Can a Meniscal Repair Surgery Heighten a Patients’ Risk of Knee Osteoarthritis (OA)?
OA (Osteoarthritis) is also commonly known as wear-and tear-arthritis. This is a disorder which occurs when the cartilage (the natural cushioning between joints) wears out. It is the most common type of arthritis. When it occurs, the bones of the joints tend to rub more closely against one another owing to the reduced shock-absorbing benefits of cartilage. The rubbing causes swelling, stiffness, decreased mobility and, in some instances, the development of bone spurs.
What are the risk factors associated with OA?
Although age is a major risk factor for knee osteoarthritis, younger people can also get it. For some people, it may be hereditary while for others it can result from knee injury or infection or even from having excessive weight. Arthroscopy is one of the surgical options used to treat knee osteoarthritis and knee replacement may become necessary in severe cases.
What is a meniscal tear and how is it treated generally?
A meniscus tear refers to a common injury caused to the cartilage that ensures the knee joint is appropriately stabilized and cushioned. Surgery to repair meniscal tears has been popular and the kind of the tear is what determines whether meniscus repair can be done. However, recent research indicates that it is likely to increase the risk of osteoarthritis and cartilage loss in some patients. Thus, according to researchers, there is need for careful consideration before the decision of surgery can be made so as to avoid hastened disease onset.
Can Meniscal Repair increase the risk of knee OA?
Meniscal tears are among the most prevalent knee injuries whose pain is alleviated and joint function improved by surgery. However, according to Frank W. Roemer, M.D., from Boston University School of Medicine in Boston as well as the University of Erlangen-Nuremberg, Germany there has been growing evidence suggesting that meniscal surgery might be harmful to the knee joint when used to alleviate knee pain.
A study was conducted by Dr Roemer and his team on patients with an average age of 60.2 years, and who were mainly overweight with a BMI of 28.3. Roughly, two-thirds of the patients were women. The team studied MRI (magnetic resonance imaging) examination of 355 knees that developed osteoarthritis in the course of 5 years, and a control group which matched for age, sex, the severity of arthritis in both knees as well as BMI. Out of all the knees, 31 had meniscal surgery in the preceding year before the arthritis diagnosis, and 280 knees showed signs of meniscal damage on MRI but did not undergo surgery. The researchers evaluated the risk of developing arthritis and cartilage wear during the following year for the different groups.
The scientists established that those patients that did not have knee osteoarthritis but who had meniscal surgery had a greatly increased risk of developing both osteoarthritis and cartilage loss in the next year as compared to their counterparts who did not undergo surgery.
The study found that all the knees that had meniscal surgery during the previous year developed osteoarthritis as compared with 165 of the knees which had meniscal damage but did not undergo surgery. Besides, cartilage loss was much more widespread among those knees that had undergone surgery. Hence, 80.8 percent of knees that had undergone operation showed loss of cartilage as compared with 39.5 percent of knees that had meniscal damage and no surgery.
There is a potential bias in this study. Those patients that did not undergo the knee arthroscopy despite their ongoing knee pain, may have been less physically active as a result. The lower level of aggressive physical activity may have led to decreased overall trauma over the years, and thus lower risk of osteoarthritis. Further studies are necessary. At this point in time, orthopedic dogma mandates that a repairable meniscus tear undergo a surgical repair.
Conservative management has been found to be an alternative to surgery and it involves prescription of physical therapy in helping to maintain and restore muscle strength and scope of motion. Ice and non-steroidal anti-inflammatory medications are commonly used to treat the symptoms.