HC. Stiffness and laxity of the knee. The contributions of the supporting structures. J Bone Joint Surg Am 1976; 58-A: 583–94Google Scholar
  4. 4.
    Cox JS, Cordell LD. The degenerative effects of medial meniscus tears in dogs’ knees. Clin Orthop 1977, 125: 236–42PubMedGoogle Scholar
  5. 5.
    Jones RE, Smith EC, Reisch JS. Effects of medial meniscectomy in patients older than forty years. J Bone Joint Surg Am 1978; 60-A: 783–6Google Scholar
  6. 6.
    Seedhom BB, Hargreaves DJ. Transmission of the load in the knee joint with special reference to the role of the menisci. II. Experimental results, discussion and conclusions. Eng Med 1979; 8: 220–8Google Scholar
  7. 7.
    Kurosawa H, Fukubayashi T, Nakajima H. Load-bearing mode of the knee joint. Clin Orthop 1980; 149: 283–90PubMedGoogle Scholar
  8. 8.
    Sonne-Holm S, Fledelius I, Ahn NC. Results after meniscectomy in 147 athletes. Acta Orthop Scand 1980; 51: 303–9PubMedCrossRefGoogle Scholar
  9. 9.
    Noble J, Turner PG. The function, pathology, and surgery of the meniscus. Clin Orthop 1986; 210: 62–8PubMedGoogle Scholar
  10. 10.
    McBride ID, Reid JG. Biomechanical considerations of the menisci of the knee. Can J Sport Sci 1988; 13: 175–87PubMedGoogle Scholar
  11. 11.
    McDevitt CA, Webber RJ. The ultrastructure and biochemistry of meniscal cartilage. Clin Orthop 1989; 252: 8–18Google Scholar
  12. 12.
    Fithian DC, Kelly MA, Mow VC. Material properties and structure-function relationships in the menisci. Clin Orthop 1990; 252: 19–31PubMedGoogle Scholar
  13. 13.
    Fu FH, Thompson WO. Biomechanics and kinematics of meniscus. In: Finerman GAM, Noyes FR, editors. Biology and biomechanics of the traumatized synovial joint: the knee as a model [workshop]. Rosemont (H): American Academy of Orthopedic Surgeons, 1992: 153–83Google Scholar
  14. 14.
    Rangger C, Glötzer W, Benedetto KP. Ligamentous instability following partial arthroscopic medial meniscectomy [in German]. Unfallchirurg 1994; 97: 435–7PubMedGoogle Scholar
  15. 15.
    Mow VC, Ateshian GA, Ratcliffe A. Anatomic form and biomechanical properties of articular cartilage of the knee joint. In: Finerman GAM, Noyes FR, editors. Biology and biomechanics of the traumatized synovial joint: the knee as a model [workshop]. Rosemont (II): American Academy of Orthopedic Surgeons, 1992: 55–81Google Scholar
  16. 16.
    Mow VC, Kuei SC, Lai WM, et al. Biphasic creep and stress relaxation of articular cartilage in compression: theory and experiments. J Biomech Eng 1980; 102: 73–84PubMedCrossRefGoogle Scholar
  17. 17.
    Fairbank TJ. Knee joint changes after meniscectomy. J Bone Joint Surg Br 1948; 30-B: 664–70Google Scholar
  18. 18.
    Streli R. Spätergebnisse nach partieller Meniskusresektion bei 82 Fällen. Der Chirurg 1955; 3: 97–103Google Scholar
  19. 19.
    Huckel JR. Is meniscectomy a benign procedure? A long-term follow-up study. Can J Surg 1965; 8: 254–60Google Scholar
  20. 20.
    Gear WL. The late results of meniscectomy. Br J Surg 1967; 54: 270–2PubMedCrossRefGoogle Scholar
  21. 21.
    Jackson JP. Degenerative changes in the knee after meniscectomy. J Bone Joint Surg Br 1967; 49-B: 584Google Scholar
  22. 22.
    Jackson JP. Degenerative changes in the knee after meniscectomy. BMJ 1968; 2: 525–7PubMedCrossRefGoogle Scholar
  23. 23.
    Ahlbäck S. Osteoarthrosis of the knee: a radiographic investigation. Acta Radiol Diagn Stockh 1968; 277 Suppl.: 7–72Google Scholar
  24. 24.
    Tapper EM, Hoover NW. Late results after meniscectomy. J Bone Joint Surg Am 1969; 51-A: 517–26Google Scholar
  25. 25.
    Appel H. Late results after meniscectomy in the knee joint: a clinical and radiological follow-up investigation. Acta Orthop Scand Suppl 1970; 133: 1–111PubMedGoogle Scholar
  26. 26.
    Johnson RJ, Kettelkamp DB, Clark W, et al. Factors affecting late results after meniscectomy. J Bone Joint Surg Am 1974; 56-A: 719–29Google Scholar
  27. 27.
    Dandy DJ, Jackson RW. The diagnosis of problems after meniscectomy. J Bone Joint Surg Br 1975; 57-B: 349–52Google Scholar
  28. 28.
    Dandy DJ, Jackson RW. Meniscectomy and chondromalacia of the femoral condyle. J Bone Joint Surg Am 1975; 57-A: 1116–9Google Scholar
  29. 29.
    Jones RE, Smith EC, Reisch JS. Effects of medial meniscectomy in patients older than forty years. J Bone Joint Surg Am 1978; 60-A: 783–6Google Scholar
  30. 30.
    Fox JM, Blazina ME, Carlson GJ. Multiphasic view of medial meniscectomy. Am J Sports Med 1979; 7: 161–4PubMedCrossRefGoogle Scholar
  31. 31.
    Yocum LA, Kerlan RK, Jobe FW, et al. Isolated lateral meniscectomy. J Bone Joint Surg Am 1979; 61-A: 338–42Google Scholar
  32. 32.
    Allen PR, Denham RA, Swan AV. Late degenerative changes after meniscectomy. J Bone Joint Surg Br 1984; 66-B: 666–71Google Scholar
  33. 33.
    Jorgensen U, Sonne-Holm S, Lauridsen F, et al. Long-term follow-up of meniscectomy in athletes. A prospective longitudinal study. J Bone Joint Surg Br 1987; 69-B: 80–3Google Scholar
  34. 34.
    Soballe K, Hansen AJ. Late results after meniscectomy in children. Injury 1987; 18: 182–4PubMedCrossRefGoogle Scholar
  35. 35.
    Covall DJ, Wasilewski SA. Roentgenographic changes after arthroscopic meniscectomy: five-year follow-up in patients more than 45 years old. Arthroscopy 1992; 8: 242–6PubMedCrossRefGoogle Scholar
  36. 36.
    Fauno P, Nielsen AB. Arthroscopic partial meniscectomy: a long-term follow-up. Arthroscopy 1992; 8: 345–9PubMedCrossRefGoogle Scholar
  37. 37.
    Bolano LE, Grana WA. Isolated partial meniscectomy. Functional radiographic evaluation at five years. Am J Sports Med 1993; 21: 432–7PubMedCrossRefGoogle Scholar
  38. 38.
    Rangger C, Klestil T, Glötzer W, et al. Osteoarthritis after arthroscopic partial meniscectomy. Am J Sports Med 1995: 23: 240–4PubMedCrossRefGoogle Scholar
  39. 39.
    Lanzer WL, Komenda G. Changes in articular cartilage after meniscectomy. Clin Orthop 1990; 252: 41–8PubMedGoogle Scholar
  40. 40.
    Mehraban F, Kuo SY, Riera H, et al. Prostromelysin and procollagenase genes are differentially up-regulated in chondrocytes from the knees of rabbits with experimental osteoarthritis. Arthritis Rheum 1994; 37: 1189–97PubMedCrossRefGoogle Scholar
  41. 41.
    Fahmy NRM, Williams EA, Noble J. Meniscal pathology and osteoarthritis of the knee. J Bone Joint Surg Br 1983; 65-B: 24–8Google Scholar
  42. 42.
    Northmore-Ball MD, Dandy DJ, Jackson RW. Arthroscopic, open partial, and total meniscectomy. J Bone Joint Surg Br 1983; 65-B: 400–4Google Scholar
  43. 43.
    Hoshikawa Y, Kurosawa H, Fukubayashi T, et al. The prognosis of meniscectomy in athletes. Am J Sports Med 1983; 11:8–13PubMedCrossRefGoogle Scholar
  44. 44.
    Katz JN, Harris TM, Larson MG, et al. Predictors of functional outcomes after arthroscopic partial meniscectomy. J Rheumatol 1992; 1938-42Google Scholar
  45. 45.
    Wouters E, Bassett FH, Hardaker WT, et al. An algorithm for arthroscopy in the over-50 age group. Am J Sports Med 1992; 20: 141–5PubMedCrossRefGoogle Scholar
  46. 46.
    Bonamo JJ, Kessler KJ, Noah J. Arthroscopic meniscectomy in patients over the age of 40. Am J Sports Med 1992; 20: 422–9PubMedCrossRefGoogle Scholar
  47. 47.
    Osti L, Liu SH, Raskin A, et al. Partial lateral meniscectomy in athletes. Arthroscopy 1994; 10: 424–30PubMedCrossRefGoogle Scholar
  48. 48.
    Bagnolesi P, Cilotti A, Campassi C, et al. Radiologie assessment of the knee after meniscectomy [in Italian]. Radiol Med (Torino) 1995; 90: 194–201Google Scholar
  49. 49.
    Matsusue Y, Thomson NL. Arthroscopic partial meniscectomy in patients over 40 years old: a 5 to 11 year follow-up study. Arthroscopy 1996; 12: 39–44PubMedCrossRefGoogle Scholar
  50. 50.
    Boszotta H, Helperstorfer W, Kölndorfer G, et al. The long-term results after arthroscopic meniscectomy [in German]. Aktuelle Traumatol 1994; 24: 30–4PubMedGoogle Scholar
  51. 51.
    Chantraine A. Knee joint in soccer players: osteoarthritis and axis deviation. Med Sci Sports Exerc 1985; 17: 434–9PubMedCrossRefGoogle Scholar
  52. 52.
    Howe J, Johnson RJ. Knee injuries in skiing. Orthop Clin North Am 1985; 16: 303–14PubMedGoogle Scholar
  53. 53.
    Baker BE, Peckham AC, Pupparo F, et al. Review of meniscal injury and associated sports. Am J Sports Med 1985; 13: 1–4PubMedCrossRefGoogle Scholar
  54. 54.
    Neyret P, Donell ST, Dejour D, et al. Partial meniscectomy and anterior cruciate ligament rupture in soccer players. Am J Sports Med 1993; 21: 455–60PubMedCrossRefGoogle Scholar
  55. 55.
    Whipple TL, Caspari RB, Meyers JF. Arthroscopic meniscectomy. An interim report at three to four years after operation. Clin Orthop 1984; 183: 105–14PubMedGoogle Scholar
  56. 56.
    Hamberg P, Gillquist J. Knee function after arthroscopic meniscectomy. Acta Orthop Scand 1984; 55: 172–5PubMedCrossRefGoogle Scholar
  57. 57.
    Simpson DA, Thomas NP, Aichroth PM. Open and closed meniscectomy. J Bone Joint Surg Br 1986; 68-B: 301–4Google Scholar
  58. 58.
    Gillquist J, Oretorp N. Arthroscopic partial meniscectomy. Clin Orthop 1982; 167: 29–33PubMedGoogle Scholar
  59. 59.
    Ogilvie-Harries DJ, Bauer M, Correy P. Prostaglandin inhibition and the rate of recovery after arthroscopic meniscectomy. J Bone Joint Surg Br 1985; 67-B: 567–71Google Scholar
  60. 60.
    Drez D, Ritter M, Rosenberg T. Pain relief after arthroscopy: naproxen sodium compared to propoxyphene napsylate with acetominophen. South Med J 1987; 80: 440–3PubMedCrossRefGoogle Scholar
  61. 61.
    Van der Schilden JL. Improvements in rehabilitation of the postmeniscectomized or meniscal-repaired patient. Clin Orthop 1990; 252: 73–9Google Scholar
  62. 62.
    Schimmer RC, Brülhart KB, Duff C, et al. Fourteen years experience of arthroscopic meniscal surgery: long-term outcome [in German]. Arthroskopie 1993; 6: 228–33Google Scholar
  63. 63.
    Engel JM. Schmerztherapie der Arthrose. Internist 1994; 35:41–8PubMedGoogle Scholar
  64. 64.
    Doyle DV, Lanham JG. Routine drug treatment of osteoarthritis. Clin Rheum Dis 1994; 10: 277–91Google Scholar
  65. 65.
    Ghosh P, Read R, Armstrong S, et al. The effects of intraarticular administration of hyaluronan in a model of early osteoarthritis in sheep. I. Gait analysis and radiological and morphological studies. Semin Arthritis Rheum 1993; 22 Suppl. 1: 18–30PubMedCrossRefGoogle Scholar
  66. 66.
    Armstrong S, Read R, Gosh P. The effects of intraarticular hyaluronan on cartilage and subchondral bone changes in an ovine model of osteoarthritis. J Rheumatol 1994; 21: 680–8PubMedGoogle Scholar
  67. 67.
    Graf J, Neusel E, Schneider E, et al. Intra-articular treatment with hyaluronic acid in osteoarthritis of the knee joint: a controlled trial versus mucopolysaccharide polysulfuric acid ester. Clin Exp Rheumatol 1993; 11: 367–72PubMedGoogle Scholar
  68. 68.
    Puhl W, Bernau A, Greiling H, et al. Intraartikuläres Na-Hyaluronat bei Gonarthrose: eine multizentrische Doppelblindstudie. Osteoarthritis Cartilage 1993; 1: 233–41PubMedCrossRefGoogle Scholar
  69. 69.
    Donnelly S, Huskisson EC. Intra-articular hyaluronic acid in the treatment of osteoarthritis of the knee. Eur J Rheumatol 1995; 1: 1–2Google Scholar
  70. 70.
    Dean DD, Muniz OE, Rodriguez I, et al. Amelioration of lapine osteoarthritis by treatment with glycosaminoglycan-peptide association complex (Rumalon®). Arthritis Rheum 1991; 34: 304–13PubMedCrossRefGoogle Scholar
  71. 71.
    Moskowitz RW, Reese JH, Young RG, et al. The effects of Rumalon®, a glycosaminoglycan peptide complex, in a partial meniscectomy model of osteoarthritis in rabbits. J Rheumatol 1991; 18:205–9PubMedGoogle Scholar
  72. 72.
    Mannoni A, Altman RD, Muniz OE, et al. The effects of methotrexate on normal and osteoarthritic lapine articular cartilage. J Rheumatol 1993; 20: 849–55PubMedGoogle Scholar
  73. 73.
    Fisher NM, Pendergast DR, Gresham GE, et al. Muscle rehabilitation: its effect on muscular and functional performance of patients with knee osteoarthritis. Arch Phys Med Rehabil 1991; 72: 367–74PubMedGoogle Scholar
  74. 74.
    Blair SN, Kohl HW, Gordon NF, et al. How much physical activity is good for health?. Annu Rev Public Health 1992; 13: 99–126PubMedCrossRefGoogle Scholar
  75. 75.
    Hurley MV, Newham DJ. The influence of arthrogenous muscle inhibition on quadriceps rehabilitation of patients with early, unilateral osteoarthritic knees. Br J Rheumatol 1993; 32: 127–31PubMedCrossRefGoogle Scholar
  76. 76.
    Fisher NM, Gresham GE, Abrams M, et al. Quantitative effects of physical therapy on muscular and functional performance in subjects with osteoarthritis of the knees. Arch Phys Med Rehabil 1993; 74: 840–7PubMedCrossRefGoogle Scholar
  77. 77.
    Minor MA. Exercise in the management of osteoarthritis of the knee and hip. Arthritis Care Res 1994; 198-204Google Scholar
  78. 78.
    Tan J, Balci N, Sepici V, et al. Isokinetic and isometric strength in osteoarthrosis of the knee. Am J Phys Med Rehabil 1995; 74: 364–9PubMedCrossRefGoogle Scholar
  79. 79.
    Peterson MGE, Kovar-Toledano PA, Otis JC, et al. Effect of a walking program on gait characteristic in patients with osteoarthritis. Arthritis Care Res 1993; 6: 11–8PubMedCrossRefGoogle Scholar
  80. 80.
    Voloshin D, Wesk J. Influence of artificial shock absorbers on human gait. Clin Orthop 1981; 160: 52–6PubMedGoogle Scholar
  81. 81.
    Coventry MB. Osteotomy about the knee for degenerative and rheumatoid arthritis: indications, operative technique, and results. J Bone Joint Surg Am 1973; 55-A: 23–48Google Scholar
  82. 82.
    Coventry MB. Current concepts review: upper tibial osteotomy for osteoarthritis. J Bone Joint Surg Am 1985; 67-A: 1136–40Google Scholar
  83. 83.
    Goodfellow JW, O’Connor JJ. Clinical results of the oxford knee: surface arthroplasty of the tibiofemoral joint with a meniscal bearing prosthesis. Clin Orthop 1986; 205: 21–42PubMedGoogle Scholar
  84. 84.
    Freeman MAR. Total knee replacement at the Royal London hospital: 21 years’ experience. In: Aichroth PM, Cannon Jr WD, editors. Knee surgery: current practice. London: Martin Dunitz Ltd, 1992: 641–52Google Scholar
  85. 85.
    Burks RT. Arthroscopy and degenerative arthritis of the knee: a review of the literature. Arthroscopy 1990; 6: 43–7PubMedCrossRefGoogle Scholar
  86. 86.
    Rand JA. Role of arthroscopy in osteoarthritis of the knee. Arthroscopy 1991; 7: 358–63PubMedCrossRefGoogle Scholar
  87. 87.
    Glinz W. Arthroskopische Operationstechniken bei degenerativen Meniscus- und Gelenkflächenschäden des Kniegelenks. Chirurg 1993; 64: 371–8PubMedGoogle Scholar
  88. 88.
    Merchan ECR, Galindo E. Arthroscope-guided surgery versus nonoperative treatment for limited degenerative osteoarthritis of the femorotibial joint in patients over 50 years of age: a prospective comparative study. Arthroscopy 1993; 9: 663–7PubMedCrossRefGoogle Scholar
  89. 89.
    Dye SF, McBride JT, Chew M, et al. Unrecognized abnormal osseus metabolic activity in patients with documented meniscal pathology. Am J Sports Med 1989; 17: 723–4Google Scholar
  90. 90.
    Crues JV, Ryu R, Morgan FW. Meniscal pathology. The expanding role of magnetic resonance imaging. Clin Orthop 1990; 252: 80–7PubMedGoogle Scholar
  91. 91.
    Rangger C, Klestil T, Kathrein A, et al. Influence of magnetic resonance imaging on indication for arthroscopy of the knee. Clin Orthop 1996; 330: 133–42PubMedCrossRefGoogle Scholar
  92. 92.
    DeHaven KE, Black KP, Griffiths HJ. Open meniscus repair. Am J Sports Med 1989; 17: 788–95PubMedCrossRefGoogle Scholar
  93. 93.
    Henning CE, Lynch MA, Yearout KM, et al. Arthroscopic meniscal repair using an exogenous fibrin clot. Clin Orthop 1990; 252: 64–72PubMedGoogle Scholar
  94. 94.
    Arnoczky SP, Warren RF, McDevitt CA. Meniscal replacement using a cryopreserved allograft. An experimental study in dogs. Clin Orthop 1990; 252: 121–8PubMedGoogle Scholar
  95. 95.
    Stone KR, Rodkey WG, Webber RJ, et al. Future directions. Collagen-based prostheses for meniscal regeneration. Clin Orthop 1990; 252: 129–35PubMedGoogle Scholar

Copyright information

© Adis International Limited 1997

Authors and Affiliations

  • Christoph Rangger
    • 1
  • Anton Kathrein
    • 1
  • Thomas Klestil
    • 1
  • Wulf Glötzer
    • 1
  1. 1.Department of TraumatologyUniversity Hospital of InnsbruckInnsbruckAustria
  2. 2.Universitätsklinik für UnfallchirurgieInnsbruckAustria

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