Arthritic Knees May Begin With Cartilage Loss

MONDAY, Feb. 27 (HealthDay News)

Damage to a pair of key knee structures called meniscus is associated with advanced cartilage loss in early knee osteoarthritis, Boston researchers report. Each knee is supported and protected by a pair of C-shaped meniscus that provide load bearing and shock absorption functions, along with stability enhancement.

The onset of knee osteoarthritis is fairly common after surgical removal of all or part of a torn meniscus (meniscectomy), but little is known about the impact of meniscal damage and abnormalities on cartilage loss in knees of people predisposed to osteoarthritis, noted researchers from Boston University School of Medicine.

This study included 257 people with knee osteoarthtritis who had MRI imaging of their most severely affected knee at the start of the study, and then again at 15 and 30 months into the study. The researchers used the MRI images to measure the position of the meniscus and to evaluate the severity of meniscal damage.

Of the MRI-assessed knees, 29 percent had a previous injury, 27 percent had a previous surgery, and 5 percent had a previous meniscectomy.

As expected, the researchers found a strong association between meniscal malposition and meniscal damage. There was also a strong association between meniscal tears and cartilage loss. In addition, the study found that reductions in coverage and height of the meniscus -- caused by partial dislocation of the meniscus -- increased the risk of cartilage loss. The findings appear in the March issue of Arthritis & Rheumatism.

This study did not implicate meniscus damage as a cause of osteoarthritis and did not distinguish the type of meniscal tear that may be linked to cartilage loss. However, the researchers said the findings highlight the importance of a strong, whole meniscus in protecting the knee from rapid damage in the early stages of disease, and perhaps lessening the need for replacement surgery.
"At present, efforts are being made to preserve a damaged meniscus rather than remove it, and an industry of meniscal replacement is developing," the authors wrote. "Our study points to the need for critical, prospective evaluation of these new therapeutic options."

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