Combination of Proximal Fibulectomy with Arthroscopic Partial Meniscectomy for Medial Compartment Osteoarthritis Accompanied by Medial Meniscal Tear

Abstract

Introduction: Medial compartment osteoarthritis is usually accompanied by medial meniscal tear. The treatment of symptomatic mild medial compartment osteoarthritis and medial meniscal tears in middle-aged and elderly patients is controversial. Aim: This study aimed to assess the efficacy of proximal fibulectomy combined with Arthroscopic Partial Meniscectomy (APM) for symptomatic middle-aged and elderly patients with mild medial compartment osteoarthritis and medial meniscal tears. Materials and Methods: Consecutive hospitalised patients treated with concomitant proximal fibulectomy and APM from April 2013 to June 2014 were included in the study. Proximal fibulectomy and APM were done by the same group of surgeons. APM was performed initially to manage medial meniscal tears. This was followed by the proximal fibulectomy, during which a 20-mm long proximal fibular segment was excised. Preoperative and postoperative Visual Analog Scale (VAS) pain scores, Hospital for Special Surgery (HSS) knee scores, and Ahlbäck grading of knee osteoarthritis were collected. Postoperative complications and subjective patient satisfaction were recorded. For statistical analysis of the VAS and HSS score, Wilcoxon signed-rank test and the paired t-test were used to compare over time, respectively. Results: A total of 31 out of 38 patients were included. Seven patients were excluded due to follow up loss. The mean follow up duration was 25.3±1.5 months. The postoperative median VAS score and Interquartile Range (IQR) were 0 (0–1), which was significantly lower than the preoperative median VAS score and interquartile range 6 (5–7) (p< 0.001). The mean HSS score improved from 78.2±8.2 points preoperatively to 90.1±4.5 points postoperatively (p< 0.001). No patients had radiographic evidence of osteoarthritis progression or fibular bony union, or required conversion to other surgeries. Subjective patient satisfaction was rated very satisfied in 7 patients (22.6%), satisfied in 20 patients (64.5%), fairly satisfied in 3 patients (9.7%), and not satisfied in 1 patient (3.2%). Complication in a single patient included a temporary palsy of the superficial peroneal nerve. Conclusion: Proximal fibulectomy combined with APM produced satisfactory surgical outcomes in our patient cohort at two years after treatment. Concomitant proximal fibulectomy and APM may be considered to be a safe and minimally invasive treatment.

Keywords

• fibula
• knee
• meniscus
• osteotomy