Knee pain, aching, or stiffness: role of meniscal damage

2007/12/03

The Multicenter Osteoarthritis Study (MOST) group of Dr. Martin Englund and colleagues from Boston University School of Medicine evaluated the effect of meniscal damage on the development of frequent knee pain, aching, or stiffness in middle-aged and older adults. They showed that in this age group any association between meniscal damage and the development of frequent knee pain seems to be present because both pain and meniscal damage are related to OA and not because of a direct link between the two.

The MOST study is a prospective study with 3,026 individuals of the age of 50 years or older who have knee osteoarthritis (OA) or are at high risk of developing this disorder. The investigators examined knees at baseline and at 15 months.
Male and female study participants, Caucasians and members of ethnic minorities, had been recruited from two U.S. communities (Birmingham, Alabama, and Iowa City, Iowa). Through telephone interviews and clinical visits with the subjects, 110 “case knees” were identified. They were defined as knees free from symptoms at baseline, which had developed frequent pain, aching, or stiffness after the study period of 15 months. A random sample of 220 controls was drawn from those knees with no frequent symptoms at baseline that did not become “case knees”.
Using 1.0-T MRI performed at baseline and at follow-up, two musculoskeletal radiologists blinded to the case-control status assessed the meniscal damage based on the following scale: 0 = intact, 1 = minor tear, 2 = nondisplaced tear or prior surgical repair, and 3 = displaced tear, resection, maceration, or destruction. The impact of meniscal damage was analyzed by contingency tables and logistic regression.
Both in case knees (38%) and in controls (29%) meniscal damage was common at baseline. While there was a modest association between the meniscal damage score (range 0-3) and the development of frequent knee pain, aching, or stiffness (Odds Ratio 1.21, 95% confidence interval 0.96-1.51, adjusted for age, sex, and BMI), meniscal damage was mostly present in knees with OA. Considering the co-occurrence of OA, investigators found no independent association between meniscal damage and the development of frequent knee symptoms (Odds Ratio 1.05, 95% confidence interval 0.80-1.37).
In summary, there was no independent association between meniscal damage and the development of frequent knee symptoms. Dr. Englund said that “meniscal damage in older adults is highly associated with OA of the knee, however, meniscal damage often seems not to be directly responsible for later symptoms, while other features of OA may be so.”

Englund M, Niu J, Guermazi A, et al: Effect of meniscal damage on the development of frequent knee pain, aching, or stiffness. Arthritis Rheum 2007;56(12):4048-54.