Magnetic resonance imaging in knee synovitis: Clinical utility in differentiating asymptomatic and symptomatic meniscal tears

Abstract

SummaryIt is well documented that meniscal tears may be found frequently by MRI as an incidental finding in asymptomatic knees. We aim to review the literature regarding the ability of MRI to differentiate between asymptomatic and symptomatic meniscal tears. Ovid MEDLINE, MEDLINE inProcess, Cochrane reviews, Web of Science, Embase and CINAHL were systematically searched. A total of 1251 publications were screened based on their titles, abstracts and full texts, of which 1213 publications were excluded because they did not address the relationship between synovitis and meniscal tears, were case reports or reviews, concerned atypical patient populations or reported surgical research. Of the 38 retained publications, only two reported results specific to perimeniscal synovitis, while 36 discussed less specific but relevant findings. The small number of heterogeneous results describing perimeniscal synovitis precluded meta-analysis. In the symptomatic knee, identification of the likelihood of a meniscal tear contributing to the patient's pain is of significance to the orthopaedic surgeon. In our literature review, we have identified that localised synovitis and displacement of the meniscus are two features that may assist in identifying the subgroup of patients that may benefit from meniscal intervention.

Associations between MRI-defined structural pathology and generalized and localized knee pain – the Oulu Knee Osteoarthritis study

“…14 In our study, 50.0% of symptomatic subjects and 31.7% of asymptomatic subjects had meniscal tears but maceration and extrusions were infrequent in asymptomatic group. Meniscal lesions have been thought to be almost universal in subjects with knee OA and thus unlikely a cause of knee pain 4,5,33,34 as shown also in our study. On the contrary, Torres et al 30 demonstrated an association between meniscal tears and pain, however, it cannot be discriminated whether there was a true association between meniscal tears and pain or coincidental meniscal tears with other painful structural pathologies 34 because the results were not adjusted for another MRI-findings.…”

“…Meniscal lesions have been thought to be almost universal in subjects with knee OA and thus unlikely a cause of knee pain 4,5,33,34 as shown also in our study. On the contrary, Torres et al 30 demonstrated an association between meniscal tears and pain, however, it cannot be discriminated whether there was a true association between meniscal tears and pain or coincidental meniscal tears with other painful structural pathologies 34 because the results were not adjusted for another MRI-findings. Meniscal extrusions or subluxations have been reported to be more common in symptomatic knee OA subjects than in asymptomatic controls 35e37 , potentially due to altered biomechanical loading following the loss of meniscal function and bulging and mechanical stretching of the joint capsule richly innervated with nociceptive fibres 37 .…”

An Up-to-Date Review of the Meniscus Literature: A Systematic Summary of Systematic Reviews and Meta-analyses

“…20,109,125 Shakoor et al 121 found that 3-dimensional (3D) fast spin-echo and 3D gradient-echo MRI sequences had similar diagnostic accuracy in detecting meniscal tears compared with 2-dimensional MRI sequences, but sensitivity of 3D fast spin-echo was slightly better than 3D gradient-echo sequences for detecting lateral meniscal tears. Troupis et al 135 concluded that localized synovitis and displacement of the meniscus on MRI scans may be predictive of patients who could benefit from meniscal intervention. A further 3 meta-analyses 27,35,142 found good to moderate pooled sensitivity (78%-89%) and specificity (84%-90%) for ultrasound in diagnosing meniscal tears with arthroscopy as the reference standard, although Dai et al 27 noted considerable heterogeneity between studies.…”

The TeMPO trial (treatment of meniscal tears in osteoarthritis): rationale and design features for a four arm randomized controlled clinical trial

“…Subjects must also have imaging evidence of meniscal tear and mild to moderate osteoarthritic changes. Because the majority of meniscal tears identified in middle-aged and older persons are asymptomatic, [ 2 , 3 , 27 , 28 ] TeMPO inclusion criteria stipulate that the location (medial vs. lateral) of reported meniscal tear-like knee symptoms must concur with the location (medial vs. lateral compartment) of the MRI-documented meniscal tear. The study defines ‘osteoarthritis change’ as evidence of partial or full thickness cartilage lesions on MRI in any knee compartment.…”