Arthritis

Updated 08 April 2016

Common knee surgery may lead to osteoarthritis and loss of cartilage

Surgery for a meniscal tear, a knee injury common for those who play contact sports such as rugby, may actually increase the risk of osteoarthritis and cartilage loss in some patients.

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This is according to research presented today at the annual meeting of the Radiological Society of North America (RSNA). The findings show that the decision for surgery requires careful consideration in order to avoid accelerated disease onset, researchers said.

The new study focused on the meniscus, a wedge-shaped piece of cartilage in the knee that acts as a shock absorber between the femur, or thigh bone, and tibia, or shin bone. The two menisci in each knee also play an important role in joint stability. Meniscal tears are among the most common knee injuries, and surgery is often performed to alleviate pain.

"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. "However, increasing evidence is emerging that suggests meniscal surgery may be detrimental to the knee joint."

For the study, Dr. Roemer and colleagues examined data from the Osteoarthritis Initiative, a large, ongoing observational study of knee osteoarthritis incidence and progression. 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. Also part of the analysis were control cases with no meniscal damage. The researchers assessed the risk of developing arthritis and cartilage loss during the following year for the different groups.

Read: Doctors with vested interest order more knee MRI's


Findings of the study


"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.

All 31 of the knees that underwent meniscal surgery during the prior year developed osteoarthritis, compared with 165 (59 percent) 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 percent of knees with surgery showed cartilage loss, compared with 39.5 percent of knees with meniscal damage and no surgery.

An alternative to surgery is conservative management. In conservative management, physical therapy is prescribed to help maintain and restore muscle strength and range of motion. Symptoms are commonly treated with ice and non-steroidal anti-inflammatory medications.

"The indications for meniscal surgery might need to be discussed more carefully in order to avoid accelerated knee joint degeneration," Dr. Roemer said.


Read more:

Injections May Boost Knee Surgery Success

Physical therapy can be as good as knee surgery


 

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Professor Asgar Ali Kalla completed his MBChB (Bachelor of Medicine and Bachelor of Surgery) degree in 1975 at the University of Cape Town and his FRCP in 2003 in London. Professor Ali Kalla is the Isaac Albow Chair of Rheumatology at the University of Cape Town and also the Head of Division of Rheumatology at Groote Schuur Hospital. He has participated in a number of clinical trials for rheumatology and is active in community outreach. Prof Ali Kalla is an expert in Arthritis for Health24.

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