Effect of meniscal damage on the development of frequent knee pain, aching, or stiffness

Osteoarthritis: current role of imaging

Osteoarthritis (OA) is the most prevalent joint disease; it is increasingly common in the aging population of Western society and has a major health economic impact. Despite surgery and symptom-oriented approaches there is no efficient treatment. Conventional radiography has played a role in the past in confirming diagnosis and demonstrating late bony changes and joint space narrowing. MRI has become the method of choice in large research endeavors and may become important for individualized treatment planning. This article focuses on radiography and MRI, with insight into other modalities, such as ultrasound, scintigraphy, and CT. Their role in OA diagnosis, follow-up, and research is discussed.

The role of the meniscus in osteoarthritis genesis

The history of treating meniscal lesions has been characterized by firm belief in "radical" surgery, with serious long-term consequences for the individual and society. The menisci play a critical protective role for the knee joint through shock absorption and load distribution. Currently, the consensus in surgical treatment of meniscal tears is to preserve as much functional meniscal tissue as possible. Still, meniscal lesions are common, especially in the osteoarthritic knee. For health professionals, these lesions present a challenge in choosing the treatment that is best for the patient in both the short term and long term. A degenerative lesion, in the middle-aged or older patient, could suggest early-stage knee osteoarthritis and should be treated accordingly. Surgical resection of nonobstructive degenerate lesions may only remove evidence of the disorder while the osteoarthritis degradation proceeds. Well-designed randomized, controlled clinical trials are needed.

The contribution of genes to osteoarthritis

Osteoarthritis (OA) is the most prevalent form of arthritis in the elderly. A large body of evidence, including familial aggregation and classic twin studies, indicates that primary OA has a strong hereditary component that is likely polygenic in nature. Traits related to OA, such as longitudinal changes in cartilage volume and progression of radiographic features, are also under genetic control. In recent years several linkage analyses and candidate gene studies have been performed and unveiled some of the specific genes involved in disease risk, such as FRZB and GDF5. This article discusses the impact that future genome-wide association scans can have on our understanding of the pathogenesis of OA and on identifying individuals at high risk for developing severe OA.

Clinical knee findings in floor layers with focus on meniscal status

BACKGROUND

The aim of this study was to examine the prevalence of self-reported and clinical knee morbidity among floor layers compared to a group of graphic designers, with special attention to meniscal status.

METHODS

We obtained information about knee complaints by questionnaire and conducted a bilateral clinical and radiographic knee examination in 134 male floor layers and 120 male graphic designers. After the exclusion of subjects with reports of earlier knee injuries the odds ratio (OR) with 95% confidence intervals (CI) of knee complaints and clinical findings were computed among floor layers compared to graphic designers, using logistic regression. Estimates were adjusted for effects of body mass index, age and knee straining sports. Using radiographic evaluations, we conducted side-specific sensitivity analyses regarding clinical signs of meniscal lesions after the exclusion of participants with tibiofemoral (TF) osteoarthritis (OA).

RESULTS

Reports of knee pain (OR = 2.7, 95% CI = 1.5-4.6), pain during stair walking (OR = 2.2, 95% CI = 1.3-3.9) and symptoms of catching of the knee joint (OR = 2.9, 95% CI = 1.4-5.7) were more prevalent among floor layers compared to graphic designers. Additionally, significant more floor layers than graphic designers had clinical signs suggesting possible meniscal lesions: a positive McMurray test (OR = 2.4, 95% CI = 1.1-5.0) and TF joint line tenderness (OR = 5.4, 95% CI = 2.4-12.0). Excluding floor layers (n = 22) and graphic designers (n = 15) with radiographic TF OA did not alter this trend between the two study groups: a positive McMurray test (OR = 2.2, 95% CI = 1.0-4.9), TF joint line tenderness (OR = 5.0, 95% CI = 2.0-12.5).

CONCLUSION

Results indicate that floor layers have a high prevalence of both self-reported and clinical knee morbidity. Clinical knee findings suggesting possible meniscal lesions were significant more prevalent among floor layers compared to a group of low-level exposed graphic designers and an association with occupational kneeling could be possible. However, causality cannot be confirmed due to the cross-sectional study design.

The contribution of genes to osteoarthritis

Osteoarthritis (OA) is the most prevalent form of arthritis in the elderly. A large body of evidence, including familial aggregation and classic twin studies, indicates that primary OA has a strong hereditary component that is likely polygenic in nature. Furthermore, traits related to OA, such as longitudinal changes in cartilage volume and progression of radiographic features, are also under genetic control. In recent years, several linkage analysis and candidate gene studies have been performed and have unveiled some of the specific genes involved in disease risk, such as FRZB and GDF5. The authors discuss the impact that future genome-wide association scans can have on our understanding of the pathogenesis of OA and on identifying individuals at high risk for developing severe OA.

Incidental meniscal findings on knee MRI in middle-aged and elderly persons

BACKGROUND

Magnetic resonance imaging (MRI) of the knee is often performed in patients who have knee symptoms of unclear cause. When meniscal tears are found, it is commonly assumed that the symptoms are attributable to them. However, there is a paucity of data regarding the prevalence of meniscal damage in the general population and the association of meniscal tears with knee symptoms and with radiographic evidence of osteoarthritis.

METHODS

We studied persons from Framingham, Massachusetts, who were drawn from census-tract data and random-digit telephone dialing. Subjects were 50 to 90 years of age and ambulatory; selection was not made on the basis of knee or other joint problems. We assessed the integrity of the menisci in the right knee on 1.5-tesla MRI scans obtained from 991 subjects (57% of whom were women). Symptoms involving the right knee were evaluated by questionnaire.

RESULTS

The prevalence of a meniscal tear or of meniscal destruction in the right knee as detected on MRI ranged from 19% (95% confidence interval [CI], 15 to 24) among women 50 to 59 years of age to 56% (95% CI, 46 to 66) among men 70 to 90 years of age; prevalences were not materially lower when subjects who had had previous knee surgery were excluded. Among persons with radiographic evidence of osteoarthritis (Kellgren-Lawrence grade 2 or higher, on a scale of 0 to 4, with higher numbers indicating more definite signs of osteoarthritis), the prevalence of a meniscal tear was 63% among those with knee pain, aching, or stiffness on most days and 60% among those without these symptoms. The corresponding prevalences among persons without radiographic evidence of osteoarthritis were 32% and 23%. Sixty-one percent of the subjects who had meniscal tears in their knees had not had any pain, aching, or stiffness during the previous month.

CONCLUSIONS

Incidental meniscal findings on MRI of the knee are common in the general population and increase with increasing age.