Enter Your Email Address to Receive a
Copy of MedicExhange Member Demograhpics

Damage to the meniscus is a common observation on knee MRIs among middle aged and elderly persons, irrespective of knee symptoms, investigators report.

Damage to the meniscus is a common observation on knee MRIs among middle aged and elderly persons, irrespective of knee symptoms, investigators report in the New England Journal of Medicine for September 11.

To determine the prevalence of meniscal damage and its association with knee pain and stiffness, Dr. Martin Englund, at the Boston University School of Medicine, and co-investigators studied MRI scans of the right knee of 991 randomly selected, ambulatory subjects, ages 50 to 90, living in Framingham, Massachusetts.

MRI revealed meniscal damage in 35 per cent of subjects. Damage to the meniscus was more common among men than women (42 per cent vs 30 per cent), and increased with age (p < 0.001 for trend), affecting more than 50 per cent of subjects over the age of 69.

A majority of the meniscal tears (61 per cent) were in people who had not had any pain, aching, or stiffness in the previous month, the authors report.

Knee radiographs were performed for 963 of the subjects. Among those with radiographic evidence of osteoarthritis, the prevalence of a meniscal tear was 63 per cent among those with knee pain or stiffness on most days, and 60 per cent among those who were asymptomatic. Corresponding rates among subjects without osteoarthritis were 32 per cent and 23 per cent.

Although a meniscal tear may signal early osteoarthritis, Dr. Englund's team points out, "other structures or processes... may be causing the pain, such as synovitis or bone marrow lesions." Meniscectomy, they say, is unlikely to have much effect on symptoms in patients with osteoarthritis.

"Identifying a tear in a person with knee pain does not mean that the tear is the cause of the pain," Dr. Robert G. Marx, from Weill Medical College of Cornell University in New York, emphasizes in a Journal editorial. He advises physicians "to individualize decision making with respect to arthroscopic surgery for patients with osteoarthritis of the knee."

N Engl J Med 2008;359:1108-1115