Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 21, 00128, Rome, Italy.
Department of Orthopaedic and Trauma Surgery, Casa di Cura Città of Parma, 43123, Parma, Italy.
Musculoskelet Surg. 2023 Sep;107(3):269-277. doi: 10.1007/s12306-023-00783-0. Epub 2023 Apr 4.
The etiology of post-arthroscopic osteonecrosis of the knee (PAONK) is still unknown. The aims of this systematic review were to analyze the main characteristics of patients who developed osteonecrosis after arthroscopy. We considered for inclusion in the review case reports, case series, retrospective and prospective clinical trial, that involved patients who developed osteonecrosis of the knee within 1 year of arthroscopy for meniscal lesion or anterior cruciate ligament rupture with or without chondropathy. In all cases, there was a pre-operative magnetic resonance imaging that excluded the presence of osteonecrosis. We used the MINORS criteria to estimate the risk of bias. A total of 13 studies that involved 125 patients were included in the review. Only 14 out of 55 patients performed the pre-operative MRI after the "window period", which we considered 6 weeks between the onset of symptoms and positive MRI findings. A diagnosis of PAONK was made for 55 patients within 1 year of surgery. Of these, 29% was treated conservatively, while 71% repeated surgery. Osteonecrosis after knee arthroscopy is a reality and surgeon shouldn't underestimate the persistence or re-emergence of symptoms after arthroscopy. It may be due to subchondral insufficiency fractures in osteopenic bone, without evidence of necrosis. However, there are not elements enough to differentiate clinical and radiological characteristics of PAONK from SPONK. Terminology should be simplified, distinguishing subchondral insufficiency fractures of the knee as a precursor of primary osteonecrosis of the knee.
关节镜检查后膝关节骨坏死（PAONK）的病因尚不清楚。本系统评价的目的是分析发生关节镜检查后骨坏死的患者的主要特征。我们认为纳入评价的有：关节镜下半月板病变或前交叉韧带断裂伴或不伴软骨病患者，在关节镜检查后 1 年内发生膝关节骨坏死的病例报告、病例系列、回顾性和前瞻性临床试验。所有病例均有术前磁共振成像（MRI）排除骨坏死。我们使用 MINORS 标准评估偏倚风险。共纳入了 13 项研究，涉及 125 名患者。在 55 名患者中，仅有 14 名患者在“窗口期”后进行了术前 MRI 检查，我们认为窗口期是指症状出现和 MRI 阳性结果之间的 6 周时间。在术后 1 年内，55 名患者被诊断为 PAONK。其中 29%接受了保守治疗，71%患者接受了重复手术。膝关节关节镜检查后发生骨坏死是客观存在的，外科医生不应低估关节镜检查后症状的持续或再次出现。这可能是由于骨质疏松骨的软骨下不全骨折，没有坏死的证据。然而，目前还没有足够的元素来区分 PAONK 和 SPONK 的临床和影像学特征。术语应简化，将膝关节软骨下不全骨折作为膝关节原发性骨坏死的前兆。
