Degenerative meniscus: Pathogenesis, diagnosis, and treatment options

Abstract

The symptomatic degenerative meniscus continues to be a source of discomfort for a significant number of patients. With vascular penetration of less than one-third of the adult meniscus, healing potential in the setting of chronic degeneration remains low. Continued hoop and shear stresses upon the degenerative meniscus results in gross failure, often in the form of complex tears in the posterior horn and midbody. Patient history and physical examination are critical to determine the true source of pain, particularly with the significant incidence of simultaneous articular pathology. Joint line tenderness, a positive McMurray test, and mechanical catching or locking can be highly suggestive of a meniscal source of knee pain and dysfunction. Radiographs and magnetic resonance imaging are frequently utilized to examine for osteoarthritis and to verify the presence of meniscal tears, in addition to ruling out other sources of pain. Non-operative therapy focused on non-steroidal anti-inflammatory drugs and physical therapy may be able to provide pain relief as well as improve mechanical function of the knee joint. For patients refractory to conservative therapy, arthroscopic partial meniscectomy can provide short-term gains regarding pain relief, especially when combined with an effective, regular physiotherapy program. Patients with clear mechanical symptoms and meniscal pathology may benefit from arthroscopic partial meniscectomy, but surgery is not a guaranteed success, especially with concomitant articular pathology. Ultimately, the long-term outcomes of either treatment arm provide similar results for most patients. Further study is needed regarding the short and long-term outcomes regarding conservative and surgical therapy, with a particular focus on the economic impact of treatment as well.

In vivo cartilage strain increases following medial meniscal tear and correlates with synovial fluid matrix metalloproteinase activity

“…In general, degenerative tears are associated with increased age and osteoarthritic changes (Berthiaume et al, 2005; Englund, 2008; Greis et al, 2002). Additionally, degenerative tears often have an insidious onset of symptoms without a specific traumatic event initiating injury (Englund, 2008; Howell et al, 2014; Sihvonen et al, 2013). Therefore, to minimize the effects that existing joint degeneration may be playing in the measurements of the present study, patient inclusion criteria were enforced to recruit individuals with an identifiable, traumatic injury and no MRI evidence of cartilage degeneration on the femoral condyles or tibial plateaus of both knees.…”

The Treatment of Non-Traumatic Meniscus Lesions

“…Further trials are needed to better define this subgroup of patients. ►Cite this as: Petersen M eniscal tears can cause pain or locking of the knee joint and prevent those affected from participating in sporting activities, while at the same time reducing their quality of life (1)(2)(3)(4)(5). Radiological studies have shown that osteoarthritis can be a longterm consequence of meniscal injury (2,(6)(7)(8).…”

“…The majority of meniscal injuries occur without adequate trauma (3,4,9). The prevalence of nontraumatic meniscus lesions is 31% according to the Framingham study (9).…”

“…The prevalence of nontraumatic meniscus lesions is 31% according to the Framingham study (9). Arthroscopic partial meniscectomy has been the first-line treatment for these injuries for a long time (3,4,(10)(11)(12) and positive clinical outcomes have been demonstrated for this procedure in several cohort studies (10)(11)(12).…”

Optical spectroscopic determination of human meniscus composition

“…Degenerative tears have been suggested to account for about 50% of meniscal tears and are described as “lesions of middle age”, and this pattern of tear was most frequently seen in the posterior horn of the medial meniscus . These injuries tend to impair the load bearing capacity of meniscus and decreases the biomechanical integrity of the tissue, resulting in overloading of cartilage, and ultimately to osteoarthritis (OA) . Hence, early detection of changes in meniscal composition is essential for prevention, or management of meniscal pathologies and control of OA.…”