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Meniscal Tears and Osteoarthritis

Is Meniscal Damage or Meniscus Surgery a Risk Factor for Osteoarthritis?

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Updated April 19, 2012

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Meniscal tears are common knee injuries. Most often, you hear about athletes who experience meniscal tears, but actually, any individual at any age can tear a meniscus.

What Is the Meniscus?

Three bones come together to form your knee joint -- the femur (thighbone), tibia (shinbone), and patella (kneecap). Between the femoral and tibial components of the knee, there are two wedge-shaped pieces of cartilage -- each one is called a meniscus. Each tough and rubbery meniscus serves to cushion the knee joint and stabilize it.

What Is a Meniscal Tear?

A meniscus can tear. Often, a meniscal tear occurs suddenly during athletic activity. Contact sports (for example, football) can easily cause a meniscal tear -- but you can squat or twist the knee and cause a meniscal tear, too. In older people, meniscal tears can occur after cartilage wears thin and weakens. If the menisci are weakened due to aging, any sort of twisting movement can be enough to cause a tear.

There are different types of meniscal tears: bucket handle, transverse, longitudinal, flap, parrot-beak, and torn horn. The name is based on where the tear occurred on the meniscus.

What Symptoms Are Associated With Meniscal Tears?

The first sign of a meniscal tear may be that you feel a "pop" around the knee. Other symptoms commonly associated with a meniscal tear include pain, stiffness, swelling, locking knee, the feeling of your knee giving way, and restricted range of motion. A piece of torn meniscus can detach amd become loose, potentially causing your knee to pop, slip, or lock.

How Is a Meniscal Tear Diagnosed and Treated?

An MRI can help detect a meniscal tear. X-rays do not show meniscal tears. Doctors can also utilize a McMurray test to help diagnose a meniscal tear. With the McMurray test, your doctor will bend and straighten your knee while gently twisting your shin bone. Feeling or even hearing a click along the sides of your knee suggest a torn meniscus.

Treatment of a meniscal tear depends on several factors, including the location of the tear, your age, and your activity level. The outer third of the meniscus has more blood supply than the inner two-thirds. A tear on the outer, more vascularized part of the meniscus may heal on its own or it can be repaired using arthroscopic surgery. A tear on the inner, less vascularized part of the meniscus is usually trimmed away since the margins of the tear often cannot grow back together. Rehabilitation usually follows a post-surgical period of knee immobilization. If the approach to healing is non-surgical, rest, ice, compression, and elevation (R.I.C.E.) are important.

Mensical Tear and Concomitant Osteoarthritis

According to Mayo Clinic, there are more than 300,000 knee arthroscopies performed each year in the United States on patients who have a meniscal tear and osteoarthritis in the same knee compartment -- as if surgeons might be able to fix both problems at once. Yet while arthroscopy is considered effective for meniscal tears alone, its effectiveness for associated osteoarthritis is less clear. We do know that arthroscopy is ineffective for treating advanced knee osteoarthritis.

A study, known as the MeTeOR study (Meniscal Tear With Osteoarthritis Research), is currently being conducted to evaluate the effect of arthroscopy versus non-surgical treatment in a group of more than 300 patients with both a meniscal tear and mild to moderate knee osteoarthritis. There are 7 orthopedic centers in the U.S. involved in the study, which is sponsored by the National Institutes of Health.

Do Meniscal Tears Predispose Patients to Develop Osteoarthritis?

Several studies have concluded that a meniscal tear can lead to knee osteoarthritis. On the flip side of that, knee osteoarthritis can lead to a spontaneous meniscal tear through breakdown and weakening (degeneration) of the meniscus. A degenerative meniscal lesion observed on MRI is suggestive of early osteoarthritis. Even with surgical resection to remove degenerative lesions, osteoarthritis may still progress.

Partial meniscal resection has been associated with less radiographic knee osteoarthritis (i.e., knee osteoarthritis observed on x-ray) than total meniscectomy. There is also evidence that meniscal damage not treated surgically remains a significant risk factor for the development of radiographic knee osteoarthritis.

Sources:

The role of the meniscus in knee osteoarthritis: a cause or consequence? Englund M et al. Radiologic Clinics of North America. 2009 Jul;47(4):703-12.
http://www.ncbi.nlm.nih.gov/pubmed/19631077

The meniscus in knee osteoarthritis. Englund M et al. Rheumatic Diseases Clinics of North America. 2009 Aug;35(3):579-90.
http://www.ncbi.nlm.nih.gov/pubmed/19931804

Meniscal tear in knees without surgery and the development of radiographic osteoarthritis among middle-aged and elderly persons: The Multicenter Osteoarthritis Study. Englund M et al. Arthritis and Rheumatism. 2009 Mar;60(3):831-9.
http://www.ncbi.nlm.nih.gov/pubmed/19248082

Meniscal Tear With Osteoarthritis (MeTeOR) Study. Accessed April 13, 2012.
http://www.mayoclinic.org/medicalprofs/meteor-study.html

Meniscal Tears. AAOS. February 2009.
http://www.orthoinfo.aaos.org/topic.cfm?topic=A00358

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