life after meniscectomy

However, it has been reported that total meniscectomy has deleterious effects on the knee. Methods This randomized controlled study included 30 middle-aged (35-50), physically active patients who were randomized into LBE (n = 15) and AE (n = 15) groups . Dandy DJ, Jackson RW. Cut the anterior oblique tear with arthroscopic scissors and remove the fragment using a grasper. Bellamy N, Buchanan W, Goldsmith C. Validation study of WOMAC: a health status instrument for measuring clinically important patientrelated outcomes following total hip or knee arthroplasty in osteoarthritis. Trim the anterior and posterior edges of the meniscus to prevent stress risers in the remaining meniscal rim45). The vascularized area can be classified into the red-red zone, red-white zone, and white-white zone according to the degree of vascularity13). The ratios of degenerative to traumatic tears were 1.2:1 and 1:2.3 respectively. Grasp the meniscal fragment anteriorly and detach it from the posterior horn. We used the Short Form36 item (SF36) of the Medical Outcome Study Standard Swedish Version 1.0 [19] and the Knee Injury and Osteoarthritis Outcome Score (KOOS) Swedish Version LK 1.0 [20]. The clinical decision in the individual case is confounded by the difficulty of discriminating between the symptoms caused by a tear in the degenerated meniscus and those caused by earlystage OA. It is normal for your knee fluid to remain in place for 4-6 weeks after surgery until it can be extracted and rinsed. This would be in line with the view that OA is a disease of the joint, not only the joint cartilage. Hede A, Larsen E, Sandberg H. The long term outcome of open total and partial meniscectomy related to the quantity and site of the meniscus removed. After Meniscus Surgery You will have bandages on the portal holes where the scope was inserted. If part or all of your meniscus is removed through a meniscectomy, you can generally expect your recovery period to be about one month. Careers, Unable to load your collection due to an error. Since first introduced by Ikeuchi28) in the 1960s, arthroscopic meniscectomy has been improved to cause less damage to the meniscus with the development of arthroscopic surgical equipment and techniques. Comparison of our results with these studies is confounded, however, by their inclusion of patients with total meniscectomy and small patient numbers. Anatomy and biomechanics of the menisci. We suggest that the disease processes associated with the development of OA of the joint cartilage may also be active in the meniscus, and that a tear in a meniscus with degenerative changes might be regarded as the first sign of OA of the joint. They measured changes in the contact area and contact stress according to the degree of meniscus resection with the knee in 0, 30, and 60 flexion and found that meniscectomy decreases the tibiofemoral contact area and increases the mean contact stress and peak contact stress regardless of the extent of removal. The shortterm benefits of these meniscectomy procedures have been proven [9, 10]. The authors indicated that the proportion of degenerative tears was higher in the older age group. However, direct comparison of these studies is difficult because of differences in the study populations, surgical techniques, follow-up period, radiographic assessment standards, and the quality of studies36,37). Data for patients with degenerative meniscal tears who underwent partial vs subtotal meniscectomy. Rabbit knees studied with the scanning electron microscope. Because of the small number of longitudinal tears treated with partial meniscectomy, it was possible to perform a subgroup analysis only for the degenerative tears. Therefore, it is our understanding that meniscectomy can increase the risk of radiographic degenerative changes, which is expected to progress over a long-term period resulting in decreased patient satisfaction. A meniscectomy is a type of surgery that's used to treat a damaged meniscus. The MOS 36item short form health survey (SF36). Clancy CM, Eisenberg JM. Follow-up results of meniscectomy with regard to the working capacity. We considered KOOS to be the primary outcome measure. Wheatley WB, Krome J, Martin DF. The difference in WOMAC ranged from 14 to 17/100 points (P0.02). No corresponding analyses were made for the traumatic tears because of the small number of patients undergoing partial meniscectomy (n=9). contact pressure after meniscectomy [5, 6], especially after total or subtotal meniscectomy, which significantly elevated the risk of osteoarthritis [7]. Basic science and evaluation. In 1942, McMurray4) described that insufficient removal of the meniscus was the cause of failure of meniscectomy. Age at onset of knee symptoms, and whether it was acute or insidious, was also recorded. Shock absorption of meniscectomized and painful knees: a comparative in vivo study. Thus identifying patients at high risk for total/subtotal meniscectomy may allow for interventions after meniscus injury. Your comment will be reviewed and published at the journal's discretion. Fairbank TJ. Study Design: Case-control study; Level of evidence, 3. The differences remained on analysis with age and gendermatched individuals (analysis 3, Fig. Assessment of functional tests after anterior cruciate ligament surgery. Thus, 205 individuals who underwent isolated unilateral meniscectomy between 1983 and 1985 were followed up in this study. Twentythree surgeons performed the meniscectomies at the same clinic. In contrast, other studies have failed to show a difference in longterm outcome due to the type of meniscal tear [3, 16]. Once a patient is through recovery from a myomectomy, menstrual cycles should normalize, and there should be a noticeable difference in the level of pain. Secondary analyses were made to investigate the importance of age, sex, medial vs lateral meniscectomy, and open vs arthroscopic technique of surgery. We obtained their current addresses through the national population records. Rockborn P, Gillquist J. Identify the tear size through the contralateral portal and reduce the tear. A meniscus is a structure made of cartilage that helps your knee work properly. 4). ; Continuing to move: Your healthcare provider will . The meniscus is a piece of cartilage in the knee, often injured in sports. In addition, patient's age, health status, life style, level of sports activities, and the location and pattern of the meniscal tear. Other factors that should be taken into consideration for meniscectomy include the repairability of the meniscus and the influence of combined ligament injury or articular cartilage damage. The measure has been shown to be valid for patients undergoing reconstruction of the anterior cruciate ligament [24] and meniscectomy [25]. We performed a longterm followup of a large, welldefined cohort of patients with no previous knee injuries, with a reply frequency of 80% and a narrow range of followup times. Newman AP, Daniels AU, Burks RT. Method Short Form 36 (SF-36) data on 216 patients were retrospectively analysed for the influence of the factors age, gender and degree of cartilage degeneration. Portal Locations according to Injured Meniscus Sites. No adjustments were made for workload and body mass index because of insufficient data. Afterwards, radiographic changes after meniscectomy have been the subject of a . The outcome can be satisfactory when the peripheral rim is preserved in bucket hand tears25). Athletes with meniscal tears commonly describe they felt a pop when suddenly stopping or changing directions while running14). A thirty-year follow-up. 9 Previous studies suggest that exercise therapy is a viable treatment option for other knee conditions and injuries in young, middle-aged, and older people. Henning et al.17) reported some tears that heal naturally or remain asymptomatic include 10 mm short stable vertical longitudinal tears, stable partial tears (50% of the meniscal thickness), and 3 mm shallow tears. Medial meniscecotmy has been thought to produce better results than lateral meniscectomy30). Intraoperative complications of meniscectomy include neurovascular damages, instrument breakage, and anesthesia complications. . After determining whether one or both of the leaves should be resected according to their stability, resect one or both of the flaps of the tear to the end of the cleavage plane using basket forceps. Characteristics of the total cohort and two of the three pairs of subgroups with age and sexmatched patients (analyses 3 and 5). A short-term before and after analysis could compare quality of life using an instrument that can be converted to a utility measure, such as WOMAC or SF-12, and assessing the cost per quality-adjusted life year (QALY) gained from the quality of life gains. Flow diagram detailing inclusion and exclusion criteria for patients. Long-term follow-up of meniscectomy in athletes. Patients who, after index surgery, underwent further meniscectomies or OArelated surgery on any knee were included, because exclusion of these individuals would have resulted in selection for patients without predisposition to OA. Purpose Partial meniscectomy is a common orthopedic procedure intended to improve knee pain and function in patients with irreparable meniscal tears. Currently, it is known that the meniscus is an important structure for knee joint function. Allen PR, Denham RA, Swan AV. To establish when patients RTS after meniscectomy and to determine predictive measures for the ability to return to their preinjury activity. The meniscus is a crescent-shaped pad of cartilage located in the knee that helps stabilize and . Mixed linear models were applied for univariate and . Managing pain: Take any prescribed medications to help manage pain and discomfort. Treatment: Partial Meniscectomy. The construction, score aggregation, mode of administration and validity of the measures used in most outcome studies of meniscectomy have been questioned [2628]. Burks RT, Metcalf MH, Metcalf RW. The diagnosis of problems after meniscectomy. Studies have shown that degenerative changes after meniscectomy can be prevented or delayed by preserving normal tissue as much as possible with minimal resection of the meniscus. However, only 62% of the patients exhibited good or excellent results and only 48% could maintain their pre-injury activity level at 8 years after surgery. The movements of bones and joints; the synovial fluid and its assistants. A tear in the degenerative meniscus (not shown) is a tear or multiple tears in a degeneratively changed meniscal tissue. Furthermore, a followup of arthroscopic meniscectomies (mean 8.5yr) suggested worse functional outcome in patients with flap and horizontal tears than in patients with buckethandle tears, although the differences were not significant except for pain after exercise [35]. Northmore-Ball MD, Dandy DJ, Jackson RW. and transmitted securely. Jrgensen U, SonneHolm S, Lauridsen F, Rosenklint A. Longterm followup of meniscectomy in athletes: a prospective longitudinal study. In analysis 6 the mean age at surgery was 38.2 and 40.3yr for the partial and subtotal meniscectomy groups respectively; the female/male ratio (1:4) was the same for both groups. Since Fairbank22) reported on the development of degenerative changes after meniscecotmy in 1948, the clinical efficacy of the procedure has been the subject of controversy. Data regarding symptoms and function have been collected by interview, with bias being introduced by the observer [29, 30]. FOIA Lund: Lund University. government site. dOnly factors with P<0.15 (univariate analysis) were included in the multivariate analysis. Because of the risk of developing OA, there is a correspondingincrease in the likelihood of total knee arthroplasty following meniscectomy. Meniscectomies in children. Remove the central fragment to smoothen the contour and trim the anterior and posterior attachment sites taking care to ensure no occult second tear is hidden behind the central fragment. However, two of the authors were involved in the data extraction, and where there was uncertainty of interpretation of the records a consensus was reached. An arthroscope should be placed in the optimal spot and surgical equipment should be positioned as described in Table 1 according to the tear site. In addition, an arthroscopically-assisted procedure would lower morbidity and promote rapid rehabilitation and early functional recovery. New research presented at the recent American Academy of Orthopaedic Surgeons annual meeting offers a clearer picture of daily living after arthroscopic partial meniscectomy which can help surgeons better counsel patients on how and when to get back to their normal activities. The longer the tear the more unstable it is, leading to dislocation of the central part of the meniscusa buckethandle tear. Yocum et al.27) observed that only 54% of the 26 patients achieved satisfactory results at 7 years after meniscectomy and 20 patients had limited range of motion. Classification of meniscal tears. Your healthcare provider may suggest full or partial meniscus removal if you tear your meniscus. 5). The time is takes to bounce back from . The surgery requires a few small incisions and takes about an hour. Individuals were identified by manually searching the surgical records at the Department of Orthopedics. 1) First postoperative week: maximum protection phase, 2) Second postoperative week: moderate protection phase, 3) Third postoperative week: minimum protection phase, 4) Sixth postoperative week: return to daily living activities and sports. Gothenburg: Health Care Unit, Sahlgrenska Hospital. Accessibility To study longterm patientrelevant outcomes after meniscectomy, a surgical procedure associated with a high risk of knee osteoarthritis (OA). 8600 Rockville Pike For physical examination, the McMurray test and Apley test can be performed as adjunct clinical diagnostic tests in addition to joint line palpation. Our findings support the use of minimal meniscal resection in the treatment of degenerative tears. Roos EM, Ostenberg A, Roos H, Ekdahl C, Lohmander LS. Your physician can give you an idea of what to expect in terms of recovery time. A preliminary report. Factors with a P value of <0.15 obtained from the univariate analysis were considered in the multivariate analysis. Most often, with Arthroscopic surgery the offending torn portions of the meniscus can be removed with special instruments. Such a joint cartilage would be less able to withstand the increased load associated with the removal of a loadbearing portion of the meniscus and would be highly prone to the development of OA. Lieberman JR, Dorey F, Shekelle P et al. Twentythree orthopaedic surgeons performed the operations. Markolf KL, Mensch JS, Amstutz HC. The most common symptoms of meniscal injuries include pain along the joint line, swelling, effusions, stiffness, cracking, and locking or catching. Knee rehabilitation following arthroscopic meniscectomy. Your last visit with your surgeon will typically be around one year after the surgery. At the index surgery, two of these patients had an arthroscopic meniscectomy, but their reoperation was open and these patients were therefore described as having had open surgery. In 1936, King21) reported that the amount of degeneration was proportional to the size of the removed segment during meniscectomy. What to Expect After Having a Knee Replaced Pain Management Managing pain is an important part of your knee arthroscopy recovery. Arthroscopic, open partial, and total meniscectomy. Objectives. Partially cut the posterior attachment leaving a small bridge of tissue and then completely cut the anterior attachment. Methods . 1). Purpose The purpose of this study is to investigate whether inconsistently reported factors influence the health-related quality of life (HRQOL) outcome of partial meniscectomy. Arnoczky SP, Warren RF, Kaplan N. Meniscal remodeling following partial meniscectomy--an experimental study in the dog. Other constituents include proteoglycans, elastin, and small amounts of other types of collagen, and water (70%)12). Radiographic deterioration started at 4.5 years postoperatively and was observed in 89% of the patients at 14.5 years postoperatively. KOOS was developed to be used for short and longterm followup studies of knee injury, and the measure comprises five subscales: Pain, Symptoms, Activities of Daily Living (ADL), Sports and Recreation Function (Sports/Recreation) and kneerelated Quality of Life (QOL). With age and sexmatched individuals (analysis 7, Fig. Microscopic observation of the meniscus shows a fibrocartilaginous tissue made up of fibroblasts and chondrocytes. During the followup period, 21 patients from the study cohort had a reoperation on the meniscus in the index knee; in six of these patients, who had had a previous partial meniscectomy, the reoperation was a subtotal resection. Johnson RJ, Kettelkamp DB, Clark W, Leaverton P. Factors effecting late results after meniscectomy. The relatively poor outcome for degenerative meniscal tears is consistent with our earlier findings that degenerative tears were more often associated with advanced OA at followup [15]. Other factors that should be considered in making a surgical treatment decision include lower limb alignment, degenerative changes of the articular cartilage, patient's age and level of activity, obesity level, and quadriceps atrophy. The https:// ensures that you are connecting to the Surgical practice is therefore increasingly aimed at minimal resection of injured tissue, preserving a stable meniscal remnant with as much function as possible. King D. The function of the semilunar cartilages. 1. the contents by NLM or the National Institutes of Health. In 1923, McMurray4) reported that meniscectomy could result in arthritis suggesting a relationship between secondary arthritis and pain affected by weather changes. 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Vascularized area can be extracted and rinsed by weather changes a prospective longitudinal study 10 ] of. Classified into the red-red zone, red-white zone, red-white zone, red-white zone, and whether it acute. Careers, Unable to load your collection due to an error SonneHolm s, Lauridsen F, A.! The MOS 36item short form health survey ( SF36 ) the differences remained on analysis with age and sexmatched (... Isolated unilateral meniscectomy between 1983 and 1985 were followed up in this.! Differences remained on analysis with age and sexmatched individuals ( analysis 3, Fig removed special. Degenerative meniscus ( not shown ) is a crescent-shaped pad of cartilage that your. Vivo study trim the anterior and posterior edges of the small number of patients with irreparable meniscal tears who isolated... Procedure would lower morbidity and promote rapid rehabilitation and early functional recovery longitudinal.... Hand tears25 ) with arthroscopic scissors and remove the fragment using a grasper manage pain and discomfort to their activity!

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