The Journal of Bone and Joint Surgery (American) 85:4-9 (2003)
© 2003 The Journal of Bone and Joint Surgery, Inc.
The Clinical Importance of Meniscal Tears Demonstrated by Magnetic Resonance Imaging in Osteoarthritis of the Knee*
Timothy Bhattacharyya, MD,
Daniel Gale, MD,
Peter Dewire, MD,
Saara Totterman, MD,
M. Elon Gale, MD,
Sara McLaughlin, MPH,
Thomas A. Einhorn, MD and
David T. Felson, MD, MPH
Investigation performed at the Clinical Epidemiology Research and Training Unit, Arthritis Center, and Department of Orthopaedics, Boston University Medical Center, and the Department of Radiology, VA Boston Healthcare System, Boston, Massachusetts
Timothy Bhattacharyya, MD
Peter Dewire, MD
Thomas A. Einhorn, MD
Department of Orthopaedic Surgery, 720 Harrison Avenue, Suite 808, Boston, MA 02118
Daniel Gale, MD
M. Elon Gale, MD
Department of Radiology, VA Boston Healthcare System, Jamaica Plain Campus, 150 South Huntington Avenue, Boston, MA 02130
Saara Totterman, MD
Department of Radiology, University of Rochester Medical Center, 601 Elmwood Avenue, P.O. Box 694, Rochester, NY 14624
Sara McLaughlin, MPH
David T. Felson, MD, MPH
Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, 715 Albany Street, A203, Boston, MA 02118. E-mail address for D.T. Felson: dfelson{at}bu.edu
In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from the National Institutes of Health (Grant AR47785), the Arthritis Foundation, and Bayer. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
*A related commentary appears on p. 156 of this issue of
The Journal as well as in the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM (call our subscription department, at 781-449-9780, to order the CD-ROM).
Background: Meniscal tears are frequently found during magnetic resonance imaging of osteoarthritic knees. However, the prevalence and clinical relevance of these tears have not been determined. This study was designed to investigate the relationship between meniscal tears and osteoarthritis and between such tears and pain in patients with osteoarthritis.
Methods: Magnetic resonance imaging and plain radiography of the knee were performed in a group of 154 patients with clinical symptoms of knee osteoarthritis and a group of forty-nine age-matched asymptomatic controls. Pain scores (according to a 100-mm visual analog scale) and functional scores (according to the Western Ontario and McMaster University Osteoarthritis Index [WOMAC]) were determined for ninety-one of the patients with symptomatic osteoarthritis. Meniscal tears were defined as tears extending to an articular surface as seen on magnetic resonance imaging.
Results: A medial or lateral meniscal tear was a very common finding in the asymptomatic subjects (prevalence, 76%) but was more common in the patients with symptomatic osteoarthritis (91%) (p < 0.005). In the group with symptomatic osteoarthritis, a higher Kellgren-Lawrence radiographic grade was correlated with a higher frequency of meniscal tears (r = 0.26, p < 0.001), and men had a higher prevalence of meniscal tears than did women (p < 0.01). However, there was no significant difference with regard to the pain or WOMAC score between the patients with and those without a medial or lateral meniscal tear in the osteoarthritic group (p = 0.8 to 0.9 for all comparisons). The power of the study was 80% to detect a difference in the WOMAC scores of 15 points and a difference in the scores on the visual analog scale of 16 mm.
Conclusions: Meniscal tears are highly prevalent in both asymptomatic and clinically osteoarthritic knees of older individuals. However, osteoarthritic knees with a meniscal tear are not more painful than those without a tear, and the meniscal tears do not affect functional status. These data do not support the routine use of magnetic resonance imaging for the evaluation and management of meniscal tears in patients with osteoarthritis of the knee.
Level of Evidence: Diagnostic study, Level I-1 (testing of previously developed diagnostic criteria in series of consecutive patients [with universally applied reference "gold" standard]). See p. 2 for complete description of levels of evidence.
 CiteULike  Connotea  Del.icio.us  Technorati What's this?
This article has been cited by other articles:
|
|
|
|
 
A. Kirkley, T. B. Birmingham, R. B. Litchfield, J. R. Giffin, K. R. Willits, C. J. Wong, B. G. Feagan, A. Donner, S. H. Griffin, L. M. D'Ascanio, et al.
A Randomized Trial of Arthroscopic Surgery for Osteoarthritis of the Knee
N. Engl. J. Med.,
September 11, 2008;
359(11):
1097 - 1107.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Englund, A. Guermazi, D. Gale, D. J. Hunter, P. Aliabadi, M. Clancy, and D. T. Felson
Incidental Meniscal Findings on Knee MRI in Middle-Aged and Elderly Persons
N. Engl. J. Med.,
September 11, 2008;
359(11):
1108 - 1115.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. G. Marx
Arthroscopic Surgery for Osteoarthritis of the Knee?
N. Engl. J. Med.,
September 11, 2008;
359(11):
1169 - 1170.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J-P Raynauld, J Martel-Pelletier, M-J Berthiaume, F Abram, D Choquette, B Haraoui, J F Beary, G A Cline, J M Meyer, and J-P Pelletier
Correlation between bone lesion changes and cartilage volume loss in patients with osteoarthritis of the knee as assessed by quantitative magnetic resonance imaging over a 24-month period
Ann Rheum Dis,
May 1, 2008;
67(5):
683 - 688.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. D. Fabricant and P. Jokl
Surgical Outcomes After Arthroscopic Partial Meniscectomy
J. Am. Acad. Ortho. Surg.,
November 1, 2007;
15(11):
647 - 653.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. Guss and T. Bhattacharyya
Perioperative management of the obese orthopaedic patient.
J. Am. Acad. Ortho. Surg.,
July 1, 2006;
14(7):
425 - 432.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. K. Aaron, A. H. Skolnick, S. E. Reinert, and D. McK. Ciombor
Arthroscopic Debridement for Osteoarthritis of the Knee
J. Bone Joint Surg. Am.,
May 1, 2006;
88(5):
936 - 943.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. J Hunter and D. T Felson
Osteoarthritis.
BMJ,
March 18, 2006;
332(7542):
639 - 642.
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. T. Felson
Clinical practice. Osteoarthritis of the knee.
N. Engl. J. Med.,
February 23, 2006;
354(8):
841 - 848.
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. W. Hayes, D. A. Jamadar, G. W. Welch, M. L. Jannausch, L. L. Lachance, D. C. Capul, and M. R. Sowers
Osteoarthritis of the Knee: Comparison of MR Imaging Findings with Radiographic Severity Measurements and Pain in Middle-aged Women
Radiology,
December 1, 2005;
237(3):
998 - 1007.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. D. Miller
What's New in Sports Medicine
J. Bone Joint Surg. Am.,
March 1, 2004;
86(3):
653 - 661.
[Full Text]
[PDF]
|
|
|
|
|
|
|
POEM: Asymptomatic meniscal tears are as common as symptomatic ones
BMJ,
April 19, 2003;
326(7394):
0 - 0.
[Full Text]
[PDF]
|
|
|
|
|
|
|
W. Garrett Jr.
Evaluation and Treatment of the Arthritic Knee
J. Bone Joint Surg. Am.,
January 17, 2003;
85(1):
156 - 157.
[Full Text]
[PDF]
|
|
|
|
