Barras LA, Pareek A, Parkes CW, Song BM, Camp CL, Saris DBF, Stuart MJ, Krych AJ. Post-arthroscopic Subchondral Insufficiency Fractures of the Knee Yield High Rate of Conversion to Arthroplasty.
Arthroscopy 2021;
37:2545-2553. [PMID:
33774060 DOI:
10.1016/j.arthro.2021.03.029]
[Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 03/08/2021] [Accepted: 03/10/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE
To evaluate both the potential causes and resultant outcomes in patients in whom subchondral insufficiency fracture of the knee (SIFK) develops after arthroscopy.
METHODS
We performed a retrospective review of all patients with a magnetic resonance imaging diagnosis of SIFK after arthroscopic meniscectomy and chondroplasty over a 12-year period.
RESULTS
A total of 28 patients were included, with a mean age of 61 years and mean follow-up period of 5.7 years. SIFK showed a predilection for the medial compartment (n = 25, 89%), specifically the medial femoral condyle (n = 21, 75%). In 7 patients (25%), SIFK developed in both the femoral condyle and tibial plateau in the ipsilateral compartment. Fifteen patients (54%) went on to conversion to arthroplasty at a mean of 0.72 years. The rate of survival free of conversion to arthroplasty was 57%, 45%, and 40% at 1 year, 2 years, and 5 years, respectively. Furthermore, 63% of patients with a meniscal tear and SIFK in the same compartment went on to arthroplasty (P = .04). There was an increased risk of conversion to arthroplasty if SIFK was present in both the femur and tibia in the same compartment (P = .04). A higher Kellgren-Lawrence grade at the time of the SIFK diagnosis increased the likelihood of eventual arthroplasty (P = .03). The presence of SIFK in both the femur and tibia in the ipsilateral compartment, an increased Kellgren-Lawrence grade, and a meniscal tear or prior meniscectomy in the same compartment as SIFK were associated with an increased risk of eventual arthroplasty.
CONCLUSIONS
Post-arthroscopic SIFK most commonly occurs in the medial compartment, particularly in patients who underwent a prior meniscectomy. The presence of meniscal root and radial tears in these patients is notable (75%). Ultimately, there is a high rate of progression of arthrosis (33%) and eventual conversion to arthroplasty.
LEVEL OF EVIDENCE
Level IV, case series.
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