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Long Term Results After Arthroscopic Meniscectomy: The Role of Preexisting Cartilage Fibrillation in a 13 Year Follow-Up of 60 Patients
Linköping University, Department of Medical and Health Sciences, Sports Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
Linköping University, Department of Medical and Health Sciences, Sports Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
1996 (English)In: International Journal of Sports Medicine, ISSN 0172-4622, E-ISSN 1439-3964, Vol. 17, no 8, 608-613 p.Article in journal (Refereed) Published
Abstract [en]

Sixty patients with stable knees and arthroscopic menisectomy were matched into two groups according to the presence of early degenerative changes at the operation. Patients with severe cartilage changes were excluded. The patients were between 20 and 40 years of age at the operation and no patient had previous surgery on the involved knee. The intraarticular findings were documented at surgery and the patients were re-examined 12 to 15 years after the meniscectomy. Pre-existing cartilage fibrillation at the meniscectomy did not seem to influence the long-term results. At the follow-up no difference was found between the groups at the physical examination, in subjective complaints, in knee function and activity or in radio-graphic findings. In the total group 62 % had early signs of arthrosis (Fairbank changes) and 42 % narrowing of the joint space (Ahlback grade 1-2) in the operated knee. No one had more severe changes. Radiographic signs of arthrosis were 4 times commoner in the operated knee compared to the non-operated kne after partial meniscectomy and 7 times commoner in the operated knee after subtotal meniscectomy. Arthrosis at the follow-up was seen three times more often in patients older than 30 years of age at surgery than in younger patients. The functional outcome was good and 70 % were still active in sports compared to 90 % before the operation.

Place, publisher, year, edition, pages
1996. Vol. 17, no 8, 608-613 p.
Keyword [en]
Cartilage fibrillation, arthroscopic meniscectomy, arthrosis
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-79486DOI: 10.1055/s-2007-972903OAI: oai:DiVA.org:liu-79486DiVA: diva2:542817
Available from: 2012-08-03 Created: 2012-08-03 Last updated: 2017-12-07Bibliographically approved
In thesis
1. Clinical and radiographic outcome of meniscectomy and meniscus repair in the stable knee
Open this publication in new window or tab >>Clinical and radiographic outcome of meniscectomy and meniscus repair in the stable knee
2000 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Increasing knowledge about the function of the meniscus and arthroscopy have made meniscus surgery more conservative. Arthroscopy was developed during the 70's and enabled the surgeon to select the most appropriate and tissue conserving therapy for a meniscus lesion. Arthroscopic meniscectomy and meniscus repair were introduced as new techniques for treatment of meniscus lesions.

This thesis comprises five long term follow-up studies of arthroscopic meniscectomy and open meniscus repair and one short term follow-up study of arthroscopic meniscectomy.

The long term follow-up studies include 152 patients, 113 with meniscectomy and 39 with meniscus repair, with stable knees, age less than 44 years and without preexisting gonarthrosis. All patients had a diagnostic at1hroscopy at the index operation and were evaluated clinically and radiographically 13-14 years after surgery.

At follow-up the frequency of radiographic changes was high but in general the radiographic changes were of a low grade. Only seven patients, 4 of 86 (5%) after partial meniscectomy and 3 of 27. (11%) after total meniscectomy fulfilled the criteria for gonarthrosis (minimal joint space less than 3 mm on radiographs and symptoms). More radiographic changes were found after total meniscectomy than after partial meniscectomy, meniscus repair or than in an un-injured control group. A similar rate of radiographic changes was seen when meniscus repair was compared to matched patients with partial and total meniscectomy. Knee function was in general good at follow-up and did not differ between patients with total meniscectomy and partial meniscectomy but patients with meniscus repair had a somewhat better knee function than a group of patients with partial and total meniscectomy. Cartilage fibril1ation present at meniscectomy did not influence the frequency of radiographic changes, knee function or activity at follow-up but older patients had more radiographic changes after meniscectomy than younger patients. The activity level decreased in a similar fashion over time after total meniscectomy, partial meniscectomy, meniscus repair and in un-injured subjects indicating that factors other than the knee injury and meniscus operation determines the decline in activity.

Thus, irrespective of meniscus treatment (arthroscopic partial/total meniscectomy and meniscus repair), in a 13-14 year perspective, the grade of radiographic changes in the knee joint were relatively low with no influence on activity and little influence on knee function.

In the short term follow-up study original data from patients with arthroscopic meniscectomy in the early 80' s when the technique was new was compared to similar data from patients operated today, when the technique is in routine use. The operation time was shorter and the frequency of subtotal meniscectomy was less today. In contrast to the early 80's the procedure is entirely out-patient. However, recovery and in particular return to sports were delayed today in comparison to previously.

A less supervised rehabilitation is suggested to be the main cause to the delayed recovery and a generosity with supervised rehabilitation after arthroscopic meniscectomy is advisable.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet, 2000. 60 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 616
Keyword
Arthroscopy, Meniscectomy, Meniscus Repair, Follow-up, Arthrosis
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-28071 (URN)12835 (Local ID)91-7219-573-8 (ISBN)12835 (Archive number)12835 (OAI)
Public defence
2000-02-18, Sal K3, Kåkenhus, Bredgatan 33, Campus Norrköping, Norrköping, 09:00 (Swedish)
Opponent
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-11-09Bibliographically approved

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Rockborn, PeterGillquist, Jan

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