Original Articles
Arthroscopic partial meniscectomy in patients over 70 years of age*

https://doi.org/10.1053/jars.2001.20099Get rights and content

Abstract

Purpose: This study was conducted to determine the importance of age as a limiting factor as well as to assess the role of age in combination with cartilage damage or osteoarthritis as predicting factors for the outcome after arthroscopic partial meniscectomy. Type of Study: Case series. Methods: We reviewed 97 patients over 70 years of age who underwent an arthroscopic partial meniscectomy between 1992 and 1996. At the time of evaluation, 5 patients had died and 1 patient was unavailable, leaving 91 patients (95 knees) suitable for assessment. There were 56 women and 35 men. The average age at time of surgery was 74 years (range, 70 to 84 years). The mean follow-up period was 4 years (range, 2 to 6 years). Assessment of the cases by 1 investigator included medical records and preoperative radiographs of the knee joint, with the main interest focused on evidence of osteoarthritis using the classification of Kellgren and Lawrence. Evaluation of cartilage damage was performed on surgical videotapes according to Outerbridge. All 91 patients were personally interviewed by telephone. The questionnaire included influence of the operation on knee pain, quality and duration of satisfaction, requirement of further surgery, and whether the patient would undergo the same operation again. Results: According to the Kellgren and Lawrence classification, 80% of patients had radiographic evidence of osteoarthritis grade 0-2, and 20% had grade 3-4. According to Outerbridge, 43% of the patients had cartilage damage grade 0-2 and 57% had grade 3-4; 81% of the patients with osteoarthritis grade 0-2 and 83% of the patients with cartilage damage grade 0-2 had a satisfactory outcome when followed-up for more than 2 years. Among the patients with osteoarthritis grade 3-4 or cartilage damage grade 3-4, 55% and 69%, respectively, were satisfied when followed-up for more than 2 years; 45% and 37%, respectively, required a further surgery after 1 to 4 years. The grade of osteoarthritis had significant influence on satisfaction (P < .01), on whether the patients would have the operation done again (P = .01), and on whether they required further surgery (P = .04). The severity of cartilage damage only had a significant influence on whether the patients would undergo the operation again (P = .01). Conclusions: Pre-existing degenerative changes appeared to affect the outcome more than the patient’s age. However, arthroscopic partial meniscectomy was followed by satisfactory results in more than two thirds of our cases even if performed in the presence of moderate degenerative changes. But two thirds does not correspond with the good results usually obtained in a younger population. Therefore, the indication for surgery and the expected outcome have to be evaluated carefully in elderly patients.

Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 7 (September), 2001: pp 732–736

Section snippets

Methods

Between 1992 and 1996, 97 patients older than 70 years underwent arthroscopic partial meniscectomy at our clinic. At the time of evaluation, 5 patients had died and 1 patient was unavailable, leaving 91 patients (95 knees) entered in the study. There were 56 women and 35 men. The average age at time of surgery was 74 years (range, 70 to 84 years). The mean follow-up period was 4 years (range, 2 to 6 years).

The time between onset of symptoms and arthroscopic treatment varied from 1 to 12 months

Results

At follow-up of 2 years or longer, 81% of the patients with osteoarthritis grade 0-2 and 83% of the patients with cartilage damage grade 0-2 presented a satisfactory outcome (Table 1).

. Percentage of Satisfactory Results

Empty CellGrade 0-1-2Grade 3-4
Osteoarthritis (Kellgren & Lawrence grading)81%55%
Cartilage damage (Outerbridge grading)83%69%

NOTE. 45% of patients with grade 3-4 osteoarthritis and 37% of patients with grade 3-4 cartilage damage went on to further surgery, usually a total knee arthroplasty.

Discussion

Pre-existing degenerative articular changes have often been reported as the most important predicting factor for the outcome following arthroscopic partial meniscectomy in the elderly.3, 4, 6, 7, 8, 9 Furthermore, if some reported better outcome in patients with recent trauma history,6, 10, 13 they often compared these patients with another group of patients with degenerative meniscal tears or osteoarthritis. In fact, these studies were also advocating the importance of the degenerative

Conclusion

Our results suggest that the outcome after arthroscopic partial meniscectomy seems to be more affected by pre-existing degenerative changes than by the patient’s age. However, it is possible to obtain satisfactory results in patients over 70 years old (more than two thirds of all our cases) even in the presence of mild to moderate degenerative articular changes. Furthermore, if cartilage changes do not exceed grade 2 according to Outerbridge, or if the radiologic evidence of osteoarthritis does

References (20)

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*

Address correspondence and reprint requests to Xavier Crevoisier, M.D., Hôpital Orthopédique de la Suisse Romande, Pierre-Decker 4, CH-1005 Lausanne, Switzerland. E-mail: [email protected]

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