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Grinding, Clicking, and Pivot Pain Resolve in Most Patients After Knee Arthroscopy

      ABSTRACT

      Purpose

      To determine whether knee arthroscopy alleviates the symptom constellation of knee grinding/clicking, catching/locking, and pivot pain.

      Methods

      One-year follow-up data from 584 consecutive subjects who underwent knee arthroscopy from August 2012 to December 2019 were collected prospectively. Subjects reported frequency of knee grinding/clicking, catching/locking, and/or pivot pain preoperatively and one and two years postoperatively. A single surgeon performed each procedure and documented all intraoperative pathology. We measured the postoperative resolution or persistence of these symptoms and used multivariable regression models to identify preoperative demographic and clinical variables that predicted symptom persistence. We also assessed changes in the Pain, Activities of Daily Living (ADL), and Quality of Life (QOL) subscales of the Knee Injury and Osteoarthritis Outcome Score (KOOS).

      Results

      Postoperative symptom resolution was more likely for grinding/clicking (65.6%) and pivot pain (67.8%) than for catching/locking (44.1%). Smoking status, overweight/obesity, absence of meniscal tear, and number of compartments with focal cartilage lesions predicted persistence of one or more PRKS. KOOS subscale scores consistently improved by at least one standard deviation. Individuals who had resolution of PRKS exhibited roughly twofold improvements in KOOS Pain, ADL and Quality of Life scores compared to those whose symptoms persisted. Persistence of pivot pain was associated with the least improvement of the three KOOS subscales.

      Conclusions

      Two in three patients with grinding/clicking or pivot pain experience symptom resolution after knee arthroscopy, though catching/locking is more likely to persist. Smoking status, overweight/obesity, absence of meniscal tear, and number of compartments with focal cartilage lesions predict symptom persistence after knee arthroscopy.
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      REFERENCES

      1. Cullen KA, Hall MJ, Golosinskiy A. Ambulatory surgery in the United States, 2006. Natl Health Stat Report. 2009:1-25.

        • Thorlund J.B.
        • Pihl K.
        • Nissen N.
        • et al.
        Conundrum of mechanical knee symptoms: signifying feature of a meniscal tear?.
        Br J Sports Med. 2019; 53: 299-303
        • Englund M.
        • Guermazi A.
        • Gale D.
        • et al.
        Incidental meniscal findings on knee MRI in middle-aged and elderly persons.
        N Engl J Med. 2008; 359: 1108-1115
        • Bhattacharyya T.
        • Gale D.
        • Dewire P.
        • et al.
        The clinical importance of meniscal tears demonstrated by magnetic resonance imaging in osteoarthritis of the knee.
        J Bone Joint Surg Am. 2003; 85: 4-9
        • Ding C.
        • Martel-Pelletier J.
        • Pelletier J.P.
        • et al.
        Meniscal tear as an osteoarthritis risk factor in a largely non-osteoarthritic cohort: a cross-sectional study.
        J Rheumatol. 2007; 34: 776-784
        • Englund M.
        • Guermazi A.
        • Roemer F.W.
        • et al.
        Meniscal tear in knees without surgery and the development of radiographic osteoarthritis among middle-aged and elderly persons: The Multicenter Osteoarthritis Study.
        Arthritis Rheum. 2009; 60: 831-839
        • Pihl K.
        • Englund M.
        • Lohmander L.S.
        • et al.
        Signs of knee osteoarthritis common in 620 patients undergoing arthroscopic surgery for meniscal tear.
        Acta Orthop. 2017; 88: 90-95
        • Bisson L.J.
        • Kluczynski M.A.
        • Wind W.M.
        • et al.
        Isolated Arthroscopic Partial Meniscectomy Is More Effective at Improving Meniscal Symptoms in Comparison With Mechanical Symptoms in Patients With Concomitant Untreated Chondral Lesions.
        Arthroscopy. 2022; 38: 489-497.e417
        • Farina E.M.
        • Lowenstein N.A.
        • Chang Y.
        • Arant K.R.
        • Katz J.N.
        • Matzkin E.G.
        Meniscal and Mechanical Symptoms Are Associated with Cartilage Damage, Not Meniscal Pathology.
        J Bone Joint Surg Am. 2021; 103: 381-388
        • Badlani J.T.
        • Borrero C.
        • Golla S.
        • Harner C.D.
        • Irrgang J.J.
        The effects of meniscus injury on the development of knee osteoarthritis: data from the osteoarthritis initiative.
        Am J Sports Med. 2013; 41: 1238-1244
        • Dervin G.F.
        • Stiell I.G.
        • Wells G.A.
        • Rody K.
        • Grabowski J.
        Physicians' accuracy and interrator reliability for the diagnosis of unstable meniscal tears in patients having osteoarthritis of the knee.
        Can J Surg. 2001; 44: 267-274
        • Englund M.
        • Niu J.
        • Guermazi A.
        • et al.
        Effect of meniscal damage on the development of frequent knee pain, aching, or stiffness.
        Arthritis Rheum. 2007; 56: 4048-4054
        • Sihvonen R.
        • Englund M.
        • Turkiewicz A.
        • Jarvinen T.L.
        Mechanical symptoms as an indication for knee arthroscopy in patients with degenerative meniscus tear: a prospective cohort study.
        Osteoarthritis Cartilage. 2016; 24: 1367-1375
        • Sihvonen R.
        • Englund M.
        • Turkiewicz A.
        • Jarvinen T.L.
        Mechanical Symptoms and Arthroscopic Partial Meniscectomy in Patients With Degenerative Meniscus Tear: A Secondary Analysis of a Randomized Trial.
        Ann Intern Med. 2016; 164: 449-455
        • Sihvonen R.
        • Paavola M.
        • Malmivaara A.
        • et al.
        Arthroscopic partial meniscectomy versus placebo surgery for a degenerative meniscus tear: a 2-year follow-up of the randomised controlled trial.
        Ann Rheum Dis. 2018; 77: 188-195
        • Sihvonen R.
        • Paavola M.
        • Malmivaara A.
        • et al.
        Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear.
        N Engl J Med. 2013; 369: 2515-2524
        • Roos E.M.
        • Roos H.P.
        • Lohmander L.S.
        • Ekdahl C.
        • Beynnon B.D.
        Knee Injury and Osteoarthritis Outcome Score (KOOS)--development of a self-administered outcome measure.
        J Orthop Sports Phys Ther. 1998; 28: 88-96
        • Outerbridge R.E.
        The etiology of chondromalacia patellae.
        J Bone Joint Surg Br. 1961; 43-b: 752-757
        • Slattery C.
        • Kweon C.Y.
        Classifications in Brief: Outerbridge Classification of Chondral Lesions.
        Clin Orthop Relat Res. 2018; 476: 2101-2104
        • Gauffin H.
        • Sonesson S.
        • Meunier A.
        • Magnusson H.
        • Kvist J.
        Knee Arthroscopic Surgery in Middle-Aged Patients With Meniscal Symptoms: A 3-Year Follow-up of a Prospective, Randomized Study.
        Am J Sports Med. 2017; 45: 2077-2084
        • MacFarlane L.A.
        • Yang H.
        • Collins J.E.
        • et al.
        Associations among meniscal damage, meniscal symptoms and knee pain severity.
        Osteoarthritis Cartilage. 2017; 25: 850-857
        • Hare K.B.
        • Stefan Lohmander L.
        • Kise N.J.
        • Risberg M.A.
        • Roos E.M.
        Middle-aged patients with an MRI-verified medial meniscal tear report symptoms commonly associated with knee osteoarthritis.
        Acta Orthop. 2017; 88: 664-669
        • Skou S.T.
        • Pihl K.
        • Nissen N.
        • Jørgensen U.
        • Thorlund J.B.
        Patient-reported symptoms and changes up to 1 year after meniscal surgery.
        Acta Orthop. 2018; 89: 336-344
        • Hutt J.R.
        • Craik J.
        • Phadnis J.
        • Cobb A.G.
        Arthroscopy for mechanical symptoms in osteoarthritis: a cost-effective procedure.
        Knee Surg Sports Traumatol Arthrosc. 2015; 23: 3545-3549
        • Roos E.M.
        • Lohmander L.S.
        The Knee injury and Osteoarthritis Outcome Score (KOOS): from joint injury to osteoarthritis.
        Health Qual Life Outcomes. 2003; 1: 64
      2. Roos E. Knee injury and Osteoarthritis Outcome Score. Vol 2021.

        • Kirkley A.
        • Birmingham T.B.
        • Litchfield R.B.
        • et al.
        A randomized trial of arthroscopic surgery for osteoarthritis of the knee.
        N Engl J Med. 2008; 359: 1097-1107
        • Jackson J.L.
        • O'Malley P.G.
        • Kroenke K.
        Evaluation of acute knee pain in primary care.
        Ann Intern Med. 2003; 139: 575-588
        • Katz J.N.
        • Smith S.R.
        • Yang H.Y.
        • et al.
        Value of History, Physical Examination, and Radiographic Findings in the Diagnosis of Symptomatic Meniscal Tear Among Middle-Aged Subjects With Knee Pain.
        Arthritis Care Res (Hoboken). 2017; 69: 484-490
      3. Scanzello CR, McKeon B, Swaim BH, et al. Synovial inflammation in patients undergoing arthroscopic meniscectomy: molecular characterization and relationship to symptoms. Arthritis Rheum. 2011;63:391-400.

      4. Jevsevar DS, Brown GA, Jones DL, et al. The American Academy of Orthopaedic Surgeons evidence-based guideline on: treatment of osteoarthritis of the knee, 2nd edition. J Bone Joint Surg Am. 2013;95:1885-1886.