Abstract
Meniscal lesions are common and may contribute to the development of knee arthrosis. A few case-control and cross-sectional studies have identified knee-straining work as risk factors for meniscal lesions, but exposure-response relations and the role of specific exposures are uncertain, and previous results may be sensitive to reporting and selection bias. We examined the relation between meniscal lesions and cumulative exposure to heavy lifting in a prospective register-based study with complete follow-up and independent information on exposure and outcome. We established a cohort of unskilled men employed at Copenhagen Airport or in other companies in the metropolitan Copenhagen area from 1990 to 2012 (the Copenhagen Airport Cohort). The cohort at risk included 3,307 airport baggage handlers with heavy lifting and kneeling or squatting work tasks and 63,934 referents with a similar socioeconomic background and less knee-straining work. Baggage handlers lifted suitcases with an average weight of approximately 15 kg, in total approximately five tonnes during a 9-hour workday. The cohort was followed in the National Patient Register and Civil Registration System. The outcome was a first time hospital diagnosis or surgery of a meniscal lesion. Baggage handlers had a higher incidence of meniscal lesions than the referents. Within baggage handlers spline regression showed that the incidence rate ratio was 1.91 (95% confidence interval: 1.29–2.84) after five years as a baggage handler and then decreased slowly to reach unity after approximately 30 years, adjusted for effects of potential confounders. This relation between baggage handling and meniscal lesions was present for work on the apron which involves lifting in a kneeling or squatting position, but not in the baggage hall, which only involves lifting in standing positions. The results support that long-term heavy lifting in a kneeling or squatting position is a risk factor for the development of symptomatic meniscal lesions.
Highlights
Musculoskeletal disorders and disability are among the leading causes of disease burden in high-income countries [1], and knee disorders including meniscal lesions constitute a large part of these disorders.The prevalence of meniscal damage diagnosed by magnetic resonance imaging (MRI) was 30% among women and 42% among men in a general population of the United States of America, 50 to 90 years of age [2]
The cohort consisted of 3,307 baggage handlers and 63,934 referents at risk of a first time meniscal lesion in the observation period from 1990 to 2012 (Table 1)
Use of baggage lifter and belt-loader had no significant effects. In this large cohort study the risk of meniscal lesions was significantly increased for baggage handlers compared to a reference group of other unskilled workers with a variety of different work tasks
Summary
Musculoskeletal disorders and disability are among the leading causes of disease burden in high-income countries [1], and knee disorders including meniscal lesions constitute a large part of these disorders. The prevalence of meniscal damage diagnosed by magnetic resonance imaging (MRI) was 30% among women and 42% among men in a general population of the United States of America, 50 to 90 years of age [2]. The incidence of meniscal tears is reported to be 2 per 1000 patients per year in Holland [3]. Arthroscopic knee surgery for meniscal tears is one of the most common orthopedic surgical procedures in USA [5]. In 2011, the rate of meniscal surgery was 3.1 per 1000 persons in the Danish population [6]
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