Meniscal Lesions in Geriatric Population: Prevalence and Association with Knee Osteoarthritis

Abstract

Objective: This study evaluated the prevalence of different types of meniscal lesions among elderly patients with knee pain. Moreover, this study assessed the relationship between meniscal lesions and the presence of radiographic knee osteoarthritis (OA) in the elderly population. Methods: The radiographs and magnetic resonance images of one knee out of 306 patients with knee pain aged 65-89 years were reviewed for knee OA and meniscal lesions. The prevalence of different types of meniscal lesions was calculated, and the relationship between the prevalence of meniscal lesion types and the presence of radiographic knee OA was analyzed. Results: Among 306 participants, 274 (89.5%) showed radiographic knee OA. We found one or more meniscal lesion(s) in 93% of the total subjects, in 94% of all patients with knee OA, and in 84% of all patients without knee OA. The prevalence of surgically target, possible-target, and nontarget lesions were 24%, 72%, and 69%, respectively. The prevalence of surgically target lesions was significantly higher in patients with knee OA than in those without it. The most common lesion observed was meniscal extrusion, followed by the horizontal and complex meniscal tears. Conclusions: Our results demonstrated that meniscal damage is considerably prevalent among elderly individuals with knee pain, especially in those with knee OA. The fact that surgically target and possible-target lesions constitute a substantial proportion of these lesions should be considered in the clinical approach to these patients.

Natural history of new horizontal meniscal tears in individuals at risk for and with mild to moderate osteoarthritis: data from osteoarthritis initiative

“…Meniscal tears are one of the most frequently recognized pathologies in both traumatic and degenerative knees [31,32] with proven strong associations with incident KOA [11] even in knees at "preradiographic" stages [16]. Degenerative meniscal tears occur in patients without reported joint trauma [22] and in many cases are found incidentally together with cartilage structural changes.…”

Comparison between two rabbit models of posttraumatic osteoarthritis: A longitudinal tear in the medial meniscus and anterior cruciate ligament transection

“…Furthermore, although meniscectomy leads to some degenerative changes due to the reduced weight-absorbing function, it does not fully mimic the biokinematic environment in human PTOA, most of which results from ACL rupture [33][34][35] and meniscal tearing. 22,36,37 degenerative changes in the knee can benefit from arthroscopic meniscectomy, particularly if the osteoarthritis is mild. 38 However, other studies have suggested that the progression of OA may be more rapid in patients who underwent arthroscopic meniscectomy than in those who underwent conservative therapy.…”

“…Indeed, the most recent studies show that meniscal extrusion is the most commonly detected lesion in the geriatric population with OA, followed by horizontal and radial meniscal tears. 18 The above evidence suggests that a longitudinal tear model might be more useful than a horizontal or radial meniscal tear model for studying PTOA.…”

“…17 The most recent evidence demonstrated that meniscal damage is considerably prevalent among elderly individuals with knee pain, especially in those with knee OA. 18 Thus, ACLT models cannot fully reflect the abnormal biomechanisms involved in OA, making it difficult to obtain detailed information about the biological changes during early-stage OA. Of note, there are many studies in which posttraumatic OA (PTOA) was induced in small mammals by meniscal manipulation.…”

“…The most frequently applied method is destabilization of the medial meniscus (DMM) in mice, in which the medial meniscotibial ligament (MMTL) is transected, which caused the medial meniscus (MM) to be displaced medially and destabilization to occur. 19,20 However, previous clinical studies have shown that instead of meniscal destabilization, tears in the meniscus are more common in patients with knee OA 21,22 and that a considerable proportion of PTOA cases are caused by acute meniscus injuries rather than meniscal ligament injuries. 23 Jarraya et al 17 noted that longitudinal tears were more commonly observed in a younger age group (mean age 35 to 37 years), presenting a dominant risk factor for PTOA, than were degenerative (horizontal or flap) meniscal tears (mean age 49 to 50 years).…”