Resection of degenerate menisci — is it useful?

Abstract

Forty-three symptomatic patients, with a pre-operative MRI diagnosis of an isolated degenerate tear of the meniscus, treated by Arthroscopic resection were reviewed after a minimum follow up of 6 years post-surgery. Pre-operatively there was no clinical or radiological evidence of arthroses, but at surgery 65% of patients were noted to have varying degrees of articular cartilage changes, ranging from Grade I to Grade III according to Outerbridge’s classification. Six and a half years (range 6–8 years) following Arthroscopic resection of these degenerate tears 50% of the patients had moderate to severe pain in the operated knee. Their mean Lysholm score was 61.9 (range 11–100, S.D. 27.3) and the median current Tegner activity score was 3 (range 0–7, S.D. 1.65) with 86% patients having dropped their levels of activities by two grades (1–7) (P=0.0001). The SF-36 questionnaire revealed a significant difference in the mean scores for Role Physical, Role Emotional, Mental Health, Vitality and Bodily Pain categories when compared with the mean scores of the general population of similar age and sex range. This suggests that the differences arose due to knee symptoms as there was no significant difference in the mean General Health Scores for the two populations. We conclude that although Arthroscopic resection of these lesions may provide relief in the short-term, these benefits are not long lasting.

Introduction

‘A horizontal cleavage lesion’ is described by Smilie [2] as the single most common meniscal tear. Noble and Hamblen [3] discovered a prevalence of degenerate meniscal tears in 60% of an elderly group of random autopsy subjects, and concluded that not all people possessing such a lesion were likely to have had complaints from it. Meniscectomy is one of the most common of all orthopaedic surgical procedures, however, the natural history of symptoms of degenerate tears of the menisci and the role of arthroscopic procedures for their treatment remains unclear.