Patients who undergo surgery for meniscal tears have greater osteoarthritis progression
Click Here to Manage Email Alerts
Key takeaways:
- Patients who underwent arthroscopic meniscal surgery had more osteophyte progression than those who received physical therapy.
- There was no discernable difference regarding Kellgren-Lawrence grades.
Patients with osteoarthritis who undergo arthroscopic partial meniscectomy appear to demonstrate greater OARSI score progression via osteophytes, but not Kellgren-Lawrence grades, according to data published in Arthritis Care & Research.
“There has been increasing concern that arthroscopic meniscal surgery may be associated with greater progression of osteoarthritis,” Jeffrey N. Katz, MD, MSc, of Harvard Medical School, told Healio. “We examined that relationship in a randomized trial cohort of persons with meniscal tear who were followed for 5 years.”
To assess the association between arthroscopic partial meniscectomy (APM) and OA progression, Katz and colleagues analyzed data from the MeTeOR cohort, which examined meniscal tears in patients who were treated with APM vs. those who underwent a standard physical therapy regimen. Patients with severe OA were excluded from the original analysis, while Katz and colleagues further excluded those who did not participate in radiographic follow-ups, those who died before 60 months of follow-up, and those who did not have a baseline radiograph.
Patients underwent a standing bilateral posterior-anterior knee radiograph at baseline, 18 and 60 months. Radiographs were examined by three assessors who were blinded to the types of treatment. The researchers then evaluated the radiographs under two sets of context — OARSI scores and Kellgren-Lawrence grades.
The analysis included a total 142 patients, of whom 100 underwent APM and 42 completed a physical therapy regimen. The average OARSI score at baseline was 3.8 in patients who underwent APM and 4 in the group that performed physical therapy. After follow-up, patients who were treated with APM reported an average OARSI score increase of 4.1 (95% CI, 3.5-4.7), compared to an average increase of 2.4 (95% CI, 1.7-3.2) in the physical therapy group. According to the researchers, there was no statistically significant difference regarding Kellgren-Lawrence grades.
“We found that those who were treated with partial meniscectomy had greater progression in osteophytes on radiograph from baseline to 5 years than those treated nonoperatively,” Katz said. “We do not know whether these changes are clinically important. The takeaway for the clinician is that meniscal surgery may be related to greater progression of osteophytes.”
Perspective
Back to Top
David A. McLain, MD, MACR, FACP, FRCP
Meniscus tears represent the most prevalent knee injury, categorized by their location and type. These tears can happen suddenly in younger individuals during acute knee injuries, often involving rapid changes in direction with a twisted or rotated knee and a planted foot. This scenario is common in sports like football, basketball and soccer.
Alternatively, in older adults, meniscus tears can develop gradually as part of the degenerative aging process, even without significant trauma. This occurs as the menisci lose their flexibility and become less compliant with age. Most randomized, controlled trials indicate that arthroscopic partial meniscectomy (APM) does not offer better results than conservative approaches like exercise programs. Additionally, a specific trial revealed that arthroscopic partial meniscectomy was not superior to sham surgery either.
According to a recent study, an estimated 750,000 APMs are performed annually in the United States, and it is one of the most common operations in the world. Before the above referenced trial, multiple clinical trials have shown that APM surgery, compared to regular exercise and physical therapy, provides no additional benefit in older individuals with degenerative meniscal tears.
A study of Medicare patients found that 67% of the knee arthroscopies performed in patients aged 65 years and older were for APM. Since the patient outcomes with the APM procedure are no better than conservative care, the procedure in older individuals with degenerative tears is considered “low-value care,” should be avoided and used only as a last resort.
Collapse
Read more about
Click Here to Manage Email Alerts