Don't cut those menisci

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Arthritic Knee Procedures May Lead to Future Deterioration

 

By Jeff Minerd, MedPage Today Staff Writer

Reviewed by Jasmer, MD; Assistant Professor of Medicine,

University of California, San Francisco

February 27, 2006

 

 

MedPage Today Action Points

• Explain to interested patients with osteoarthritis of the knee

that, according to this study, meniscectomy or arthroscopic debridement

may place patients at increased risk for loss of cartilage in the

joint.

• Consider non-surgical alternatives to managing knee pain in

osteoarthritis patients, including weight loss and exercise, knee

braces, motion control shoes, and analgesics and anti-inflammatory

drugs.

 

Review

BOSTON, Feb. 27 - Removal part or all of a damaged meniscus to ease

osteoarthritic knee pain may be detrimental to the joint over the long

haul, a study here suggested.

Reductions in the thickness of menisci or the amount of joint area they

covered were significantly associated with subsequent loss of cartilage

in the knee, reported J. Hunter, M.D., of Boston University in

the March issue of Arthritis & Rheumatism.

Because menisci pad the medial and lateral joint surfaces of the knee,

providing stability, shock absorption, and lubrication, the absence or

reduction of menisci likely cause more wear and tear on the joint,

resulting in cartilage loss, Dr. Hunter and colleagues said. But, they

added, the study could not prove causation.

The study focused on 257 participants with knee osteoarthritis enrolled

in the Boston Osteoarthritis Knee Study. At baseline, 15 months, and 30

months, the researchers evaluated the position and integrity of menisci

and assessed cartilage loss in the joint over time.

The majority of knees (86%) had a damaged or misaligned medial

meniscus, while 63% had similar problems with the lateral meniscus.

Patients whose medial meniscus covered the least amount of joint area

were at nearly three times the risk for cartilage loss during the study

period, compared with patients with the largest area of meniscal

coverage (odds ratio=2.7; 95% confidence interval=1.5-5.2; P=.0031 for

trend).

Patients with the thinnest medial menisci also had three times the risk

for cartilage loss compared with patients with the thickest medial

menisci (OR=3.0; 95% CI=1.5-6.2; P=.0009 for trend).

Similar results were found for the lateral meniscus.

Although 27% of the study patients had undergone knee surgery, and 5%

had undergone a meniscectomy, the study did not specifically assess the

effect of surgery on subsequent cartilage loss in the knee.

However, the study " highlights the importance of an intact and

functioning meniscus in subjects with symptomatic knee osteoarthritis,

since the findings demonstrate that loss of this function has important

consequences for cartilage loss, " the authors concluded.

The study also indicated that meniscal damage is " almost universal " in

patients with knee osteoarthritis, Dr. Hunter said. While

meniscectomies are often performed to relieve pain, " all efforts should

be made not to go in and remove the menisci unless they are likely to

be the cause of arthritis symptoms, " he added.

A previous study found that tears of the menisci, common in

osteoarthritis of the knee, don't necessarily lead to an increase in

pain or other arthritis symptoms, Dr. Hunter said.

Dr. Hunter added that he would also " strongly discourage " arthroscopic

debridement unless absolutely necessary.

Before resorting to surgery, clinicians should exhaust non-surgical

methods to manage osteoarthritis pain, which include exercise and

weight loss, knee braces, motion control shoes, and analgesics and

anti-inflammatory drugs, he advised.

Primary source: Arthritis & Rheumatism

Source reference:

Hunter DJ et al. The association of meniscal pathologic changes with

cartilage loss in symptomatic knee osteoarthritis. Arthritis &

Rheumatism. 2006; 54(3):795-801.

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