TREATMENT OF THE MENISCAL LESION ASSOCIATED WITH PATELLAR LIGAMENTOPLASTY: OSTEOARTHRITIC EVOLUTION AFTER MORE THAN TEN YEARS

Abstract

Purpose: The purpose of our study was to evaluate, in a context of laxity, the incidence of meniscal lesions and their treatment on the osteoarthritic evolution after more than ten years. In 1986 and 1987, we operated 230 knees with tears of the anterior cruciate ligament using a patellar graft. Among these knees, 184 (80%) were reviewed clinically and radiographically for this study.

Material and methods: Ninety patients (49%) had healthy menisci at the operation and did not have a secondary meniscal procedure; 94 patients (51%) had a meniscal procedure before, during or after the plasty. Among these, 13 (14%) had had an earlier meniscectomy, 18 (19%) had had meniscectomy at the time of the plasty (two revisions), 35 (37%) had had sutures (five secondary failures), ten (11%) had had a long injury left in place (four revisons), and 18 (19%) with normal knees at the time of the plasty had a secondary meniscectomy.

Results: We compared the radiological results in these different populations (osteoarthritis with remodelling compared with normal images). There was a significant difference between the population with normal knee images and the population with meniscal lesions irrespective of the time of treatment (prior meniscectomy, concomitant meniscectomy and plasty, healthy menisci at the time of plasty but secondary meniscectomy). There was no significant difference between the knees with normal menisci and those with sutured menisci.

Conclusion: Saving the meniscus has a major effect on the radiological evolution of the knee. Thus isolated meniscectomy should not be performed for laxity in young patients; meniscal lesions should be sutured at the time of ligamentoplasty.