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  • Review Article
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Meniscus pathology, osteoarthritis and the treatment controversy

Nature Reviews Rheumatology volume 8, pages 412–419 (2012)Cite this article

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Abstract

The menisci are internal structures that are of central importance for a healthy knee joint; they have a key role in the structural progression of knee osteoarthritis (OA), and the risk of the disease dramatically increases if they are damaged by injury or degenerative processes. Meniscus damage might be considered a signifying feature of incipient OA in middle-aged and elderly people. As approximately every third knee of people in these groups has a damaged meniscus, tears are common incidental findings of knee MRI. However, as most tears do not cause symptoms, careful clinical evaluation is required to determine if a damaged meniscus is likely to directly impact a patient's symptoms. Conservative management of patients with knee pain and a degenerative meniscal tear should be considered as a first-line therapy before surgical treatment is contemplated. Patients with mechanical interference of joint movements, such as painful catching or locking, might need surgical treatment with meniscal repair if possible. In a subset of patients, meniscal resection might relieve pain and other symptoms that potentially originate directly from the torn meniscus. However, the possibility of an increased risk of OA if functional meniscal tissue is removed cannot be overlooked.

Key Points

  • Meniscus damage is highly prevalent in middle-aged and elderly people in the general population

  • Most meniscal tears do not cause knee pain

  • Meniscus damage is almost always present in knees with radiographic osteoarthritis (OA)

  • Meniscus damage might lead to OA and OA might lead to meniscus damage

  • Conservative management (patient education, weight reduction and/or physical exercise therapy), should always be the first treatment of choice for patients with knee pain and degenerative meniscus damage

  • Patients who experience painful catching or locking of their knee due to an unstable meniscal tear might require surgical treatment

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Figure 1: The medial and lateral meniscus seen from above.
Figure 2: MRI of healthy menisci.
Figure 3: A 'bucket handle' meniscal tear in the medial compartment.
Figure 4: The prevalence of meniscal damage in a randomly recruited population-based sample.
Figure 5: Degenerative meniscal damage.
Figure 6: Coronal intermediate weighted images showing progressive meniscal extrusion over a 3 year period.
Figure 7: The 'meniscal pathway' to knee osteoarthritis.

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Acknowledgements

M. Englund is supported by the Swedish Research Council, The Kock Foundation, Gustav V's 80-year Birthday Foundation, and the Faculty of Medicine at Lund University, Sweden.

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Authors and Affiliations

  1. Department of Orthopaedics, Clinical Sciences Lund, Lund University, Klinikgatan 22, Lund, SE-221 85, Sweden

    Martin Englund

  2. Department of Radiology, Klinikum Augsburg, Stenglinstraße 2, Augsburg, 86156, Germany

    Frank W. Roemer

  3. Department of Radiology, Boston University School of Medicine, 820 Harrison Avenue, FGH Building, 3rd Floor, Boston, 02118, MA, USA

    Daichi Hayashi, Michel D. Crema & Ali Guermazi

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  1. Martin Englund
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  2. Frank W. Roemer
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  3. Daichi Hayashi
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Contributions

M. Englund researched the data and wrote the article. F. W. Roemer researched data for the article and reviewed and/or edited the manuscript before submission. D. Hayashi and M. D. Crema reviewed and/or edited the manuscript before submission. A. Guermazi provided a substantial contribution to discussions of the content and reviewed and/or edited the manuscript before submission.

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Correspondence to Martin Englund.

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Competing interests

F. W. Roemer and M. D Crema are shareholders of Boston Imaging Core Lab. A. Guermazi is the president of Boston Imaging Core Lab, and a consultant for AstraZeneca, Genzyme, Merck Serono, Novartis, and Stryker. M. Englund and D. Hayashi declare no competing interests.

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Englund, M., Roemer, F., Hayashi, D. et al. Meniscus pathology, osteoarthritis and the treatment controversy. Nat Rev Rheumatol 8, 412–419 (2012). https://doi.org/10.1038/nrrheum.2012.69

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