Background: Osteonecrosis of the knee after various arthroscopic
procedures associated with the use of laser or radiofrequency devices has been
described in a few case reports. The purpose of this study was to report on a
series of nineteen patients with osteonecrosis of the knee after arthroscopic
procedures. A literature search was done to compare this series of patients to
previously reported cases. In addition, we analyzed the outcome after
treatment with minimally invasive knee arthroplasty.
Methods: We studied patients who had development of osteonecrosis of
the knee after a routine arthroscopic procedure. Preoperative and
postoperative clinical notes, radiographs, and magnetic resonance images of
patients were analyzed. Only those patients with no evidence of osteonecrosis
on preoperative magnetic resonance imaging who later had development of
osteonecrosis and subsequently required a knee arthroplasty were included. We
conducted a search of the current literature to compare the results seen in
our patient population with those seen in other patients with this entity.
Patients were followed both clinically and radiographically for a mean of
Results: A total of nineteen patients met the inclusion criteria.
There were fourteen women and five men with a mean age of sixty-nine years.
Six patients underwent an arthroscopy with associated holmium or
yttrium-aluminum-garnet laser treatment, ten patients had associated
radiofrequency treatment, and three patients had microfracture surgery.
Subsequent arthroplasty procedures included four unicompartmental knee
arthroplasties and fifteen tricompartmental knee arthroplasties. At the time
of final follow-up, the mean Knee Society objective score was 95 points.
Conclusions: Arthroscopic procedures may play a role in the
development of osteonecrosis of the knee. To our knowledge, this is the
largest series of patients to have development of this condition after
arthroscopy with associated laser, radiofrequency, or microfracture surgery.
The midterm results of knee arthroplasty in this unique patient population are
comparable with those of patients undergoing knee arthroplasty for
osteoarthritis of the knee.
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors on
jbjs.org for a
complete description of levels of evidence.