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Previous knee surgery may lead to future articular cartilage lesions
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Previous knee surgery — especially partial meniscectomy — may cause articular cartilage lesions, according to a National Collegiate Athletic Association award-winning study.
“The purpose of our study was to better find the prevalence and characteristics of full-thickness cartilage injury in [National Football League] NFL athletes at the NFL combine and start to assess what factors may be associated with these lesions,” Robert H. Brophy, MD, said as he presented the study at the 2011 Annual Meeting of the American Orthopaedic Society for Sports Medicine.
Brophy and his colleagues reviewed 600 knee MRIs from football players at the NFL combine between 2005 and 2009. The team recorded the players’ body mass indices, positions, examination findings and previous knee surgeries. The team examined the MRIs and classified each as having no lesions, partial thickness- or full-thickness lesions.
Less than 3% of patients displayed symptoms at evaluation. Of the patients, 60% underwent previous knee surgery. The investigators found that 10% had more than one knee surgery. About 33% of patients had a history of partial mensicectomy and 3% had a history of a meniscal repair. Two-thirds of the meniscus surgery was performed in the lateral compartment, 28% in the medial compartment and 7% in both compartments. There was a history of ACL reconstruction in 20% of knees, of which approximately 40% also underwent meniscus surgery and 12% had other surgeries, according to Brophy.
Of the knees, 61% had changes in the articular cartilage, 44% had partial-thickness changes and 17% had full-thickness changes. Full thickness lesions were present in more than one compartment in 1.4% of knees. In knees with no previous surgery, 12% had full-thickness lesions. This increased to 16% in patients with previous meniscus repair.
Brophy noted that 5% of knees with no previous lateral meniscus surgery had full-thickness articular cartilage loss in the lateral compartment, which increased to 14% in patients who had a history of lateral meniscus repair. This increased to 27% in knees with a history of partial lateral meniscectomy.
In the medial compartment, 2.3% of patients with no previous medial meniscus surgery had chondrosis. This increased to 6.6% in knees with previous partial medial meniscectomy. There was no significant difference in the incidence of full-thickness lesions among athletes with a history of ACL reconstruction (19%) or without (17%).
“Full-thickness articular cartilage injuries are common in this cohort, but there’s a higher incidence in the lateral compartment,” Brophy said. “Previous knee surgery is associated with a higher rate of full-thickness change, especially partial meniscectomy. It does appear there may be some chondroprotective effect from meniscus repair, and ACL reconstruction by itself does not appear to be a risk factor for increased chondrosis, at least in the short term in this cohort.” – by Renee Blisard
Reference:
- Brophy RH, Nepple JJ, Matava MJ, Wright RW. Previous knee surgery is a risk factor for knee articular cartilage lesions among college football athletes at the NFL combine. Presented at 2011 Annual Meeting of the American Orthopaedic Society for Sports Medicine. July 7-10. San Diego.
- Robert H. Brophy, MD, can be reached at Washington University School of Medicine, Department of Orthopedic Surgery, 660 S. Euclid, Campus Box 8233 OC, Saint Louis, MO 63110; 314-514-3564; email: brophyr@wudosis.wustl.edu.
- Disclosure: Brophy has no relevant financial disclosures.
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In this interesting retrospective study, Brophy et al address the association between previous knee surgery and the risk of developing cartilage lesion by analyzing knee MRI among elite college football players. They conclude that previous surgery, which changes native anatomy, such as partial meniscectomies, increases the risk of full-thickness cartilage loss and, moreover, that surgical attempts to restore native anatomy may have a chondroprotective effect.
Based on the numbers presented in the study, it is also possible to affirm that every event, including the actual trauma or/and a surgical procedure, that compromises the native anatomy and biomechanics of the knee increases the risk of developing abnormal knee function and therefore, development of articular cartilage injuries.
It is still not completely known, however, which factors will dictate the fate of knee articular cartilage after a trauma. Bone bruises, meniscal injuries and ligament tears should be carefully evaluated and considered as potential risk for cartilage defect. Therefore, the treatment for those injuries should be well planned to avoid bad consequences for the articular cartilage. In the case of an ACL injury, for example, an anatomical ACL reconstruction should be performed to eliminate the risk to develop cartilage damage related to non-anatomical placement.
This study represents a big step towards the preservation/restoration of the individual native anatomy in knee surgery, which is crucial in preventing development of cartilage lesions.
Future directions on biological markers, optical coherence tomography and chondral protectors may help in providing early diagnosis that aids in proper treatment leading to better outcome.
— Freddie H. Fu, MD, DSc(Hon), DPs(Hon)
Orthopedics Today Editorial Board member
University of
Pittsburgh
Disclosure: Fu has no relevant financial disclosures.