Prognostic Factors of Mid- to Long-term Clinical Outcomes after Arthroscopic Partial Meniscectomy for Medial Meniscal Tears

Abstract

Backgroud: Arthroscopic partial meniscectomy (APM) continues to be the popular treatment for meniscal tears, but recent randomized controlled trials have questioned its efficacy. To provide more evidence-based criteria for patient selection, we undertook this study to identify prognostic factors associated with clinical failure after APM for medial meniscus tears.

Methods: Medical records of 160 patients followed up for at least 5 years after APM for medial meniscal tears were retrospectively reviewed. Demographic data (age, sex, and body mass index), radiographic variables (Kellgren-Lawrence [K-L] grade and hip-knee-ankle [HKA] angle), and clinical scores (International Knee Documentation Committee score, Tegner activity scale score, Lysholm score, and Knee injury and Osteoarthritis Outcome Score) were recorded. Clinical failure was defined as the need for an additional surgical procedure (arthroscopy, osteotomy, or arthroplasty) or the presence of intolerable pain. Survivorship analysis with clinical failure as an end point was performed using Kaplan-Meier survival curves. Factors related to clinical failure were analyzed using a Cox proportional hazard model. Cutoff values were determined using areas under receiver operating characteristic (ROC) curves. Radiographic progression of osteoarthritis was analyzed using the chi-square test, and serial changes of clinical scores were analyzed using a linear mixed model.

Results: Clinical success rates were 95.7% at 5 years, 75.6% at 10 years, and 46.3% at 15 years. Age, HKA angle, and K-L grade (p = 0.01, p = 0.02, and p = 0.04, respectively) were found to be significant risk factors of clinical failure. Cutoff values at 10 years postoperatively as determined by ROC analysis were 50 years for age (sensitivity = 0.778, 1-specificity = 0.589), grade 2 for K-L grade (sensitivity = 0.778, 1-specificity = 0.109), and 5.5° for HKA angle (sensitivity = 0.667, 1-specificity = 0.258). In patients who had clinical success until 10 years after APM, radiological osteoarthritis progressed gradually. However, the clinical scores of patients who achieved clinical success did not decrease significantly over the 10-year follow-up.

Conclusions: The poor prognostic factors found to be related to clinical failure after APM for a medial meniscal tear were patient age (≥ 50 years), preoperative K-L grade (≥ grade 2), and preoperative HKA angle (≥ varus 5.5°).

Keywords: Arthroscopic meniscectomy; Clinical failure; Knee; Prognostic factor.

Fig. 1. Study flowchart. MM: medial meniscus, APM: arthroscopic partial meniscectomy, DFO: distal femoral osteotomy, HTO: high tibial osteotomy.

Fig. 2. Clinical success rates after arthroscopic partial meniscectomy.

Fig. 3. Receiver operating characteristic (ROC) curves for clinical failure at 5 years (A) and 10 years (B) postoperatively. Diagonal segments are produced by ties. HKA: hip-knee-ankle, K-L grade: Kellgren-Lawrence grade.

Fig. 4. Radiologic progression in patients who achieved clinical success at 10 years after arthroscopic partial meniscectomy.

Fig. 5. Clinical scores of the patients who achieved clinical success at 10 years after arthroscopic partial meniscectomy. KOOS: Knee injury and Osteoarthritis Outcome Score, IKDC: International Knee Documentation Committee, VAS: visual analog scale.