Signs of knee osteoarthritis common in 620 patients undergoing arthroscopic surgery for meniscal tear

Abstract

Background and purpose — Recent evidence has questioned the effect of arthroscopic knee surgery for middle-aged and older patients with degenerative meniscal tears with or without concomitant radiographic knee osteoarthritis (OA). We investigated the prevalence of early or more established knee OA and patients’ characteristics in a cohort of patients undergoing arthroscopic surgery for a meniscal tear.Patients and methods — 641 patients assigned for arthroscopy on suspicion of meniscus tear were consecutively recruited from February 2013 through January 2015. Of these, 620 patients (mean age 49 (18–77) years, 57% men) with full datasets available were included in the present study. Prior to surgery, patients completed questionnaires regarding onset of symptoms, duration of symptoms, and mechanical symptoms along with the knee injury and osteoarthritis outcome score (KOOS). At arthroscopy, the operating surgeon recorded information about meniscal pathology and cartilage damage. Early or more established knee OA was defined as the combination of self-reported frequent knee pain, cartilage damage, and the presence of degenerative meniscal tissue.Results — 43% of patients (269 of 620) had early or more established knee OA. Of these, a large proportion had severe cartilage lesions with almost half having a severe cartilage lesion in at least 1 knee compartment.Interpretation — Based on a definition including frequent knee pain, cartilage damage, and degenerative meniscal tissue, early or more established knee OA was present in 43% of patients undergoing knee arthroscopy for meniscal tear.

Wild goose chase – no predictable patient subgroups benefit from meniscal surgery: patient-reported outcomes of 641 patients 1 year after surgery

“…The majority of patients included in the development of the prognostic models were middle aged or older, reflecting current clinical practice 45–47. These patients typically have a degenerative meniscal tear,45 48 often in combination with other degenerative changes such as knee osteoarthritis (OA) 48 49. Symptoms are, therefore, likely to result from the multiple and complex processes of OA rather than the meniscal tear per se 50.…”

How Should We Define Clinically Significant Improvement on Patient-Reported Outcomes Measurement Information System Test for Patients Undergoing Knee Meniscal Surgery?

“…2,3 Studies have reported improvements in pain, function, and quality of life after meniscal surgery with worse outcomes in patients of older age, with a greater body mass index, and with complex tears on arthroscopy. 4 As part of efforts to elucidate long-term outcomes, there has been increased focus on improving the accuracy and precision of patient-reported outcome measures (PROMs) while reducing question burden (the minimum number of responses necessary to produce a score on a given PROM instrument). 5 In 2004, the National Institutes of Health developed the Patient-Reported Outcomes Measurement Information System (PROMIS), a new outcome measure using item response theory and a large database of questions from various health domains.…”

Change in patient-reported outcomes in patients with and without mechanical symptoms undergoing arthroscopic meniscal surgery: A prospective cohort study

“…In this study, older patients mainly had degenerative meniscal tears and approximately half had severe cartilage defects (i.e., ICRS grade 3e4) in at least one compartment, indicative of early or more progressed stages of knee OA 1 . That suggests that in older patients other structures than the meniscal tear per se may be the cause of symptoms.…”

“…Patients with degenerative meniscal tears are considered a patient group with early signs of or at high risk of knee osteoarthritis (OA) 1,2 . Traumatic knee injury is also a well-established risk factor for later OA 3,4 , but data on patients under 40 years with meniscal tears constituting one such subgroup with traumatic knee injury is scarce.…”