Osteonecrosis (death of bone) after arthroscopic surgery is rare but can occur. It’s not clear what causes it, but scientists think there may be some problem with the meniscus, joint cartilage, or underlying bone.
Tissue samples examined under a microscope show that this type of osteonecrosis is very much like other kinds that occur for no apparent reason at all. In either case, it’s probably not spontaneous and without a true cause. We just don’t know what it is yet.
It’s likely that the development of osteonecrosis after arthroscopic exam or surgery is multifactorial. That means when all the right conditions line up, the person develops pathologic changes at the cellular level that lead to death of bone cells.
Men and women appear to be affected equally by osteonecrosis following surgery. That statistic differs from osteonecrosis of no known cause, which is far more common in women than men. Again, just exactly what that means remains a matter of speculation.
Studies of people with this condition are few and far between. MRIs before and after don’t show anything would help surgeons pinpoint patients at risk for this condition. There was some question about whether a tiny bone fracture might be linked with osteonecrosis after arthroscopy. But there wasn’t enough evidence to prove this theory.
That brings us back to the drawing board with no clearer idea of what causes this condition than we had before. In time, MRIs, bone scans, and operative findings might help identify predictive factors. If that occurs, then surgeons will be able to screen patients ahead of time and suggest an alternative treatment for those at risk for postoperative osteonecrosis.