Published on: 16-Aug-2024
The knee joint consists of bones, ligaments, and two types of cartilage. The meniscus consists of two wedge-shaped pieces of cartilage that sit between the two major bones of the knee joint: the femur (thigh bone) and the tibia (shinbone). The meniscus serves as a shock absorber and provides stability to the knee. . Meniscus tears can be acute(due to an injury) or degenerative(due to wear and tear).
Covering the ends of the bones of the knee is a different type of cartilage, a strong, smooth, rubbery substance that allows the bones to glide over one another when you bend or straighten your knee. The most common type of arthritis in the knee, osteoarthritis, is caused by a gradual breakdown of cartilage. As the cartilage erodes, the bones ultimately rub against each other, causing pain, swelling, and stiffness.
Video Transcript
If you have a diagnosis of osteoarthritis and a meniscal tear it is important to understand that most patients who have knee arthritis will have an associated meniscal tear. In fact the number one second opinion that comes to my office is a patient who is told that they have a meniscal tear and need surgery, yet were never told about the osteoarthritis that was also present in association with the meniscal tear.
The reason this distinction is important is because patients who have a combination of arthritis, which is loss of cartilage and a meniscal tear- if they choose surgery- have sometimes no better than a 50-50 chance that their symptoms will improve. Not uncommonly, arthroscopy might be recommended if non-surgical treatment fails in a setting where a patient has arthritis with or without a meniscal tear.
If the symptoms are largely being driven by arthritis, they may not see a clinical benefit. If they do, it may be less robust and short-lived compared to patients who just have a meniscal tear. If a patient’s symptoms are significant in coming from the meniscal tear, despite having some arthritis, then the benefits of arthroscopy can be more complete and more long-lasting.
The problem is, it’s very difficult for me to predict who will definitively benefit with arthroscopy when they have both the diagnosis of arthritis and meniscal tear. Therefore it’s important that we strongly consider the use of non-surgical treatment first, as the results of arthroscopy may not yield a substantial degree of satisfaction with less pain and more function in a setting where both arthritis and meniscal tears are present.
It’s also important to understand that despite having a diagnosis of arthritis with or without a meniscal tear, that participating in activities is not associated with disease progression. Your participation in activities might escalate your symptoms but it’s not likely to further your disease process. My job is to find a way for you to reduce the symptoms associated with this arthritis and this meniscal tear and allow you to engage in high-level activities with a higher degree of satisfaction and tolerance.
The best orthopedic care starts with the best orthopedic research. I am a proud faculty member in the department of orthopedic surgery at Rush University, home to the Midwest’s largest team of bone and joint scientists. With surgeons and clinicians partnering with elite laboratory researchers and data scientists, we continue to devise new solutions that push the boundaries of what’s possible in the treatment of musculoskeletal conditions.
Our work informs orthopedic care around the world and is fueled by donors, patients and families who believe in our research to help more people lead active lives free of pain. To learn more about opportunities to participate in research or become a supporter please ask a member of my team or visit our website at this address: www.rush.edu/LiveActive.
Brian Cole, MD, MBA is an expert in shoulder, elbow and knee surgery. He is the Chairman of Surgery at Rush Oak Park Hospital and leads the Rush Orthopedic Master’s Program. Dr. Cole holds several leadership positions in national and international orthopedic societies. Please visit https://www.briancolemd.com/knee/ for additional resources.
Related: https://sportsmedicineweekly.com/therapy/physical-therapy-for-knee-osteoarthritis/ and https://sportsmedicineweekly.com/blog/midwestortho-articles/when-do-meniscus-tears-require-treatment/
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