Healthy meniscus important in knee arthritis

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Damage to the meniscus—a cartilage disk that cushions the knee joint—increases the risk of cartilage loss in patients with osteoarthritis of the knee, according to a report.

“The meniscus performs an important function in the joint and removing it (either in part or whole) will only enhance the rate of structural change within the joint,” Dr. David J. Hunter from Boston University School of Medicine, Massachusetts told Reuters Health.

Hunter and colleagues explored the role of meniscal tears and meniscal malposition as risk factors for cartilage loss in 257 men and women with knee osteoarthritis.

Each measure of meniscal malposition was associated with an increased risk of cartilage loss, the authors report. Meniscal damage was also strongly associated with cartilage loss.

“Our study results suggest that the meniscus plays an important role in further cartilage loss,” the investigators write in the journal Arthritis and Rheumatism. “However, we cannot infer causality on the basis of these findings.”

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 note. “Our study points to the need for critical, prospective evaluation of these new therapeutic options.”

“Although the study did not evaluate the risks of surgery in particular, the study suggests that more meniscus is better for patients with osteoarthritis,” Hunter said. “Thus, in the absence of symptoms such as a locked knee, I would advocate preserving the meniscus that remains and managing the osteoarthritis appropriately.”

Specifically, “In this population I would advocate managing their knee osteoarthritis with non-pharmacologic means (weight loss, knee strengthening, braces, etc.), analgesic agents, and where these have failed, surgery,” Hunter said.

SOURCE: Arthritis and Rheumatism March 2006.

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