Risk Factors for Meniscal Tears: A Systematic Review Including Meta-analysis

Abstract

Meniscal tears are commonly seen worldwide. In the Netherlands, the incidence of meniscal tears is 2 per 1000 patients per year. 16 Meniscal tears are responsible for an estimated 25 000 hospital admissions per year in England and Wales. 5 In the United States, arthroscopic partial meniscectomy after meniscal tear is the most frequent orthopaedic surgical procedure. 20 Meniscal tears lead to disability and time lost from work, and their surgical treatment increases the longterm risk of knee osteoarthritis (OA) 4-fold. 5,18,21,48 A better understanding of meniscal tears and their causality can aid in diagnosing knee disorders. 26,32 Despite its importance, little is known about the epidemiology of meniscal injury. A previously published systematic review by Reid et al 46 described, in addition to other knee disorders, risk factors for meniscal tears. The authors suggested that squatting, kneeling, crawling, chair sitting while driving, stair climbing, lifting items, and walking were all risk factors for meniscal tears. Reid et al 46 noted that kneeling was described as a risk factor in multiple studies, yet other factors were not described as such. McMillan and Nichols 38 systematically searched the literature to determine whether kneeling or squatting was causally associated with degenerative diseases of the knee. The authors concluded that work occupations involving frequent kneeling or squatting doubled the risk for developing knee OA. The authors of both articles limited their search to occupational settings and did not perform meta-analysis on the risk factors.The elapsed time between anterior cruciate ligament (ACL) injury and reconstruction surgery has been identified T T STUDY DESIGN: Systematic review with metaanalysis. T T OBJECTIVES:To review and critically appraise the literature for factors that increase the risk for meniscal tears. T T BACKGROUND:Meniscal tears are an important cause of disability and time lost from work, and are associated with a 4-fold increase in the long-term risk of knee osteoarthritis. Knowledge of the risk factors that lead to meniscal tears can help to correctly diagnose knee injuries and is important to the development of prevention strategies for knee osteoarthritis. T T METHODS:A search of the Cochrane Database of Systematic Reviews, MEDLINE, and Embase, from 1950 to January 2012, and a hand search of reference lists of all initially selected studies, without restriction on language or date of publication, were conducted. Prospective, retrospective, and case-control studies that included individuals over 16 years of age, who had no previous meniscal injuries or surgeries, were selected. A meta-analysis for 17 risk factors was performed. Where considerable heterogeneity among studies was present or the data did not provide sufficient information to perform a meta-analysis, a qualitative synthesis was conducted. T T RESULTS:Eleven studies, with a total of 7358 participants, were selected for systematic review. Data were available for meta-analysis for 10 of the 11 studies. ...

Rates of meniscal tearing in patients with chondrocalcinosis

“…Because a degenerated fibrocartilage may also fail under simple load circumstances, as reported in middle-aged workers who adopt kneeling positions [5][6][7], the goal of this study was to identify the prevalence of the meniscal tearing in patients with chondrocalcinosis.…”

A clinical prediction rule for meniscal tears in primary care: development and internal validation using a multicentre study

“…8 As a predictive factor, however, performing sports stands for an increased active life, without the necessity for a moment of trauma during sports. The known risk factors BMI, work-related kneeling and squatting, and stair climbing were not included in the final CPR, because they did not add much to the accuracy with the variables already in the model or because the results could not be interpreted because of counterintuitive findings.…”

“…8 As it was believed that several of the risk factors investigated also could be predictive factors for meniscal tears, in this study next to the variables age and sex, the variables BMI, performing sports, stair climbing, work-related kneeling and squatting, and weight-bearing during trauma were measured.…”

“…7,8,11 The following candidate predictors were collected: age, sex, BMI, origin of complaints, locked knee (yes/no), giving way, weight-bearing during trauma, performing sports, workrelated kneeling or squatting (>1 hour per day), ability to walk the stairs, effusion, warm knee, discolouration of the knee, pain during extension, and Deep Squat test. If a predictor was not interpretable or contradictive according to current knowledge, the predictor was excluded from the model.…”

“…Shrier et al suggested that effusion can be a useful sign in a young person with an acute meniscal tear, but not in older individuals with a degenerative non-traumatic tear. 5 In a recent systematic review, 8 strong evidence was provided that age >60 years, male sex, work-related kneeling and squatting, and climbing stairs are risk factors for degenerative meniscal tears. Also, strong evidence was found that prolonged waiting time for anterior cruciate ligament (ACL) reconstruction surgery after ACL injury is a risk factor for a medial meniscal tear.…”