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Facteurs de risque d’arthrose après méniscectomie partielle sur ménisque discoïde latéral
Revue de chirurgie orthopédique et traumatologique 103 (2017) 864
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Mémoire original
Facteurs de risque d’arthrose après méniscectomie partielle sur ménisque discoïde latéral夽 Risk factors for radiographic progression of osteoarthritis after partial meniscectomy of discoid lateral meniscus tear J.H. Ahn ∗ , D.M. Kang , K.J. Choi Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, 814, Siksadong, Ilsandonggu, Goyangsi, Gyeonggido, République de Corée
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Historique de l’article : Rec¸u le 29 juillet 2017 Accepté le 14 septembre 2017 Keywords: Discoid lateral meniscus Partial meniscectomy Osteoarthritis Outcomes
a b s t r a c t Introduction. – Partial meniscectomy has been preferred in the treatment of discoid lateral meniscus (DLM) with tear, rather than total or subtotal meniscectomy, which could lead to late radiographic degenerative changes. Hypothesis. – One or more risk factors contribute to radiographic progression of osteoarthritis after partial meniscectomy of DLM tear. Material and methods. – Inclusion criteria were consecutive patients who underwent arthroscopic surgeries for DLM tear from January 2005 to December 2010 by one surgeon. Exclusion criteria were pre-operative osteoarthritis with KL grade 3 or more, osteochondritis dissecans, minimal width of meniscal remnant less than 6 mm after meniscectomy, meniscal repair of an unstable discoid meniscus, age over 60 years, loss to follow-up for a minimum of 5 years and simultaneous surgery on articular cartilage or anterior cruciate ligament. According to the KL grade at the last follow-up, all enrolled knees were sorted into no progression to knee osteoarthritis (KL grade 1 or 2 – NOA) and progression to osteoarthritis (KL grade 3 or 4 – POA) groups. Multivariate logistic regression was used to analyze the risk factors of high-grade osteoarthritis. Results. – In comparison with NOA group (n = 135) and POA group (n = 67), prolonged symptom duration, increased relative percentage of DLM thickness (RPDT) and the presence of horizontal tear were significant risk factors. The presence of horizontal tear (P = 0.048, adjusted OR = 19.364) was the strongest predictor, compared with prolonged symptom duration (P = 0.030, adjusted OR = 1.150) and increased RPDT (P = 0.003, adjusted OR = 1.377). Discussion. – Horizontal tear, prolonged symptom duration, and increased RPDT are significant risk factors for radiographic progression to high-grade osteoarthritis after partial meniscectomy of DLM tear with a minimum follow-up of 5 years. Level of evidence. – III, case-control study. © 2017 Elsevier Masson SAS. All rights reserved.
DOI de l’article original : http://dx.doi.org/10.1016/j.otsr.2017.09.013. 夽 Cet article peut être consulté in extenso dans la version anglaise de la revue Orthopaedics & Traumatology: Surgery & Research sur Science Direct (sciencedirect.com) en utilisant le DOI ci-dessus. ∗ Auteur correspondant. Adresse e-mail : [email protected] (J.H. Ahn). http://dx.doi.org/10.1016/j.rcot.2017.09.418 ´ ´ 1877-0517/© 2017 Elsevier Masson SAS. Tous droits reserv es.
Disponible en ligne sur
ScienceDirect www.sciencedirect.com
Mémoire original
Facteurs de risque d’arthrose après méniscectomie partielle sur ménisque discoïde latéral夽 Risk factors for radiographic progression of osteoarthritis after partial meniscectomy of discoid lateral meniscus tear J.H. Ahn ∗ , D.M. Kang , K.J. Choi Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, 814, Siksadong, Ilsandonggu, Goyangsi, Gyeonggido, République de Corée
i n f o
a r t i c l e
Historique de l’article : Rec¸u le 29 juillet 2017 Accepté le 14 septembre 2017 Keywords: Discoid lateral meniscus Partial meniscectomy Osteoarthritis Outcomes
a b s t r a c t Introduction. – Partial meniscectomy has been preferred in the treatment of discoid lateral meniscus (DLM) with tear, rather than total or subtotal meniscectomy, which could lead to late radiographic degenerative changes. Hypothesis. – One or more risk factors contribute to radiographic progression of osteoarthritis after partial meniscectomy of DLM tear. Material and methods. – Inclusion criteria were consecutive patients who underwent arthroscopic surgeries for DLM tear from January 2005 to December 2010 by one surgeon. Exclusion criteria were pre-operative osteoarthritis with KL grade 3 or more, osteochondritis dissecans, minimal width of meniscal remnant less than 6 mm after meniscectomy, meniscal repair of an unstable discoid meniscus, age over 60 years, loss to follow-up for a minimum of 5 years and simultaneous surgery on articular cartilage or anterior cruciate ligament. According to the KL grade at the last follow-up, all enrolled knees were sorted into no progression to knee osteoarthritis (KL grade 1 or 2 – NOA) and progression to osteoarthritis (KL grade 3 or 4 – POA) groups. Multivariate logistic regression was used to analyze the risk factors of high-grade osteoarthritis. Results. – In comparison with NOA group (n = 135) and POA group (n = 67), prolonged symptom duration, increased relative percentage of DLM thickness (RPDT) and the presence of horizontal tear were significant risk factors. The presence of horizontal tear (P = 0.048, adjusted OR = 19.364) was the strongest predictor, compared with prolonged symptom duration (P = 0.030, adjusted OR = 1.150) and increased RPDT (P = 0.003, adjusted OR = 1.377). Discussion. – Horizontal tear, prolonged symptom duration, and increased RPDT are significant risk factors for radiographic progression to high-grade osteoarthritis after partial meniscectomy of DLM tear with a minimum follow-up of 5 years. Level of evidence. – III, case-control study. © 2017 Elsevier Masson SAS. All rights reserved.
DOI de l’article original : http://dx.doi.org/10.1016/j.otsr.2017.09.013. 夽 Cet article peut être consulté in extenso dans la version anglaise de la revue Orthopaedics & Traumatology: Surgery & Research sur Science Direct (sciencedirect.com) en utilisant le DOI ci-dessus. ∗ Auteur correspondant. Adresse e-mail : [email protected] (J.H. Ahn). http://dx.doi.org/10.1016/j.rcot.2017.09.418 ´ ´ 1877-0517/© 2017 Elsevier Masson SAS. Tous droits reserv es.