Our Summary

This research paper is a systematic review of studies that aim to identify factors that can predict the success of a particular type of knee surgery called Arthroscopic Partial Meniscectomy (APM). This surgery is done to treat patients with torn knee cartilages (menisci). The researchers examined studies that followed up with patients for more than a year after their surgeries to see how well they did.

They found some factors that could predict worse outcomes after the surgery: having knee arthritis visible in x-rays before the surgery, having symptoms (like pain or mobility issues) for more than a year before the surgery, and removing more than half of the damaged cartilage during the surgery. They also found that factors like the patient’s sex, how their symptoms started, the type of tear, or their level of sports activity before the surgery did not predict how well they would do after the surgery. They found mixed results about the influence of factors like age, other damage to the knee, body mass index and leg alignment.

In simpler terms, if a patient has had knee pain for a long time, has arthritis in the knee, or if the surgeon has to remove a lot of the damaged cartilage, they might not do as well after this type of knee surgery. But things like the patient’s gender or how active they were before the surgery don’t seem to affect the outcome. The researchers suggest that doctors should consider these factors when deciding who should get this type of knee surgery.

FAQs

  1. What factors are associated with a worse clinical outcome following arthroscopic partial meniscectomy (APM)?
  2. Are sex, onset of symptoms, tear type or preoperative sport level predictors for clinical outcome after APM?
  3. How does the presence of radiological knee osteoarthritis at baseline and longer duration of symptoms impact the outcome of APM?

Doctor’s Tip

A helpful tip a doctor might tell a patient about meniscectomy is to consider factors such as the duration of symptoms (more than 1 year), the presence of radiological knee osteoarthritis, and the amount of meniscal tissue resected (>50%) as predictors for a potentially worse clinical outcome following the procedure. Patients should discuss these prognostic factors with their healthcare provider to make informed decisions about their treatment options.

Suitable For

Patients who are typically recommended for meniscectomy are those with a long duration of symptoms (>1 year), radiological knee osteoarthritis, and those who may require resecting more than 50% of the meniscal tissue. Other factors such as leaving a non-intact meniscal rim after meniscectomy may also play a role in predicting clinical outcome. Patients with acute or chronic onset of symptoms, tear type, preoperative sport level, sex, age, perioperative chondral damage, body mass index, and leg alignment may not necessarily be predictors for clinical outcome following APM. These prognostic factors should be considered in clinical decision making for patients with meniscal tears.

Timeline

Before meniscectomy:

  1. Patient experiences knee pain, swelling, and limited range of motion.
  2. Patient may undergo physical examination, imaging studies (such as MRI), and possibly a trial of conservative treatment (such as rest, ice, physical therapy).
  3. If conservative treatment fails, patient may be recommended for arthroscopic partial meniscectomy.

After meniscectomy:

  1. Patient undergoes arthroscopic surgery to remove part of the damaged meniscus.
  2. Patient may experience post-operative pain, swelling, and stiffness.
  3. Patient undergoes rehabilitation and physical therapy to regain strength and range of motion in the knee.
  4. Patient gradually resumes normal activities and sports, with the goal of returning to pre-injury level of function.
  5. Long-term follow-up may be needed to monitor for any complications or progression of knee osteoarthritis.

What to Ask Your Doctor

Some questions a patient should ask their doctor about meniscectomy may include:

  1. What are the potential risks and complications associated with meniscectomy?
  2. How long is the recovery process after a meniscectomy and what can I expect during that time?
  3. Will I need physical therapy after the surgery, and if so, for how long?
  4. Are there any alternative treatments or procedures that could be considered instead of meniscectomy?
  5. How likely is it that I will need additional surgeries in the future after undergoing meniscectomy?
  6. What can I do to prevent future knee injuries or complications after the surgery?
  7. What is the success rate of meniscectomy and what factors could affect the outcome of the surgery for me specifically?
  8. Are there any specific lifestyle changes or modifications I should make before or after the surgery to optimize my recovery?
  9. How soon after the surgery can I return to my regular activities, including sports or physical exercise?
  10. What follow-up appointments or check-ins should I expect after the surgery, and how will my progress be monitored?

Reference

Authors: Eijgenraam SM, Reijman M, Bierma-Zeinstra SMA, van Yperen DT, Meuffels DE. Journal: Br J Sports Med. 2018 Apr;52(8):514-521. doi: 10.1136/bjsports-2017-097836. Epub 2017 Nov 28. PMID: 29183885