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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 6/2019

01-06-2019 | Osteoarthrosis | KNEE

Treatment options for the symptomatic post-meniscectomy knee

Authors: Matej Drobnič, Ersin Ercin, Joao Gamelas, Emmanuel T. Papacostas, Konrad Slynarski, Urszula Zdanowicz, Tim Spalding, Peter Verdonk

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 6/2019

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Abstract

Purpose

To provide a current review on the evidence for management of the symptomatic meniscus-deficient knee.

Methods

A literature review was performed detailing the natural history and origin of symptoms in a meniscus-deficient knee, in addition to strategies for non-surgical management, meniscus scaffolds, meniscus allograft transplantation (MAT), isolated cartilage repair, unloading osteotomies, meniscus prosthesis, and joint replacements which were revealed as treatment possibilities.

Results

Meniscus deficiency was recognized to lead to an early onset knee osteoarthritis (OA). A subset of patients develop post-meniscectomy syndrome: dull and nagging pain after a short pain-free interval subsequently to meniscectomy, which can be accompanied by transient effusions. Evidence for non-surgical management of post-meniscectomy knee pain is lacking. Two available meniscus scaffolds, indicated for symptomatic segmental meniscus deficiency, show pain relief at mid-term follow-up, and effect on joint preservation is unclear. MAT represents a durable solution for sub/total meniscus deficiency (80% survival at 10 years), but it is still considered a temporary solution for post-meniscectomy pain. MAT may also reduce the progression of OA. Isolated cartilage repair without a meniscus reconstruction is commonly performed, but better results were reported with preserved or reconstructed menisci. Osteotomies are used in the combination of misaligned knee and meniscus reconstruction or as pain solution for irreversible unilateral knee structural changes following a meniscectomy. Polycarbonate-urethane medial meniscus prosthesis is currently undergoing clinical trial. Joint replacements should be limited to later stages of post-meniscectomy OA.

Conclusions

Post-meniscectomy pain syndrome and post-meniscectomy knee OA are common findings after meniscus resection. Short-term pain relief is provided by non-surgical management, mid-term pain relief by meniscus scaffolds, and long-term relief by MAT, though each has differing indications. In later stages, osteotomies and joint replacements are indicated.

Level of evidence

IV.
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Metadata
Title
Treatment options for the symptomatic post-meniscectomy knee
Authors
Matej Drobnič
Ersin Ercin
Joao Gamelas
Emmanuel T. Papacostas
Konrad Slynarski
Urszula Zdanowicz
Tim Spalding
Peter Verdonk
Publication date
01-06-2019
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 6/2019
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-019-05424-3

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