Fairbank studied what changes appear in the knee after meniscectomy and whether they reflect loss of the meniscus's weight‑bearing role.
Pre- vs postoperative radiographs after medial and lateral meniscectomy, 3 months to 14 years after surgery, plus weight‑bearing films in volunteers and cadaveric knees.
Methods
Design
Comparison of pre- and postoperative radiographs
Weight‑bearing radiographs in 7 subjects
Cadaveric study of 2 knees
Patients
107 meniscectomies (80 medial, 27 lateral)
Knees with definite osteoarthritis excluded
Exposure
Medial or lateral meniscectomy
Follow-up
3 months to 14 years
Outcomes
Femoral condylar ridge
Flattening of the femoral articular surface
Joint space narrowing
Key Findings
Meniscectomy was followed by a femoral condylar ridge, joint space narrowing and condylar flattening, which Fairbank's investigations suggest result from the meniscus no longer sharing load.
After medial meniscectomy (80 knees), 43% showed a ridge and 33% showed no change.
Changes were often visible within 5 months of surgery and tended to become more obvious with time.
Radiographic changes did not correlate with symptoms, and many knees with the most marked changes functioned perfectly.
In weight‑bearing films of 7 subjects, the joint space narrowed by about 1 mm under load and by about another 1 mm by the end of the day.
Surface surveys of 2 cadaveric knees showed the femur cannot bear on the meniscus until the cartilage compresses, and Fairbank proposed that further compression raises hoop tension that lets the meniscus share load.
Board pearl
The femoral ridge is not specific to meniscectomy: it can appear before surgery, especially with long‑standing meniscal lesions, and sometimes in apparently normal knees.
Radiographic changes after meniscectomyFairbank, J Bone Joint Surg Br 1948
Ridge
Anteroposterior ridge projecting down from the femoral condyle margin over the former meniscus site
Flattening
Diffuse flattening of the marginal half of the femoral articular surface, a broader version of the ridge reaction
Narrowing
Narrowing of the joint space on the operated side
After lateral meniscectomy the opposite side sometimes looked wider, enough in 3 patients to cause mild valgus strain symptoms.
Authors' conclusion
Meniscectomy is not wholly innocuous; it interferes, at least temporarily, with the mechanics of the joint. It seems likely that narrowing of the joint space will predispose to early degenerative changes, but a connection between these appearances and later osteoarthritis is not yet established and is too indefinite to justify clinical deductions.
Fairbank studied what changes appear in the knee after meniscectomy and whether they reflect loss of the meniscus's weight‑bearing role.
Pre- vs postoperative radiographs after medial and lateral meniscectomy, 3 months to 14 years after surgery, plus weight‑bearing films in volunteers and cadaveric knees.
Methods
Design
Comparison of pre- and postoperative radiographs
Weight‑bearing radiographs in 7 subjects
Cadaveric study of 2 knees
Patients
107 meniscectomies (80 medial, 27 lateral)
Knees with definite osteoarthritis excluded
Exposure
Medial or lateral meniscectomy
Follow-up
3 months to 14 years
Outcomes
Femoral condylar ridge
Flattening of the femoral articular surface
Joint space narrowing
Key Findings
Meniscectomy was followed by a femoral condylar ridge, joint space narrowing and condylar flattening, which Fairbank's investigations suggest result from the meniscus no longer sharing load.
After medial meniscectomy (80 knees), 43% showed a ridge and 33% showed no change.
Changes were often visible within 5 months of surgery and tended to become more obvious with time.
Radiographic changes did not correlate with symptoms, and many knees with the most marked changes functioned perfectly.
In weight‑bearing films of 7 subjects, the joint space narrowed by about 1 mm under load and by about another 1 mm by the end of the day.
Surface surveys of 2 cadaveric knees showed the femur cannot bear on the meniscus until the cartilage compresses, and Fairbank proposed that further compression raises hoop tension that lets the meniscus share load.
Board pearl
The femoral ridge is not specific to meniscectomy: it can appear before surgery, especially with long‑standing meniscal lesions, and sometimes in apparently normal knees.
Radiographic changes after meniscectomyFairbank, J Bone Joint Surg Br 1948
Ridge
Anteroposterior ridge projecting down from the femoral condyle margin over the former meniscus site
Flattening
Diffuse flattening of the marginal half of the femoral articular surface, a broader version of the ridge reaction
Narrowing
Narrowing of the joint space on the operated side
After lateral meniscectomy the opposite side sometimes looked wider, enough in 3 patients to cause mild valgus strain symptoms.
Authors' conclusion
Meniscectomy is not wholly innocuous; it interferes, at least temporarily, with the mechanics of the joint. It seems likely that narrowing of the joint space will predispose to early degenerative changes, but a connection between these appearances and later osteoarthritis is not yet established and is too indefinite to justify clinical deductions.