Description
Objectives: Osteonecrosis of the knee has multiple etiologic factors; among them, one has a special interest in knee surgery. Knee osteonecrosis has been described as a postsurgical complication following arthroscopic meniscectomy. Although the pathophysiology of osteonecrosis following an arthroscopic
procedure is not fully understood, meniscal tears have been implicated in the development of osteonecrosis. The aim of this retrospective study is to report a series of patients who developed avascular necrosis after arthroscopy of the knee in an effort to delineate causal factors and treatment results.
Methods: We retrospectively studied patients from 2015 to 2023, who had developed osteonecrosis of the knee after a routine arthroscopic surgery for meniscal tears treatment. Preoperative and postoperative clinical notes, plain films, and magnetic resonance images of patients were reviewed. All adult patients with isolated meniscus tears and grade 2 or less chondral lesions were included. Patients with evidence of preoperative bone edema on MRI performed 6 weeks or longer after symptom onset were excluded. Symptomatic patients with established imagining of osteonecrosis were included in the study. Patients' follow up range from 7 months to 8 years.
Results: Eight patients out of 974 arthroscopies met the inclusion criteria. There were 1 woman and 7 men [mean age 57 (52-71)]. The lesions noted at arthroscopy included 7 medial meniscus tears that were treated with excision and 1 lateral meniscal tear that was treated with suture repair and still developed osteonecrosis. None of them was traumatic while all patients had early degenerative changes in the compartment of interest. Three patients were treated with unicompartmental knee arthroplasty with excellent postoperative functional outcomes whereas the others were treated conservatively, and osteonecrosis resolved (stage 2).
Conclusions: Osteonecrosis should be considered in older patients who have worsening symptoms after arthroscopy of the knee for degenerative meniscus tears and partial meniscectomy. Our study supports the results of other authors, who have related osteonecrosis to arthroscopic meniscectomy and also the fact that elderly patients seem to be more susceptible to develop this entity.
