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. 2017 Jun;25(6):850-857.
doi: 10.1016/j.joca.2016.12.023. Epub 2016 Dec 30.

Associations among meniscal damage, meniscal symptoms and knee pain severity

L A MacFarlane  1 , H Yang  2 , J E Collins  3 , A Guermazi  4 , M H Jones  5 , E Teeple  6 , L Xu  7 , E Losina  8 , J N Katz  9
Affiliations

Associations among meniscal damage, meniscal symptoms and knee pain severity

L A MacFarlane et al. Osteoarthritis Cartilage. 2017 Jun.

Abstract

Objective: Meniscal tears occur frequently in patients with knee osteoarthritis (OA). The aim of our study was to determine whether meniscal damage identified on magnetic resonance imaging (MRI) is associated with the severity of knee pain or the frequency of meniscal symptoms in patients with knee OA.

Methods: We performed a cross-sectional study using data from the Meniscal Tear in Osteoarthritis Research (MeTeOR) trial. We characterized meniscal damage hierarchically as: root tear; maceration; long and short complex or horizontal tears; and simple tears. Subjects completed the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain Scale and a survey of frequency of meniscal symptoms. We used multivariable general linear models to assess the relationships between meniscal damage and 1) pain severity; and 2) meniscal symptoms, after adjusting for demographic and radiographic features. In further analysis root tear was considered as a binary variable.

Results: Analysis included 227 knees. Root tears were present in 19%, maceration in 14%, long complex or horizontal tears in 22%, short complex or horizontal tears in 30%, and simple tears in 14%. Root tears were associated with higher WOMAC pain scores. The adjusted mean WOMAC pain score was 45.2 (standard error (SE) 2.7) for those with root tear and 38.7 (SE 1.2) for subjects without root tear (P = 0.03). We did not find statistically significant associations between meniscal morphology and frequency of meniscal symptoms.

Conclusion: Root tears were associated with greater pain than meniscal tears or maceration. We did not find a relationship between meniscal damage and meniscal symptoms.

Trial registration: ClinicalTrials.gov NCT00597012.

Keywords: Meniscal symptoms; Meniscal tear; Osteoarthritis; Pain.

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Conflict of interest statement

Competing Interests

Lindsey A. MacFarlane: No disclosures

Heidi Yang: No disclosures

Jamie E. Collins: No disclosures

Ali Guermazi: Dr. Guermazi is a Consultant to MerckSerono, TissueGene, OrthoTrophix,

AstraZeneca and Genzyme. He is a Shareholder of BICL, LLC.

Morgan H. Jones: Dr. Jones receives support from NIH grant R01 AR05557 09 (Jeff Katz, PI). He also receives support from NIH grant K23 AR066133 02 (Morgan Jones, PI).

Erin Teeple: Dr. Teeple was an external consultant for Tribiologics, LLC. The work was done in 2014 and she does not have an ongoing financial relationship with the company.

Li Xu: No disclosures

Elena Losina: No disclosures

Jeffrey N. Katz: No disclosures

Figures

Figure 1
Figure 1. Examples of meniscal damage on MRI with annotation
a) Vertical tear: Sagittal intermediate-weighted MRI of the knee shows a vertical tear of the posterior horn of the medial meniscus (arrow). b) Maceration: Coronal intermediate-weighted MRI of the left knee shows diminutive body of the lateral meniscus with partial maceration (arrow) and lateral extrusion. There is also a medial extrusion of medial meniscus (arrowhead). Large lateral and small medial femoral osteophytes are noted. There is a severe cartilage loss with denudation of the lateral tibial plateau which is also remodeled. c) Radial tear: Coronal fat-suppressed proton density-weighted MRI of the right knee (1) shows a small radial tear of the medial meniscus (arrow) with grade 1 sprain of the medial collateral ligament (arrowheads). Axial fat-suppressed proton density-weighted MRI (2) confirms the radial tear is located at the anterior horn and body junction of the medial meniscus (arrow). d) Horizontal tear: Sagittal fat-suppressed proton density-weighted MRI shows horizontal oblique tear of the posterior horn of the lateral meniscus (arrow). There is also a moderate Hoffa-synovitis (circle) shown as a hyperintensity signal at the intercondyar region. e) Root tear: Coronal intermediate-weighted MRI of the left knee shows a complete vertical tear of the posterior root of the medial meniscus (arrow) with medial meniscal subluxation (arrowhead).
Figure 1
Figure 1. Examples of meniscal damage on MRI with annotation
a) Vertical tear: Sagittal intermediate-weighted MRI of the knee shows a vertical tear of the posterior horn of the medial meniscus (arrow). b) Maceration: Coronal intermediate-weighted MRI of the left knee shows diminutive body of the lateral meniscus with partial maceration (arrow) and lateral extrusion. There is also a medial extrusion of medial meniscus (arrowhead). Large lateral and small medial femoral osteophytes are noted. There is a severe cartilage loss with denudation of the lateral tibial plateau which is also remodeled. c) Radial tear: Coronal fat-suppressed proton density-weighted MRI of the right knee (1) shows a small radial tear of the medial meniscus (arrow) with grade 1 sprain of the medial collateral ligament (arrowheads). Axial fat-suppressed proton density-weighted MRI (2) confirms the radial tear is located at the anterior horn and body junction of the medial meniscus (arrow). d) Horizontal tear: Sagittal fat-suppressed proton density-weighted MRI shows horizontal oblique tear of the posterior horn of the lateral meniscus (arrow). There is also a moderate Hoffa-synovitis (circle) shown as a hyperintensity signal at the intercondyar region. e) Root tear: Coronal intermediate-weighted MRI of the left knee shows a complete vertical tear of the posterior root of the medial meniscus (arrow) with medial meniscal subluxation (arrowhead).
Figure 1
Figure 1. Examples of meniscal damage on MRI with annotation
a) Vertical tear: Sagittal intermediate-weighted MRI of the knee shows a vertical tear of the posterior horn of the medial meniscus (arrow). b) Maceration: Coronal intermediate-weighted MRI of the left knee shows diminutive body of the lateral meniscus with partial maceration (arrow) and lateral extrusion. There is also a medial extrusion of medial meniscus (arrowhead). Large lateral and small medial femoral osteophytes are noted. There is a severe cartilage loss with denudation of the lateral tibial plateau which is also remodeled. c) Radial tear: Coronal fat-suppressed proton density-weighted MRI of the right knee (1) shows a small radial tear of the medial meniscus (arrow) with grade 1 sprain of the medial collateral ligament (arrowheads). Axial fat-suppressed proton density-weighted MRI (2) confirms the radial tear is located at the anterior horn and body junction of the medial meniscus (arrow). d) Horizontal tear: Sagittal fat-suppressed proton density-weighted MRI shows horizontal oblique tear of the posterior horn of the lateral meniscus (arrow). There is also a moderate Hoffa-synovitis (circle) shown as a hyperintensity signal at the intercondyar region. e) Root tear: Coronal intermediate-weighted MRI of the left knee shows a complete vertical tear of the posterior root of the medial meniscus (arrow) with medial meniscal subluxation (arrowhead).
Figure 1
Figure 1. Examples of meniscal damage on MRI with annotation
a) Vertical tear: Sagittal intermediate-weighted MRI of the knee shows a vertical tear of the posterior horn of the medial meniscus (arrow). b) Maceration: Coronal intermediate-weighted MRI of the left knee shows diminutive body of the lateral meniscus with partial maceration (arrow) and lateral extrusion. There is also a medial extrusion of medial meniscus (arrowhead). Large lateral and small medial femoral osteophytes are noted. There is a severe cartilage loss with denudation of the lateral tibial plateau which is also remodeled. c) Radial tear: Coronal fat-suppressed proton density-weighted MRI of the right knee (1) shows a small radial tear of the medial meniscus (arrow) with grade 1 sprain of the medial collateral ligament (arrowheads). Axial fat-suppressed proton density-weighted MRI (2) confirms the radial tear is located at the anterior horn and body junction of the medial meniscus (arrow). d) Horizontal tear: Sagittal fat-suppressed proton density-weighted MRI shows horizontal oblique tear of the posterior horn of the lateral meniscus (arrow). There is also a moderate Hoffa-synovitis (circle) shown as a hyperintensity signal at the intercondyar region. e) Root tear: Coronal intermediate-weighted MRI of the left knee shows a complete vertical tear of the posterior root of the medial meniscus (arrow) with medial meniscal subluxation (arrowhead).
Figure 1
Figure 1. Examples of meniscal damage on MRI with annotation
a) Vertical tear: Sagittal intermediate-weighted MRI of the knee shows a vertical tear of the posterior horn of the medial meniscus (arrow). b) Maceration: Coronal intermediate-weighted MRI of the left knee shows diminutive body of the lateral meniscus with partial maceration (arrow) and lateral extrusion. There is also a medial extrusion of medial meniscus (arrowhead). Large lateral and small medial femoral osteophytes are noted. There is a severe cartilage loss with denudation of the lateral tibial plateau which is also remodeled. c) Radial tear: Coronal fat-suppressed proton density-weighted MRI of the right knee (1) shows a small radial tear of the medial meniscus (arrow) with grade 1 sprain of the medial collateral ligament (arrowheads). Axial fat-suppressed proton density-weighted MRI (2) confirms the radial tear is located at the anterior horn and body junction of the medial meniscus (arrow). d) Horizontal tear: Sagittal fat-suppressed proton density-weighted MRI shows horizontal oblique tear of the posterior horn of the lateral meniscus (arrow). There is also a moderate Hoffa-synovitis (circle) shown as a hyperintensity signal at the intercondyar region. e) Root tear: Coronal intermediate-weighted MRI of the left knee shows a complete vertical tear of the posterior root of the medial meniscus (arrow) with medial meniscal subluxation (arrowhead).
Figure 1
Figure 1. Examples of meniscal damage on MRI with annotation
a) Vertical tear: Sagittal intermediate-weighted MRI of the knee shows a vertical tear of the posterior horn of the medial meniscus (arrow). b) Maceration: Coronal intermediate-weighted MRI of the left knee shows diminutive body of the lateral meniscus with partial maceration (arrow) and lateral extrusion. There is also a medial extrusion of medial meniscus (arrowhead). Large lateral and small medial femoral osteophytes are noted. There is a severe cartilage loss with denudation of the lateral tibial plateau which is also remodeled. c) Radial tear: Coronal fat-suppressed proton density-weighted MRI of the right knee (1) shows a small radial tear of the medial meniscus (arrow) with grade 1 sprain of the medial collateral ligament (arrowheads). Axial fat-suppressed proton density-weighted MRI (2) confirms the radial tear is located at the anterior horn and body junction of the medial meniscus (arrow). d) Horizontal tear: Sagittal fat-suppressed proton density-weighted MRI shows horizontal oblique tear of the posterior horn of the lateral meniscus (arrow). There is also a moderate Hoffa-synovitis (circle) shown as a hyperintensity signal at the intercondyar region. e) Root tear: Coronal intermediate-weighted MRI of the left knee shows a complete vertical tear of the posterior root of the medial meniscus (arrow) with medial meniscal subluxation (arrowhead).
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