Biomechanics and Clinical Outcomes of Partial Meniscectomy

Brian T. Feeley, MD; Brian C. Lau, MD

Disclosures

J Am Acad Orthop Surg. 2018;26(24):853-863. 

In This Article

Abstract and Introduction

Abstract

Partial meniscectomy for meniscus tears is one of the most common procedures performed by orthopaedic surgeons. Much research has been done to evaluate the biomechanical consequences and clinical outcomes from meniscus débridement. Biomechanically, as the portion of the meniscus that is removed increases, greater contact pressures are experienced by the cartilage, which leads to altered knee mechanics. The use of partial meniscectomy to manage degenerative meniscus tears in knees with mild preexisting arthritis and mechanical symptoms may be beneficial; however, its routine use in the degenerative knee over physical therapy alone is not supported. In younger populations, partial meniscectomy may provide equal long-term symptom relief, earlier return to play, and lower revision surgery rate compared with meniscal repair. Partial meniscectomy may result in earlier development of osteoarthritis. Treatment should be patient specific in a shared-decision making process with the patient after discussion about known outcomes.

Introduction

The meniscus has an important biomechanical role in the normal function of the knee including load bearing, shock absorption, and joint stability. Tears of the meniscus are one of the most common injuries seen by orthopedist, and arthroscopic partial meniscectomies (APMs) are one the most common procedures performed by orthopaedic surgeons.[1] Moreover, the frequency of APM increased by 49% between 1996 and 2006, and one can expect that this number has continued to rise.[1] This increase may be due to the short-term success of this procedure and the increase in patients who wish to avoid knee arthroplasty as a primary option. Meniscal tears, however, do not always directly cause knee pain, and the presence of a meniscus tear does not necessarily mean surgery is indicated. An MRI study found that 61% of asymptomatic patients had a meniscus tear identified on imaging.[2] Physicians must identify the patients who will most benefit from partial meniscectomy. Treating surgeons would be well served to understand the biomechanical implications and clinical outcomes of partial meniscectomy.

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