Middle-aged patients with an MRI-verified medial meniscal tear report symptoms commonly associated with knee osteoarthritis

Abstract

Background and purpose — No consensus exists on when to perform arthroscopic partial meniscectomy in patients with a degenerative meniscal tear. Since MRI and clinical tests are not accurate in detecting a symptomatic meniscal lesion, the patient’s symptoms often play a large role when deciding when to perform surgery. We determined the prevalence and severity of self-reported knee symptoms in patients eligible for arthroscopic partial meniscectomy due to a degenerative meniscal tear. We investigated whether symptoms commonly considered to be related to meniscus injury were associated with early radiographic signs of knee osteoarthritis.Patients and methods — We included individual baseline items from the Knee injury and Osteoarthritis Outcome Score collected in 2 randomized controlled trials evaluating treatment for an MRI-verified degenerative medial meniscal tears in 199 patients aged 35–65 years. Each item was scored as no, mild, moderate, severe, extreme, and at least “mild” considering the symptoms present. Early radiographic signs of osteoarthritis, defined as a Kellgren and Lawrence grade of at least 1, were seen in 70 patients.Results — At least monthly knee pain, pain during stair walking and when twisting on the knee, and lack of confidence in knee was present in at least 80% of the patients. Median severity was at least moderate for knee pain, pain when twisting on the knee, pain walking on stairs, lack of confidence in knee, and clicking. Mechanical symptoms such as catching were rare. Early radiographic signs of osteoarthritis were associated with an increased risk of self-reported swelling, catching, and stiffness later in the day; the odds ratio was 2.4 (95% CI 1.2–4.9), 2.3 (1.2–4.3), and 2.3 (1.1–5.0), respectively.Interpretation — Middle-aged patients with a degenerative medial meniscus tear reported symptoms commonly associated with knee osteoarthritis. Frequent knee pain, presence of lack of confidence in the knee, and clicking did not distinguish those with a meniscal tear alone from those with early radiographic knee OA. Our findings support the notion that symptoms reported by those with a degenerative meniscal tear represent early signs of knee osteoarthritis.

Diagnostic Validity of Combining History Elements and Physical Examination Tests for Traumatic and Degenerative Symptomatic Meniscal Tears

“…More than 60% of all SMT cases in our cohort reported having no mechanical symptoms as reported on individual questions from the KOOS questionnaire. This result is comparable with other cohorts with meniscal tears [3,5,21,22,51]. Also, mechanical symptoms, when present, do not arise exclusively from meniscal tears and may be positive in other disorders such as ACL tear or osteoarthritis [3,6].…”

“…The clusters correctly classified 58% and 65% of all cases and noncases (see 2 × 2 tables in Appendix 3). Although this can be expected from clustering and combination analyses [3,22,23], it may also be explained by the heterogeneous presentation of degenerative SMT, which often overlaps with knee osteoarthritis [51], as it was likely the case in our cohort; 40% participants had combined diagnoses of SMT and osteoarthritis [3].…”

Knee Arthroscopic Surgery in Middle-Aged Patients With Meniscal Symptoms: A 5-Year Follow-up of a Prospective, Randomized Study

“…46 A plausible interpretation of these findings could be that mechanical symptoms indicate general knee degeneration rather than an isolated meniscal injury. 17,46 It should be noted that the present study did not include patients with meniscal root tears that were repaired.…”

Osteoarthritis year in review 2018: mechanics

“…Due to the lack of clear guidance on when to perform a partial meniscectomy in patients with an MRI verified meniscus tear, Hare et al 59 investigated whether symptoms related to medial meniscal injuries in middle-aged patients are distinct or similar to those with early radiographic knee OA. Over 80% of the patients had moderate severity for self-reported knee pain, pain during stair walking and when twisting the knee, and lack of confidence in their knee.…”