Arthroscopic partial meniscectomy: MR imaging for prediction of outcome in middle-aged and elderly patients.

PURPOSE

To determine whether preoperative magnetic resonance (MR) imaging could help identify factors associated with poor clinical outcome after arthroscopic partial meniscectomy (APM) in middle-aged and elderly patients with meniscal tears.

MATERIALS AND METHODS

The prospective, institutional review board-approved, HIPAA-compliant study was performed with informed consent in 53 men and 47 women (average ages, 54.5 and 56.6 years, respectively). Patients underwent knee MR imaging before APM; clinical symptoms were evaluated preoperatively and 1 year postoperatively with International Knee Documentation Committee (IKDC) questionnaire. Overall severity of knee joint degeneration and severity of each feature of joint degeneration were assessed with Boston Leads Osteoarthritis Knee (BLOK) scoring system. Tear length was measured, and type of meniscal tear was classified. Spearman correlation coefficients and relative risks showed the relationship between clinical outcome after APM (difference between preoperative and postoperative IKDC scores) and severity of joint degeneration.

RESULTS

Seventy-four patients with isolated medial APM had a significant (P < .05) inverse correlation between clinical outcome and severity of cartilage loss and bone marrow edema in the medial femoral condyle and medial tibial plateau. Fifteen patients with isolated lateral APM had a significant (P < .05) inverse correlation between clinical outcome and severity of cartilage loss in the lateral femoral condyle and lateral tibial plateau and bone marrow edema in the lateral femoral condyle. One hundred patients with APM had a significant (P < .05) inverse correlation between clinical outcome and severity of meniscal extrusion, total BLOK score, and meniscal tear length. A significantly (P < .05) increased relative risk that a patient would not definitely improve after APM was observed if a meniscal root tear was present.

CONCLUSION

Poorer clinical outcome after APM was associated with greater severity of cartilage loss and bone marrow edema in the same compartment as the meniscal tear, greater severity of meniscal extrusion, greater overall severity of joint degeneration, a meniscal root tear, and a longer meniscal tear at preoperative MR imaging.