The Meniscus in Knee Osteoarthritis

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Anatomy, histology, and functions of the normal menisci in brief

The menisci are two semi-circular fibrocartilage structures positioned between the joint surfaces of the femur and tibia in the medial and lateral knee joint compartments. Each meniscus covers approximately two-thirds of the corresponding articular surface of the tibia. In cross section, both menisci are wedge-shaped with a thick peripheral base infiltrated by capillaries and nerves that penetrate 10% to 30% of the meniscus width.1, 2 The medial meniscus is firmly attached to the joint capsule,

Different types of meniscal lesions in knee OA

MRI is the preferred imaging modality for evaluating the menisci, and the procedure is an increasingly popular diagnostic procedure of meniscal lesions (Fig. 1). The sensitivity and specificity is in the range of 82% to 96% based on patients undergoing arthroscopy (using arthroscopy as the gold standard), but in subjects with prior meniscal repair the evaluation is more complex.12, 13, 14, 15

A number of typical morphologic tear patterns of the meniscus can be distinguished not only at direct

Meniscal damage—a cause to or a consequence of knee OA?

Normally configured menisci are rarely found in knees with OA. Instead they are often torn, macerated, or even totally destructed, which suggests a strong association between the disorder and the meniscus.24, 25, 29 However, the relationship between meniscal damage and knee OA is complex. A meniscal lesion in a healthy knee may eventually lead to knee OA due to the loss of meniscal function. However, knee OA may also lead to meniscal tears that, in turn, may further accelerate the disease

Genes and environment interact

A degenerative meniscal lesion was more frequently found in patients with radiographic hand OA, and subjects with bilateral knee OA had radiographic hand OA more frequently than did subjects with unilateral knee OA.40 These findings provided additional support for an interaction between genetic and environmental risk factors in OA, although metabolic effects cannot be excluded. Worse outcome after lateral meniscectomy compared with medial has been shown in several studies. The lateral meniscus

Past, present, and future treatment strategies of a torn meniscus

The first report known was of a meniscal repair: in 1883 a British surgeon successfully sutured a torn medial meniscus.46 However, 4 years later, he published another report in which he justified total removal of the meniscus rather than repair, and that view prevailed for over 80 years.47 In the late 1940s, Fairbank23 speculated that frequent radiographic changes found after total meniscectomy were due to the loss of the load-protective function of the menisci, resulting in remodeling of the

Summary

The menisci play a critical protective role for the knee joint through shock absorption and load distribution. Meniscal lesions are regular findings on MRI, especially in the osteoarthritic knee and in the form of horizontal, flap, and (or) complex tears; maceration; or destruction. However, asymptomatic lesions are common and frequent incidental findings on knee MRI of the middle-aged or older patient. This challenges the health professional in choosing the best treatment in the short- and

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References (67)

  • M. Doherty et al.

    Influence of primary generalised osteoarthritis on development of secondary osteoarthritis

    Lancet

    (1983)
  • F. Steenbrugge et al.

    Long-term assessment of arthroscopic meniscus repair: a 13-year follow-up study

    Knee

    (2002)
  • S.P. Arnoczky et al.

    Microvasculature of the human meniscus

    Am J Sports Med

    (1982)
  • B.B. Seedhom et al.

    Transmission of the load in the knee joint with special reference to the role of the meniscus (part I + II)

    Eng Med

    (1979)
  • P.S. Walker et al.

    The role of the menisci in force transmission across the Knee

    Clin Orthop Relat Res

    (1975)
  • H. Kurosawa et al.

    Load-bearing mode of the knee joint: physical behavior of the knee joint with or without menisci

    Clin Orthop

    (1980)
  • I.M. Levy et al.

    The effect of medial meniscectomy on anterior-posterior motion of the Knee

    J Bone Joint Surg Am

    (1982)
  • I.M. Levy et al.

    The effect of lateral meniscectomy on motion of the Knee

    J Bone Joint Surg Am

    (1989)
  • A.P. Assimakopoulos et al.

    The innervation of the human meniscus

    Clin Orthop

    (1992)
  • L.P. Cheung et al.

    Meniscal tears of the knee: accuracy of detection with fast spin-echo MR imaging and arthroscopic correlation in 293 patients

    Radiology

    (1997)
  • A.A. De Smet et al.

    Use of the “two-slice-touch” rule for the MRI diagnosis of meniscal tears

    AJR Am J Roentgenol

    (2006)
  • E.M. Escobedo et al.

    Usefulness of turbo spin-echo MR imaging in the evaluation of meniscal tears: comparison with a conventional spin-echo sequence

    AJR Am J Roentgenol

    (1996)
  • B.C. Vande Berg et al.

    Meniscal tears with fragments displaced in notch and recesses of knee: MR imaging with arthroscopic comparison

    Radiology

    (2005)
  • W.H. Jee et al.

    Meniscal tear configurations: categorization with MR imaging

    AJR Am J Roentgenol

    (2003)
  • J. Noble et al.

    The pathology of the degenerate meniscus lesion

    J Bone Joint Surg Br

    (1975)
  • J. Noble

    Lesions of the menisci. Autopsy incidence in adults less than fifty-five years old

    J Bone Joint Surg Am

    (1977)
  • I.S. Smillie

    Surgical pathology of the menisci. Injuries of the knee joint

    (1962)
  • M. Englund et al.

    Risk factors for symptomatic knee osteoarthritis fifteen to twenty-two years after meniscectomy

    Arthritis Rheum

    (2004)
  • T.J. Fairbank

    Knee joint changes after meniscectomy

    J Bone Joint Surg Br

    (1948)
  • M. Englund et al.

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

    N Engl J Med

    (2008)
  • T. Bhattacharyya et al.

    The clinical importance of meniscal tears demonstrated by magnetic resonance imaging in osteoarthritis of the Knee

    J Bone Joint Surg Am

    (2003)
  • C. Ding et al.

    Meniscal tear as an osteoarthritis risk factor in a largely non-osteoarthritic cohort: a cross-sectional study

    J Rheumatol

    (2007)
  • D.W. Stoller et al.

    Meniscal tears: pathologic correlation with MR imaging

    Radiology

    (1987)
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    A version of this article originally appeared in the 47:4 issue of Radiologic Clinics of North America.

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