According to a study presented at the recent Radiological Society of North America (RSNA), it’s possible that surgery to repair meniscal tears may increase the risk of osteoarthritis (OA) and cartilage loss in some patients. The researchers used data from the Osteoarthritis Initiative, an ongoing observational study of knee OA incidence and progression.
“Meniscal surgery is one of the most common orthopedic procedures performed to alleviate pain and improve joint function, ” said Frank W. Roemer, M.D., from Boston University School of Medicine in Boston and the University of Erlangen-Nuremberg in Erlangen, Germany, in the December 3, 2014 news release. “However, increasing evidence is emerging that suggests meniscal surgery may be detrimental to the knee joint.”
As indicated in the news release, “Patients in the study were on average 60.2 years old and predominantly overweight, with a mean body mass index (BMI) of 28.3. Approximately two-thirds of the patients were women. The researchers studied magnetic resonance imaging (MRI) exams of 355 knees that developed osteoarthritis during a five-year period, and a control group that was matched for age, gender, arthritic severity in both knees and BMI. Of all knees, 31 underwent meniscal surgery during the year prior to the arthritis diagnosis, and 280 knees had signs of meniscal damage on MRI but did not have surgery. There was also a group of control cases that had no meniscal damage. The researchers assessed the risk of developing arthritis and cartilage loss during the following year for the different groups.”
“We found that patients without knee osteoarthritis who underwent meniscal surgery had a highly increased risk for developing osteoarthritis and cartilage loss in the following year compared to those that did not have surgery, regardless of presence or absence of a meniscal tear in the year before, ” Dr. Roemer said in the news release.
“All 31 of the knees that underwent meniscal surgery during the prior year developed osteoarthritis, compared with 165 (59%) of the knees with meniscal damage that didn’t have surgery. In addition, cartilage loss was much more common among knees that had undergone surgery: 80.8% of knees with surgery showed cartilage loss, compared with 39.5% of knees with meniscal damage and no surgery.”
“The indications for meniscal surgery might need to be discussed more carefully in order to avoid accelerated knee joint degeneration, ” Dr. Roemer said.
Please see Dr. LaPrade’s rebuttal to this study:
http://drrobertlaprademd.com/dr-laprades-rebuttal-on-qsurgery-to-repair-meniscal-tears-in-the-knee-may-accelerate-the-onset-of-osteoarthritis-and-cartilage-lossq
The brown university study in Arthritis published July 2014 lays out the most scientific argument for physicians on how to treat patients to protect their joint in those predisposed to arthritis such as following any arthroscopic procedure. I am currently using autologous alpha-2 macroglobulin in all my patients who are at risk for developing arthritis. This includes patients following discectomy, orthoscopic procedures or previous trauma. I have even done it in my own knees. I am looking for interested physicians to do a long-term multi center project which I am quite confident will show significant chondral protection over time. This is the first real biologic that we can use now for symptomatic arthritis as well as patients at risk.