March 10, 2006

Healthy meniscus important in knee arthritis

By Will Boggs, MD

NEW YORK (Reuters Health) - 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.