Artroskopik parsiyel menisektomi yapilan hastalarda saptanan patellofemoral eklemdeki̇ kıkırdak lezyonlarinin uzun dönem prognoza etkisi

ABSTRACT The effect of patellofemoral chondral lesions on long-term prognosis in patients who underwent arthroscopic partial meniscectomy INTRODUCTION AND PURPOSE The purpose of this study is to compare the long-term clinical results after arthroscopic partial meniscectomy in patients with cartilage lesions exclusively in the patellofemoral joint (Group 1) and the patients without any cartilage lesions (Group 2). We hypothesize that cartilage lesions in the patellofemoral joint will affect long-term clinical results adversely. MATERIALS AND METHODS 44 patients aged 18-55 years who underwent arthroscopic partial meniscectomy by a single surgeon between the years of 1992 and 2008 without any history of ligamentous injury, inflammatory arthritis or previous knee surgery were included in the study. 18 patients with isolated patellofemoral joint cartilage lesions noted at surgery constituted Group 1 and 26 patients without cartilage lesions constituted Group 2. Demographic characteristics, peroperative findings, preoperative Lysholm scores, postoperative long-term Lysholm, KOOS, IKDC, Kujala scores and Tegner activity levels and Kellgren - Lawrence osteoarthritis stages on plain radiography were examined. The data were analyzed in the SPSS 24.0 software program according to the distributions of dependent and independent variables. Confidence interval was accepted to be p<0.05. RESULTS The mean follow-up was 19,8 years and the patients in Group 1 and Group 2 were comparable in terms of age, follow-up period, operated side, and BMI. Preoperative Lysholm scores of the patients in Group 1 were found to be significantly lower than the patients in Group 2 (p=0,04). After surgical treatment, a significant improvement of Lysholm scores was achieved and maintained until latest follow-up in both groups (p=0,003, p<0,001). No difference was found between the groups in terms of the amount of increase in Lysholm scores. At latest follow-up, 11 patients in Group 1 (61 %) and 22 patients in Group 2 (84 %) had good or excellent clinical outcomes. The patients in Group 1 demonstrated significantly lower postoperative Lysholm (p=0,043) , KOOS (p=0,032), IKDC (p=0,004), Kujala scores (p=0,004) and Tegner activity levels (p=0,001). Available plain radiography of 9 patients in Group 1 and 18 patients in Group 2 were evaluated. According to Kellgren - Lawrence staging of radiological knee osteoarthritis, in Group 1, 45 % had stage 1, 44 % had stage 2 and 11 % had stage 3 osteoarthritis, while in Group 2, 16 % had stage 1, 67 % had stage 2 and 17 % had stage 3 osteoarthritis. Deterioration of radiological outcome in presence of patellofemoral chondral lesion was not found. CONCLUSION In this long-term follow-up study, patients benefited significantly from arthroscopic partial meniscectomy. Patellofemoral chondral lesions adversely affected the preoperative and postoperative long term knee function. The relationship between radiological osteoarthritis and patellofemoral chondral lesions was unclear. Keywords: arthroscopic partial meniscectomy, meniscus tear, patellofemoral joint, cartilage lesion, long-term results