Preserving Meniscus May Be Better Than Surgery

A new study sheds light on the critical importance of an intact and functioning meniscus for patients with symptomatic osteoarthritis (OA) of the knee and finds that the trend is to preserve the meniscus rather than remove it by surgery.

The study, conducted at Boston University School of Medicine (Massachusetts, USA), focused on 257 subjects, of whom 58% were men with a mean age of 66.6 years. At the study's onset and follow-up examinations at 15 and 30 months, participants underwent magnetic resonance imaging (MRI) of the more symptomatic knee. Using the MR images, researchers measured the position of the meniscus, and evaluated and scored the severity of meniscal damage. This showed that 29% had a previous injury, 27% had a previous surgery, and 5% had a previous meniscectomy.

The researchers found a high correlation between meniscal malposition and meniscal damage. The impact of meniscal abnormality on cartilage lost was most pronounced in the medial tibiofemoral joint, the inner joint connecting the knee to the lower leg. Each measure of meniscal misalignment was associated with an increased risk of cartilage loss. Meniscal tears were also strongly associated with cartilage loss. Reductions in the coverage and height of the meniscus, provoked by partial dislocation of the meniscus, also increased the risk of cartilage loss. The findings were published in the March 2006 issue of Arthritis & Rheumatism.

"At present, efforts are being made to preserve a damaged meniscus rather than remove it, and an industry of meniscal replacement is developing,” said study leader Dr. David Hunter, assistant professor of rheumatology at Boston University School of Medicine. "Our study points to the need for critical, prospective evaluation of these new therapeutic options.”

In knee OA, cartilage loss is influenced by knee injury, obesity, and age. The onset of knee OA after meniscectomy, the surgical removal of all or part of a torn meniscus, is fairly common and traditionally considered a result of the joint injury that led to the operation in the first place.



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