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Review
. 2017 Nov 6;5(4):229-236.
doi: 10.1055/s-0037-1608666. eCollection 2017 Dec.

Postarthroscopy Osteonecrosis of the Knee: Current Concepts

Francesco Di Caprio  1 , Renato Meringolo  1 , Maria Adiletta Navarra  1 , Massimiliano Mosca  2 , Lorenzo Ponziani  1
Affiliations
Review

Postarthroscopy Osteonecrosis of the Knee: Current Concepts

Francesco Di Caprio et al. Joints. .

Abstract

Knee osteonecrosis is a severe disease rapidly leading to end-stage osteoarthritis, which was classified into three categories: spontaneous, secondary, and postarthroscopy. To understand postarthroscopy osteonecrosis of the knee, all the three types of knee osteonecrosis have to be deepened. This article reviewed spontaneous and secondary osteonecroses of the knee, with special focus upon postarthroscopy osteonecrosis, which is a rare form, affecting patients operated for arthroscopic knee surgery, most commonly for meniscectomy. Due to its rarity, patients and surgeons are often unprepared for this complication. A correct diagnosis is essential for appropriate treatment, and also to determine if a preexisting osteonecrosis was present, avoiding medicolegal sequelae, although many authors agree that osteonecrosis (both spontaneous and postarthroscopy) represent unpreventable and unpredictable conditions. In spontaneous osteonecrosis, the treatment is defined according to the size and the degree of the lesion, whereas in postarthroscopy osteonecrosis, the size of the lesion has no prognostic value, and therefore, the choice of the correct treatment is based more on the timing of the diagnosis. A diagnostic and therapeutic algorithm was outlined on the basis of the actual knowledge.

Keywords: arthroscopy; knee; meniscectomy; osteonecrosis; treatment.

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Conflict of interest statement

Conflict of Interest None.

Figures

Fig. 1
Fig. 1
Treatment algorithm for SPONK. NSAIDS, nonsteroidal anti-inflammatory drugs; SPONK, spontaneous osteonecrosis of the knee; TKA, total knee arthroplasty; UKA, unicompartmental knee arthroplasty.
Fig. 2
Fig. 2
Magnetic resonance imaging T2 scan showing bone marrow edema in the early phase of osteonecrosis of the medial femoral condyle.
Fig. 3
Fig. 3
Magnetic resonance imaging T1 scan showing the delineated necrotic area surrounded by bone marrow edema.
Fig. 4
Fig. 4
Diagnostic algorithm for ONPK. BME, bone marrow edema; ONPK, osteonecrosis in the postoperative knee; MRI, magnetic resonance imaging; SPONK, spontaneous osteonecrosis of the knee.
Fig. 5
Fig. 5
X-rays showing a core decompression procedure in for osteonecrosis of the medial femoral condyle.
Fig. 6
Fig. 6
Osteonecrosis of the medial femoral condyle treated by high tibial osteotomy.
Fig. 7
Fig. 7
Treatment algorithm for ONPK. NSAIDS, nonsteroidal anti-inflammatory drugs; ONPK, osteonecrosis in the postoperative knee; TKA, total knee arthroplasty; UKA, unicompartmental knee arthroplasty.
See this image and copyright information in PMC

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