TY - JOUR
T1 - Post-arthroscopic Subchondral Insufficiency Fractures of the Knee Yield High Rate of Conversion to Arthroplasty
AU - Barras, Laurel A.
AU - Pareek, Ayoosh
AU - Parkes, Chad W.
AU - Song, Bryant M.
AU - Camp, Christopher L.
AU - Saris, Daniel B.F.
AU - Stuart, Michael J.
AU - Krych, Aaron J.
N1 - Funding Information:
The authors report the following potential conflicts of interest or sources of funding: A.P. receives hospitality payments from Stryker, United States, outside the submitted work. C.L.C. receives hospitality payments from Arthrex, United States, Zimmer Biomet, United States, and Stryker and receives educational support from Arthrex, outside the submitted work. D.B.F.S. is on the editorial or governing board of Cartilage, receives research support from JRF, and is a paid consultant for Smith & Nephew, outside the submitted work. M.J.S. is on the editorial or governing board of American Journal of Sports Medicine, receives intellectual property royalties from Arthrex; is a paid consultant for Arthrex; and receives research support from Arthrex and Stryker, outside the submitted work. A.J.K. receives research support from Aesculap/B Braun, Arthritis Foundation, Ceterix, Histogenics, United States, Exactech, and Gemini Medical; is on editorial or governing board of American Journal of Sports Medicine; is a board or committee member of International Cartilage Repair Society, International Society of Arthroscopy, Knee Surgery & Orthopaedic Sports Medicine, United States, Minnesota Orthopedic Society, and Musculoskeletal Transplantation Foundation, United States; is a paid consultant for Arthrex, Musculoskeletal Transplantation Foundation, Vericel, DePuy, JRF, United States, and Responsive Arthroscopy; receives travel/lodging from Arthrex and Musculoskeletal Transplantation Foundation; and is a paid speaker for Arthrex and Musculoskeletal Transplantation Foundation, outside the submitted work. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Publisher Copyright:
© 2021 Arthroscopy Association of North America
PY - 2021/8
Y1 - 2021/8
N2 - 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.
AB - 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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U2 - 10.1016/j.arthro.2021.03.029
DO - 10.1016/j.arthro.2021.03.029
M3 - Article
C2 - 33774060
AN - SCOPUS:85106300664
SN - 0749-8063
VL - 37
SP - 2545
EP - 2553
JO - Arthroscopy - Journal of Arthroscopic and Related Surgery
JF - Arthroscopy - Journal of Arthroscopic and Related Surgery
IS - 8
ER -