Better Outcomes but no Difference in Joint Space Narrowing at Five Years among Patients without Unstable Chondral Lesions versus those with Unstable Chondral Lesions (Left In Situ) at the time of Arthroscopic Partial Meniscectomy.

Abstract

PURPOSE\nTo compare 5-year outcomes among patients with and without unstable chondral lesions undergoing APM.\n\n\nMETHODS\nUsing data from the Chondral Lesions And Meniscal Procedures (ChAMP) Trial, we compared outcomes for patients with unstable chondral lesions found at the time of APM and left in situ (CL-noDeb, N=71) versus patients without unstable chondral lesions (NoCL, N=47) at 5 years after APM. Outcomes included the Western Ontario and McMaster Universities Arthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS), visual analog pain scale (VAS), Short-form Health Survey (SF-36), physical knee measurements, progressive joint space narrowing on radiographs, and the rate of additional knee surgery. Multivariate linear regression was used to obtain mean differences (MDs) with corresponding 95% CIs adjusted for age, body mass index, and preoperative score (for postoperative scores).\n\n\nRESULTS\nCompared with CL-noDeb, NoCL subjects had significantly greater improvement at 5 years in the KOOS score for function in sport and recreation (MD=9.9, 95% CI: 0.7, 19.1), SF-36 pain (MD=13.9, 95% CI: 5.5, 22.3), knee extension (MD=0.8, 95% CI: 0.1, 1.5), and decreased quadriceps circumference at the mid-portion of the patella (MD=-1.5, 95% CI: -2.7, -0.3). A greater proportion of patients in the NoCL group achieved the MCID for all outcome scores except for the WOMAC pain score (89% CL-NoDeb vs 87% NoCL) and SF-36 general (29% CL-NoDeb vs 23% NoCL). There were no significant group differences in measures of progressive radiographic joint space narrowing in any compartments of the operative knee and no significant difference in the rate of additional knee surgery within 5 years of the initial APM.\n\n\nCONCLUSION\nPatients undergoing APM without unstable chondral lesions had statistically significantly better outcomes than patients with unstable chondral lesions at 5 years after surgery, however there were no group differences in progressive radiographic joint space narrowing.