Degenerative tears of the posterior horn of the medial meniscus: correlation between MRI findings and outcome following intra-articular steroid/bupivacaine injection of the knee

Abstract

To evaluate the response of symptomatic degenerative tears of the posterior horn of the medial meniscus to guided intra-articular knee steroid/bupivacaine injection and to correlate clinical outcomes with preprocedural findings at magnetic resonance imaging (MRI). Sixty patients who had clinical and MRI evidence of a symptomatic degenerative tear of the posterior horn of the medial meniscus, isolated or accompanied by additional features of degenerative arthritis, who had failed conservative approaches (physiotherapy, non-steroidal anti-inflammatories, and 3 months rest/knee bracing) were included in the study. Patients underwent intra-articular knee steroid/bupivacaine injection and were followed clinically for a minimum of 6 months. Preprocedural MRI findings were correlated with duration of symptoms, clinical response to injection (recorded as complete, partial or no response) and duration of response to injection. Forty-nine of 60 patients (82%) reported an improvement in symptoms following guided intra-articular knee steroid/bupivacaine injection (complete: 25 patients (42%), partial: 24 (40%) patients). Improvement was sustained in 32 of 60 patients (53%) at follow-up. Thirteen of 18 patients (72%) who had an isolated degenerative tear of the posterior horn of the medial meniscus recorded a complete resolution of symptoms. This was sustained at follow-up in 10 patients (56%). Intra-articular steroid/bupivacaine knee joint injection reduced pain symptoms in the majority of patients (81.7%) with degenerative tears of the posterior horn of the medial meniscus, usually with a sustained response. Preprocedural MRI appearances correlate with response to injection. Patients with isolated tears are more likely to have a favourable outcome.