RESEARCH ARTICLE


Coronal Knee Alignment 40 Years after Total Meniscectomy in Adolescents: A Prospective Cohort Study



I.P. Pengas1 , W. Nash 2 , Wasim Khan3, *, A. Assiotis 4 , J. Banks 5 , M.J. McNicholas 5
1 University Hospitals of Coventry & Warwickshire, Clifford Bridge Road, Coventry, West Midlands, CV2 2DX, UK
2 Queen Elizabeth Hospital, Stadium Road, Woolwich, London, SE18 4QH, UK
3 Cardiff and Vale Orthopaedic Centre, Llandough Hospital, University Hospital Wales Health Board, Cardiff, CF64 2XX, UK
4 Hillingdon Hospital, Pield Heath Road, Uxbridge. UB8 3NN, UK
5 University Hospital Aintree Teaching Hospital NHS Foundation Trust, Longmoor Lane, Liverpool, L9 7AL, UK


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© 2017 Pengas et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Clinical Knee Fellow, Cardiff and Vale Orthopaedic Centre, Llandough Hospital, University Hospital Wales Health Board, Cardiff, CF64 2XX, UK; Tel: +44 (0) 7791 025554; Fax: +44 (0) 1707 655059; E-mails: wasimkhan@doctors.org.uk; wasim.khan@ucl.ac.uk.


Abstract

Introduction:

Meniscectomies result in altered knee biomechanics and increase contact forces on the operated knee joint.

Methods:

We assessed coronal knee alignment in relation to radiological osteoarthritis grading, clinical range of movement and patient reported outcome measures 40 years after total open meniscectomies in adolescence. Thirty eight knees (30 patients) that underwent total open meniscectomy were assessed on standardised weight-bearing anteroposterior radiographs for deviation from ‘physiological valgus angle’ in either direction (magnitude of malalignment). These values were analysed as per site of meniscectomy for correlations with radiographic scoring systems, range of motion and patient reported outcome measures.

Results:

Tibiofemoral angle was significantly more varus, and the magnitude of malalignment was significantly higher for the medial meniscectomy patients. The range of flexion was lower for those patients who underwent medial and lateral meniscectomies of the same knee. The patients who underwent meniscectomies of both knees had worse scores for IKDC and KOOS quality of life. Tibiofemoral angle, magnitude of malalignment and range of flexion strongly correlated with Ahlback, and Kellgren and Laurence scores, but patient reported that outcome measures did not correlate.

Conclusion:

Meniscectomy induced malalignment corresponds to the site of meniscectomy and the radiographic degree of osteoarthritis. While malalignment and reduced range of movement correlate well with worsening radiographic signs of arthritis, patient reported outcome measures do not correlate.

Keywords: Meniscectomy, Malalignment, Radiographic scoring, Patient reported outcome measures.