Arthroscopic partial meniscectomy in patients over 70 years of age

This study was conducted to determine the importance of age as a limiting f actor as well as to assess the role of age in combination with cartilage da mage or osteoarthritis as predicting factors for the outcome after arthrosc opic partial meniscectomy. Type of Study: Case series. Methods: We reviewed 97 patients over 70 years of age who underwent an arthroscopic partial men iscectomy between 1992 and 1996. At the time of evaluation, 5 patients had died and I patient was unavailable, leaving 91 patients (95 knees) suitable for assessment. There were 56 women and 35 men. The average age at time of surgery was 74 years (range, 70 to 84 years). The mean follow-up period wa s 4 years (range, 2 to 6 years). Assessment of the cases by I investigator included medical records and preoperative radiographs of the knee joint, wi th the main interest focused on evidence of osteoarthritis using the classi fication of Kellgren and Lawrence. Evaluation of cartilage damage was perfo rmed on surgical videotapes according to Outerbridge. All 91 patients were personally interviewed by telephone. The questionnaire included influence o f the operation on knee pain, quality and duration of satisfaction, require ment of further surgery, and whether the patient would under go the same op eration again. Results: According to the Kellgren and Lawrence classificati on, 80% of patients had radiographic evidence of osteoarthritis grade 0-2, and 20% had grade 3-4. According to Outerbridge, 43% of the patients had ca rtilage damage grade 0-2 and 57% had grade 3-4; 81% of the patients with os teoarthritis grade 0-2 and 83% of the patients with cartilage damage grade 0-2 had a satisfactory outcome when followed-up for more than 2 years. Amon g the patients with osteoarthritis grade 3-4 or cartilage damage grade 3-4, 55% and 69%, respectively, were satisfied when followed-up for more than 2 years; 45% and 37%, respectively, required a further surgery after I to 4 years. The grade of osteoarthritis had significant influence on satisfactio n (P<.01), on whether the patients would have the operation done again (P=. 01), and on whether they required further surgery (P=.04). The severity of cartilage damage only had a significant influence on whether the patients w ould undergo the operation again (P=.01). Conclusions: Pro-existing degener ative changes appeared to affect the outcome more than the patient's age. H owever, arthroscopic partial meniscectomy was followed by satisfactory resu lts in more than two thirds of our cases even if performed in the presence of moderate degenerative changes. But two thirds does not correspond with t he good results usually obtained in a younger population. Therefore, the in dication for surgery and the expected outcome have to be evaluated carefull y in elderly patients.