WASHINGTON, DC—Meniscal resection may do little to relieve pain among older patients with knee osteoarthritis (OA), as meniscal tears are common but rarely cause any symptoms, according to new data presented at the 70th Annual Meeting of the American College of Rheumatology (ACR) in Washington, DC.¹

"Resecting the meniscus is only removing the evidence, not addressing the symptoms," lead researcher Martin Englund, MD, PhD, research associate at Boston University School of Medicine, told CIAOMed.

The new study included 400 participants from the Framingham Osteoarthritis Study who underwent magnetic resonance imaging (MRI) scans of their right knees to look for meniscal abnormalities. All films were graded by a single reader. Meniscal tears were defined as a signal extending to meniscal surface on >e;2 slices. Patients also underwent fixed flexion, weight-bearing knee x-rays, and they answered questionnaires about their joint pain and symptoms, including whether they experienced knee pain on a daily basis.

Patients had a mean age of 62 years, 57% were women, and the average body mass index was 29. Frequent knee pain was a symptom in 22% of patients, and 16% had evidence of tibiofemoral radiographic osteoarthritis (ROA), which was defined as a Kellgren/Lawrence grade >e;2.

Overall, 28% of participants had a meniscal tear with an additional 22% having intrameniscal signal abnormalities, but no definite tear. Nine percent of patients had meniscal maceration/resection. Of knees with meniscal tear, 77% of tears were in the medial meniscus, and 77% of these were in the posterior horn. Of all tears, 79% were horizontal, oblique, or complex lesions, the study found.

The prevalence of meniscal tears increased with advancing age, as did the prevalence of ROA.

Meniscal tears were more common in men than women and were associated with ROA. Specifically, 32% of patients with tears had ROA compared with 9% of those without tears, the study found.

There was no association between having a meniscal tear and having "knee pain on most days." Researchers also found that 26% of asymptomatic knees had meniscal tears.

"Meniscal tear on MRI is strongly associated with ROA, but poorly associated with symptoms," Dr. Englund said. "Be aware of how frequent tears are in the adult knee, and know that they exist even in asymptomatic knees."

The researchers speculated that meniscal tears might cause infrequent knee pain, so they also asked participants about any pain they had experienced within the last month. Most patients with tears reported no pain, aching, or stiffness during the last month.

"I think clinicians should still order MRIs when they feel they are needed, but they need a plan. The probability of finding a tear is high, and it is difficult to tell if the tear is causing the symptoms," Dr. Englund said. "Meniscal tears are so frequent in older adults that it is [an almost] normal finding," he said. These tears are distinct from those found in young, healthy adults, Dr. Englund pointed out, because they are due mainly to degenerative changes in the meniscus.

"Use clinical sense, especially if the patient has mechanical symptoms such as catching or locking that may be caused by the tear," Dr. Englund added.


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Reference

1. Englund M, Hunter DJ, Gale D, et al. Meniscal MRI signal abnormalities including tears and their association with knee symptoms and osteoarthritis in the community. Presented at: the American College of Rheumatology Meeting; November 14, 2006; Washington, DC. Abstract 1227.