The role of arthroscopy in those patients with osteoarthrosis and meniscal tears

There has been a lot of debate recently regarding the role of arthroscopy (keyhole surgery) in those people that have a meniscal cartilage tear and osteoarthrosis.

Osteoarthrosis is also known as osteoarthritis, and is wear and tear of the articular cartilage or joint surface. For most people it is an age related phenomenon. It can also occur as a result of an injury to the knee, previous surgery, as a result of an inflammatory condition, and there has also been a genetic link identified.

Meniscal cartilage is the tissue that sits in between the two joint surfaces and in the knee this is the femur (thigh bone) and tibia (leg bone). The meniscus acts as a shock absorber reducing the amount of wear and tear between these two bones. The meniscus frequently tears due to injury in those people less than 30 years of age. Unfortunately for people over 35 years of age the meniscus tears through a degeneration or “wear and tear”. The reason it does this is because as we age there is an alteration in the composition of the meniscus and therefore the forces placed on the altered meniscus causes it to tear. There does not need to be an injury at all and most of the time will occur from a small event such as missing a step, twisting awkwardly or getting out of your car. People can have meniscal tears and not know they do until an event occurs to inflame their knee.

Thankfully osteoarthrosis occurs in most people who are over 55 years of age, however if there is a genetic link, previous injury or surgery to your knee, you may get arthrosis sooner.

Meniscal tears that cause locking or jamming of the knee with ongoing pain, swelling and feelings of instability (giving way / collapsing) will normally settle down in only a small minority of patients. Arthroscopy will benefit patients but this is dependent on the tear pattern of the meniscus. It has been well documented that not all meniscal tears are the same and those people who have complex tears, flap tears, bucket handle tears or tears with extrusion will generally have a better result following arthroscopy than if not operated on and when compared with other tear patterns. Recently there has been an ongoing debate as to the benefit of arthroscopy in those patients who have co-existing meniscal pathology and osteoarthrosis. This debate has been fueled by doctors and surgeons publishing research either supporting the use of arthroscopy or stating that arthroscopy is of no benefit to these patients. This makes the job of the surgeon difficult because although research guides our treatment of patients’ blanket results cannot be applied to individuals.

This is where the clinical judgment of the surgeon is important in determining which candidates with a meniscal tear and arthrosis are suitable for surgery.

In my opinion, patients who have a moderate (nearly bone-on-bone) or severe (bone-on-bone) level of osteoarthrosis with a meniscal tear will not benefit from an arthroscopy. These patients will have options available to them but may at some stage require knee replacement. Patients who have no or mild osteoarthrosis will on the whole benefit following arthroscopy of the knee but must have symptoms, clinical signs, and MRI findings of a meniscal tear. Those patients who have a meniscal tear but have no or few symptoms and signs will not have a clinical benefit from arthroscopy.

If you have any questions regarding this or any other knee related issue please do not hesitate to contact us by submitting our enquiry form.