Chondrolysis after partial lateral meniscectomy in athletes

Rapid chondrolysis after partial arthroscopic lateral meniscectomy has been seldom reported in literature. Considering the relatively high number of partial lateral meniscectomy performed, we cannot understand why this complication is so rare. The purpose of this paper is to report a series of athletes developing a chondrolysis associated with posterolateral corner laxity after a partial lateral meniscectomy and attempt to hypothesize the pathogenesis of this devastating complication. Five male professional soccer players of Italian championship with a mean age of 26.8 years underwent a partial lateral meniscectomy because of a traumatic lateral meniscus tear. Patients showed a slight varus knee and there were clinical signs compatible with a meniscal tear. No other pathological sign were found. An MRI scan confirmed these findings. After surgery patients were unable to resume sport activities because of swelling and knee pain during training sessions. At a mean time of 8 months (range 6-12 months) from surgery patients were re-examined and a new MRI scan was performed. Clinical examination revealed a slight swelling of the knee and signs of posterolateral corner laxity. MRI scan revealed intra-articular fluid and pathological findings of knee posterolateral corner associated with a thinning of the articular cartilage. Arthroscopy showed free cartilagineous debris floating into the knee and a high grade of cartilage damage on the lateral compartment. The evaluation of lateral compartment, ruled-out a new tear of the meniscal remnant and showed a positive drive-trough sign with knee in the Fig. 4 positioning. All patients had an open re-tensioning of the posterior meniscofemoral capsule, and in one case, an augmentation of the popliteal tendon using a free semitendinous graft was also done. This surgery gave a complete resolution of symptoms and patients resumed sports activities without any restriction after a period between 4 and 5 months. Based on this experience we hypothesize that partial lateral meniscectomy may have a role in causing a subtle rotatory instability that combined with high stress of sports activity can dramatically increase the susceptibility of joint to chondrolysis, Varus knee seems to be a possible predisposing factor. Open surgery addressing the insufficiency of lateral or posterolateral corner has been found to be effective in improving knee function and resolve patients symptoms at a short-term follow-up.