Richard Kijowski MD, Presenter: Nothing to Disclose

Michael Anthony Woods MD, Abstract Co-Author: Nothing to Disclose

John Wilson, Abstract Co-Author: Nothing to Disclose

Tim McGuine, Abstract Co-Author: Nothing to Disclose

Ben K. Graf MD, Abstract Co-Author: Royalties, Smith & Nephew plc

Arthur August De Smet MD, Abstract Co-Author: Nothing to Disclose

The success rate of arthroscopic partial menisectomy (APM) in patients over 45 years of age is significantly lower than that for younger individuals due the higher prevalence of concomitant degeneration joint disease. This study was performed to determine whether preoperative MRI could be used to predict clinical outcome after APM in patients over 45 years of age.

The study group was comprised of 100 patients over 45 years of age who had an MRI exam of the knee performed prior to APM. The clinical symptoms of all patients were evaluated preoperatively and at 1 year follow-up using the IKDC questionnaire, an extensively validated knee surgical outcome measure. A musculoskeletal radiologist, blinded to clinical and surgical findings, reviewed all MRI exams and used the Boston Leeds Osteoarthritis Knee Scoring (BLOKS) system to grade the severity of cartilage loss (CL), bone marrow edema (BME), osteophytes, meniscal extrusion, joint effusion, synovitis, ACL tear, bursitis, loose bodies, ganglion cysts, and Baker’s cysts. Spearman’s correlation coefficients were used to determine the relationship between clinical outcome after APM (measured as the difference in the preoperative and 1 year follow-up IKDC scores) and the severity of the MRI parameters of joint degeneration.

For all 100 patients undergoing APM, there was a significant (p<0.05) inverse correlation between clinical outcome and the severity of CL in the medial femoral condyle (MFC) and medial tibial plateau (MTP), the severity of BME in the MFC and lateral femoral condyle (LFC), and the severity of meniscal extrusion. For the 75 patients undergoing isolated medial APM, there was a significant (p<0.05) inverse correlation between clinical outcome and the severity of CL and BME within the MFC and MTP. For the 15 patients undergoing isolated lateral APM, there was a significant (p<0.05) inverse correlation between clinical outcome and the severity of CL in the LFC and lateral tibial plateau (LTP) and BME within the LFC.

Clinical outcome after APM in patients over 45 years of age is inversely correlated with the severity of meniscal extrusion and the severity of CL and BME within the same compartment as the meniscal tear on preoperative MRI.

Preoperative MRI can be used to predict clinical outcome after arthroscopic partial meniscectomy in middle-aged and elderly patients.

Kijowski, R, Woods, M, Wilson, J, McGuine, T, Graf, B, De Smet, A, Preoperative MRI as a Predictor of Clinical Outcome after Arthroscopic Partial Menisectomy in Middle Aged and Elderly Patients.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8013010.html