How Does the Presence of Unstable Chondral Lesions Affect Patient Outcomes After Partial Meniscectomy? The ChAMP Randomized Controlled Trial

Abstract

Background:

Chondral lesions are commonly encountered during arthroscopic partial meniscectomy (APM); however, it is unknown how these lesions affect postoperative outcomes.

Purpose:

The authors compared postoperative outcomes among patients with and without unstable chondral lesions 1 year after APM.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

The authors conducted a secondary analysis of data from the ChAMP (Chondral Lesions and Meniscus Procedures) randomized controlled trial. They compared the following outcomes for patients with unstable chondral lesions that were left in situ and observed (CL-noDeb) versus patients without unstable chondral lesions (NoCL) at 1 year after APM: Western Ontario and McMaster Universities Osteoarthritis Index, Knee injury and Osteoarthritis Outcome Score, visual analog scale for pain, the Short Form Health Survey, range of motion, quadriceps circumference, and effusion. Multivariate linear regression was used to obtain mean differences (MDs) with corresponding 95% CIs adjusted for age, body mass index, and preoperative score (for postoperative scores).

Results:

Compared with the CL-noDeb group, the NoCL group had greater improvement in Western Ontario and McMaster Universities Osteoarthritis Index for pain (MD, 7.9, 95% CI: 2.7-13.1), stiffness (MD, 9.1, 95% CI: 1.9-16.3), and physical function (MD, 4.6, 95% CI: 0.1-9.0) and Knee injury and Osteoarthritis Outcome Score for pain (MD, 8.4, 95% CI: 2.7-14.0), function in sport and recreation (MD, 11, 95% CI: 3.0-19.1), and quality of life (MD, 10.4, 95% CI: 2.3-18.5). The NoCL group was less likely than the CL-noDeb group to have an effusion (P = .02) 1 year after surgery.

Conclusion:

Patients undergoing APM without unstable chondral lesions had better outcomes than patients with unstable chondral lesions.

Keywords

meniscus chondral lesion debridement outcomes

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References

Aroen

Loken

Heir

et al . Articular cartilage lesions in 993 consecutive knee arthroscopies. Am J Sports Med. 2004;32(1):211-215.

Bellamy

Buchanan

Goldsmith

Campbell

Stitt

. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988;15(12):1833-1840.

Bisson

Kluczynski

Wind

et al . Design of a randomized controlled trial to compare debridement to observation of chondral lesions encountered during partial meniscectomy: the ChAMP (Chondral Lesions and Meniscus Procedures) Trial. Contemp Clin Trials. 2015;45(pt B):281-286.

Bisson

Kluczynski

Wind

et al . Patient-reported outcomes of debridement versus observation of chondral lesions found during partial meniscectomy: the Chondral Lesions and Meniscus Procedures (ChAMP) Randomized Controlled Trial. Bone Joint Surgery Am. 2017;99:1078-1085.

Blazek

Favre

Asay

Erhart-Hledik

Andriacchi

. Age and obesity alter the relationship between femoral articular cartilage thickness and ambulatory loads in individuals without osteoarthritis. J Orthop Res. 2014;32(3):394-402.

Chang

Falconer

Stulberg

Arnold

Manheim

Dyer

. A randomized, controlled trial of arthroscopic surgery versus closed-needle joint lavage for patients with osteoarthritis of the knee. Arthritis Rheum. 1993;36(3):289-296.

Dervin

Stiell

Rody

Grabowski

. Effect of arthroscopic debridement for osteoarthritis of the knee on health-related quality of life. J Bone Joint Surg Am. 2003;85(1):10-19.

Engelhart

Nelson

Lewis

et al . Validation of the Knee injury and Osteoarthritis Outcome Score subscales for patients with articular cartilage lesions of the knee. Am J Sports Med. 2012;40(10):2264-2272.

Englund

. The role of biomechanics in the initiation and progression of OA of the knee. Best Pract Res Clin Rheumatol. 2010;24(1):39-46.

10.

Fabricant

Rosenberger

Jokl

Ickovics

. Predictors of short-term recovery differ from those of long-term outcome after arthroscopic partial meniscectomy. Arthroscopy. 2008;24(7):769-778.

11.

Guermazi

Niu

Hayashi

et al . Prevalence of abnormalities in knees detected by MRI in adults without knee osteoarthritis: population based observational study (Framingham Osteoarthritis Study). BMJ. 2012;345:e5339.

12.

Haviv

Bronak

Kosashvili

Thein

. Which patients are less likely to improve during the first year after arthroscopic partial meniscectomy? A multivariate analysis of 201 patients with prospective follow-up. Knee Surg Sports Traumatol Arthrosc. 2016;24(5):1427-1431.

13.

Haviv

Bronak

Thein

. Correlation between body mass index and chondral lesions in isolated medial meniscus tears. Indian J Orthop. 2015;49(2):176-180.

14.

Herrlin

Hallander

Wange

Weidenhielm

Werner

. Arthroscopic or conservative treatment of degenerative medial meniscal tears: a prospective randomised trial. Knee Surg Sports Traumatol Arthrosc. 2007;15(4):393-401.

15.

Hjelle

Solheim

Strand

Muri

Brittberg

. Articular cartilage defects in 1,000 knee arthroscopies. Arthroscopy. 2002;18(7):730-734.

16.

Joseph

Hou

Nardo

et al . MRI findings associated with development of incident knee pain over 48 months: data from the osteoarthritis initiative. Skeletal Radiol. 2016;45(5):653-660.

17.

Katz

Brophy

Chaisson

et al . Surgery versus physical therapy for a meniscal tear and osteoarthritis. N Engl J Med. 2013;368(18):1675-1684.

18.

Kim

Bosque

Meehan

Jamali

Marder

. Increase in outpatient knee arthroscopy in the United States: a comparison of National Surveys of Ambulatory Surgery, 1996 and 2006. J Bone Joint Surg Am. 2011;93(11):994-1000.

19.

Kirkley

Birmingham

Litchfield

et al . A randomized trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med. 2008;359(11):1097-1107.

20.

Kosinski

Keller

Hatoum

Kong

Ware

Jr.

The SF-36 Health Survey as a generic outcome measure in clinical trials of patients with osteoarthritis and rheumatoid arthritis: tests of data quality, scaling assumptions and score reliability. Med Care. 1999;37(5)(suppl):MS10-MS22.

21.

Lamplot

Brophy

. The role for arthroscopic partial meniscectomy in knees with degenerative changes: a systematic review. Bone Joint J. 2016;98(7):934-938.

22.

Little

Rubin

. Statistical Analysis With Missing Data. 2nd ed. New York, NY: Wiley; 2002.

23.

Mackinnon

. The use and reporting of multiple imputation in medical research—a review. J Intern Med. 2010;268(6):586-593.

24.

McDermott

. Meniscal tears, repairs and replacement: their relevance to osteoarthritis of the knee. Br J Sports Med. 2011;45(4):292-297.

25.

McLaren

Blokker

Fowler

Roth

Rock

. Arthroscopic debridement of the knee for osteoarthrosis. Can J Surg. 1991;34(6):595-598.

26.

Meredith

Losina

Mahomed

Wright

Katz

. Factors predicting functional and radiographic outcomes after arthroscopic partial meniscectomy: a review of the literature. Arthroscopy. 2005;21(2):211-223.

27.

Montgomery

Foster

Ngo

et al . Trends in the surgical treatment of articular cartilage defects of the knee in the United States. Knee Surg Sports Traumatol Arthrosc. 2014;22(9):2070-2075.

28.

Moseley

O’Malley

Petersen

et al . A controlled trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med. 2002;347(2):81-88.

29.

Outerbridge

. The etiology of chondromalacia patellae. J Bone Joint Surg Br. 1961;43:752-757.

30.

Roos

Klassbo

Lohmander

. WOMAC osteoarthritis index: reliability, validity, and responsiveness in patients with arthroscopically assessed osteoarthritis. Scand J Rheumatol. 1999;28(4):210-215.

31.

Roos

Lohmander

Ekdahl

Beynnon

. Knee injury and Osteoarthritis Outcome Score (KOOS)—development of a self-administered outcome measure. J Orthop Sports Phys Ther. 1998;28(2):88-96.

32.

Salata

Gibbs

Sekiya

. A systematic review of clinical outcomes in patients undergoing meniscectomy. Am J Sports Med. 2010;38(9):1907-1916.

33.

Sellards

Nho

Cole

. Chondral injuries. Curr Opin Rheumatol. 2002;14(2):134-141.

34.

Shin

Lee

. Arthroscopic treatment for osteoarthritic knee. Knee Surg Relat Res. 2012;24(4):187-192.

35.

Sihvonen

Paavola

Malmivaara

et al . Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear. N Engl J Med. 2013;369(26):2515-2524.

36.

Sofu

Oner

Camurcu

Gursu

Ucpunar

Sahin

. Predictors of the clinical outcome after arthroscopic partial meniscectomy for acute trauma-related symptomatic medial meniscal tear in patients more than 60 years of age. Arthroscopy. 2016;32(6):1125-1132.

37.

Solomon

Simel

Bates

Katz

Schaffer

. The rational clinical examination: does this patient have a torn meniscus or ligament of the knee? Value of the physical examination. JAMA. 2001;286(13):1610-1620.

38.

Ware

Jr Sherbourne

. The MOS 36-item short-form health survey (SF-36): I. Conceptual framework and item selection. Med Care. 1992;30(6):473-483.

39.

Wessel

. The reliability and validity of pain threshold measurements in osteoarthritis of the knee. Scand J Rheumatol. 1995;24(4):238-242.

40.

Widuchowski

Trzaska

. Articular cartilage defects: study of 25,124 knee arthroscopies. Knee. 2007;14(3):177-182.

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