The effect of meniscal tears on cartilage loss of the knee: findings on serial MRIs.

BACKGROUND

The relationship between meniscal tears and progressive loss of hyaline cartilage and osteoarthritis of the knee has been reported in the literature. The current treatment protocols for meniscal tears include conservative treatment, meniscal repair, and meniscectomy. Treatment plans are based on factors such as tear pattern, patient age, and associated pathology. The mechanism, pattern, and treatment of meniscal tears vary with age and activity level. Younger, more active patients often sustain more acute tears, which are more amenable to repair due to increased propensity for healing compared with older patients. It is unclear which patients or types of meniscal tears will go on to sustain cartilage loss or osteoarthritis.

OBJECTIVE

In our study, we aimed to determine magnetic resonance imaging (MRI) findings in patients with meniscal tears that may be predictive as a risk factor for future cartilage loss.

METHODS

A database was retrospectively searched for patients with ≥ 2 MRIs of the same knee over a 7-year period, with the initial report containing the keyword "meniscal tear." Follow-up examinations were then evaluated for cartilage loss.

RESULTS

Seventy-six meniscal tears were evaluated. Initial MRI findings associated with cartilage loss included subchondral bone marrow edema (P < 0.0001), meniscal extrusion (P < 0.001), radial meniscal tear (P = 0.017), and posterior horn meniscal tear (P = 0.031). In patients without meniscectomy, cartilage loss was observed in 38% (15/39) compared with 76% (28/37) in patients with meniscectomy, (P = 0.0001).

CONCLUSION

Subchondral bone marrow edema and meniscal extrusion were the strongest MRI predictors for cartilage loss in an untreated knee with a meniscal tear. There was significantly greater cartilage loss in patients post-meniscectomy at follow-up than in those who did not undergo meniscectomy.