Degenerative meniscus: Pathogenesis, diagnosis, and treatment options

Abstract

The symptomatic degenerative meniscus continues to be a source of discomfort for a significant number of patients. With vascular penetration of less than one-third of the adult meniscus, healing potential in the setting of chronic degeneration remains low. Continued hoop and shear stresses upon the degenerative meniscus results in gross failure, often in the form of complex tears in the posterior horn and midbody. Patient history and physical examination are critical to determine the true source of pain, particularly with the significant incidence of simultaneous articular pathology. Joint line tenderness, a positive McMurray test, and mechanical catching or locking can be highly suggestive of a meniscal source of knee pain and dysfunction. Radiographs and magnetic resonance imaging are frequently utilized to examine for osteoarthritis and to verify the presence of meniscal tears, in addition to ruling out other sources of pain. Non-operative therapy focused on non-steroidal anti-inflammatory drugs and physical therapy may be able to provide pain relief as well as improve mechanical function of the knee joint. For patients refractory to conservative therapy, arthroscopic partial meniscectomy can provide short-term gains regarding pain relief, especially when combined with an effective, regular physiotherapy program. Patients with clear mechanical symptoms and meniscal pathology may benefit from arthroscopic partial meniscectomy, but surgery is not a guaranteed success, especially with concomitant articular pathology. Ultimately, the long-term outcomes of either treatment arm provide similar results for most patients. Further study is needed regarding the short and long-term outcomes regarding conservative and surgical therapy, with a particular focus on the economic impact of treatment as well.

Keywords: Meniscus; Degenerative joint disease; Meniscal tear; Osteoarthritis; Arthroscopy

Core tip: The healing potential of chronic degenerative menisci remains poor. Persistent hoop and shear stresses create complex tears in the posterior horn and midbody. Conservative treatment with anti-inflammatory medications and physical therapy may provide pain relief and improve mechanical knee function. For patients refractory to conservative therapy, arthroscopic partial meniscectomy can provide short-term pain relief when combined with a physiotherapy program. Surgery, however, is not a guaranteed success, especially in the presence of articular pathology. Long-term outcomes of surgical or non-surgical treatment have been shown to be similar for most patient subsets.