Subchondral fracture caused by unevenly stiffened meniscus after radiofrequency-assisted arthroscopic knee meniscectomy: A case report and review of the literature☆
| Autor: | Norio Kawahara, Kiyokazu Fukui, Katsutaka Yonezawa, Akihiro Shioya, Yoshiyuki Tachi, Hiroaki Hirata |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Meniscus (anatomy) Condyle Article 03 medical and health sciences 0302 clinical medicine Postarthroscopic osteonecrosis of the knee Insufficiency fracture Medicine Spontaneous osteonecrosis of the knee Subchondral fracture Unicompartmental knee arthroplasty business.industry medicine.disease musculoskeletal system Torn meniscus Surgery body regions Knee pain medicine.anatomical_structure 030220 oncology & carcinogenesis 030211 gastroenterology & hepatology medicine.symptom business Medial meniscus Radiofrequency-assisted arthroscopic knee meniscectomy |
| Zdroj: | International Journal of Surgery Case Reports |
| ISSN: | 2210-2612 |
| Popis: | Highlights • Although the worsening of symptoms following knee arthroscopy in older patients is often labeled as progression of arthritic symptoms, subchondral insufficiency fracture following arthroscopy may be underdiagnosed. • There is a possibility that uneven stiffening of the meniscus causes concentration of stress that resulted in postarthroscopic subchondral fracture. • Surgeons should consider avoiding subsequent subchondral fracture when to use radiofrequency in the debridement of a torn meniscus. Introduction Causality for postarthroscopic osteonecrosis of the knee is unknown, and related mechanisms have been poorly characterized. Presentation of case This report describes a case of a 69-year-old man with subchondral fracture occurring after arthroscopic meniscectomy using a radiofrequency assisted shaver. The patient experienced increasingly intense knee pain 10 months after the meniscectomy. MR imaging revealed postarthroscopic osteonecrosis of the knee in the femoral medial condyle, requiring unicompartmental knee arthroplasty. A mid-coronal cut section of the resected medial femoral condyle showed a linear fracture line parallel to the subchondral bone endplate. Histopathological examination showed prominent callus formation on both sides of the fracture, comprised of reactive woven bone and granulation tissue. The middle portion of the resected medial meniscus was of uneven height, with significant stiffening of the higher side. The stiffened region of the medial meniscus corresponded to the subchondral fracture in the medial femoral condyle. Discussion The etiology of post-arthroscopic osteonecrosis of the knee is controversial, but it seems possible that altered knee biomechanics after meniscectomy may predispose patients to osteonecrosis. The findings of the current case suggested that uneven stiffening of the meniscus caused concentration of stress that resulted in postarthroscopic subchondral fracture. Conclusion Subchondral insufficiency fracture following arthroscopy may be underdiagnosed. Surgeons need to carefully consider the risk of subchondral fracture following uneven stiffening of the meniscus when to use radiofrequency in the debridement of a torn meniscus. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|