Türker Mehmet, Çetik Özgur, Çırpar Meriç, Durusoy Serhat, Cömert Barış
Department of Orthopedics and Traumatology, Faculty of Medicine, Kırıkkale University, Yenimahalle Sağlık Caddesi, Merkez, 71100, Kirikkale, Turkey,
Knee Surg Sports Traumatol Arthrosc. 2015 Jan;23(1):246-50. doi: 10.1007/s00167-013-2450-y. Epub 2013 Feb 27.
Spontaneous subchondral osteonecrosis of the knee joint confined to a localized area of one condyle can occur after arthroscopic procedures. Meniscal tears, arthroscopic meniscectomy, and radiofrequency chondroplasty are aetiological factors in the development of osteonecrosis. The aim of this study was to investigate whether the incidence of osteonecrosis increased when mechanical or radiofrequency chondroplasty was used in conjunction with arthroscopic meniscectomy.
In this prospective clinical trial, arthroscopic meniscectomy was the primary treatment in 75 patients (mean age 40 ± 13) with stage II and III degenerative changes on the articular cartilage. Patients had to meet the following criteria: 1) have preoperative MRI and plain film radiographs showing no evidence of osteonecrosis; 2) be symptomatic for at least 6 weeks before the preoperative MRI; and 3) have arthroscopically confirmed stage II or III chondral lesion. A preoperative MRI was performed for all patients. For treatment of chondral lesions, debridement with a shaver or chondroplasty with a monopolar RF energy system was used. Patients were divided into three treatment groups. Partial meniscectomy of the medial or lateral (or both) menisci was performed on all patients, but patients in group 2 additionally received mechanical debridement of the chondral lesion, and those in group 3 were additionally treated with RF chondroplasty. Patients in group 1 were treated with partial meniscectomy alone. Patients were re-examined after 6 months, at which time a repeat MRI was performed.
Development of osteonecrosis was detected during the postoperative MRIs of five patients: two in group 1, two in group 2, and one in group 3.
The addition of mechanical or RF chondroplasty to meniscectomy did not increase the number of patients with osteonecrosis. Also, RF chondroplasty, which is commonly proposed to be an aetiological factor, resulted in a decrease in the number of patients that developed osteonecrosis.
II.
膝关节自发性软骨下骨坏死可局限于一个髁的局部区域，且可发生于关节镜手术后。半月板撕裂、关节镜下半月板切除术及射频软骨成形术是骨坏死发生的病因。本研究旨在调查在关节镜下半月板切除术联合使用机械或射频软骨成形术时，骨坏死的发生率是否会增加。
在这项前瞻性临床试验中，关节镜下半月板切除术是75例（平均年龄40±13岁）关节软骨出现II期和III期退变改变患者的主要治疗方法。患者必须符合以下标准：1）术前MRI和X线平片显示无骨坏死证据；2）术前MRI前有至少6周的症状；3）关节镜检查确诊为II期或III期软骨损伤。所有患者均进行了术前MRI检查。对于软骨损伤的治疗，采用刨削器清创或单极射频能量系统进行软骨成形术。患者分为三个治疗组。所有患者均行内侧或外侧（或双侧）半月板部分切除术，但第2组患者还接受了软骨损伤的机械清创，第3组患者还接受了射频软骨成形术。第1组患者仅接受半月板部分切除术。患者在6个月后复查，此时进行重复MRI检查。
在5例患者的术后MRI检查中发现了骨坏死的发生：第1组2例，第2组2例，第3组1例。
半月板切除术联合机械或射频软骨成形术并未增加骨坏死患者的数量。此外，通常被认为是病因的射频软骨成形术导致发生骨坏死的患者数量减少。
II级。
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