The Meniscus in Knee Osteoarthritis
Section snippets
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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A version of this article originally appeared in the 47:4 issue of Radiologic Clinics of North America.