Abstract
PurposeThe management of meniscal tears is a widely researched and evolving field. Previous studies reporting the incidence of meniscal tears are outdated and not representative of current practice. The aim of this study was to report the current incidence of MRI confirmed meniscal tears in patients with a symptomatic knee and the current intervention rate in a large NHS trust.MethodsRadiology reports from 13,358 consecutive magnetic resonance imaging scans between 2015 and 2017, performed at a large UK hospital serving a population of 470,000, were assessed to identify patients with meniscal tears. The hospital database was interrogated to explore the subsequent treatment undertaken by the patient. A linear regression model was used to identify if any factors predicted subsequent arthroscopy.Results1737 patients with isolated meniscal tears were identified in patients undergoing an MRI for knee pain, suggesting a rate of 222 MRI confirmed tears per 100,000 of the population aged 18 to 55 years old. 47% attended outpatient appointments and 22% underwent arthroscopy. Root tears [odds ratio (95% CI) 2.24 (1.0, 4.49); p = 0.049] and bucket handle tears were significantly associated with subsequent surgery, with no difference between the other types of tears. The presence of chondral changes did not significantly affect the rate of surgery [0.81 (0.60, 1.08); n.s].ConclusionMeniscal tears were found to be more common than previously described. However, less than half present to secondary care and only 22% undergo arthroscopy. These findings should inform future study design and recruitment strategies. In agreement with previous literature, bucket handle tears and root tears were significant predictors of subsequent surgery.Level of evidenceIII.
Highlights
Meniscal tears have been estimated to affect 60–70 per 100,000 of the population [1]
The aim of this study is to review consecutive magnetic resonance imaging (MRI) scans performed for patients with a symptomatic knee over a 3-year period at a large NHS trust to: 1. Explore the epidemiology of meniscal tears, in particular, to identify the current incidence of MRI confirmed meniscal tears in patients with a symptomatic knee in current practice and the proportion of these that undergo surgical management
Between January 2015 and December 2017, there were 13,358 MRI knee scans performed at University Hospital Coventry and Warwickshire (UHCW) NHS trust
Summary
Meniscal tears have been estimated to affect 60–70 per 100,000 of the population [1]. They can affect younger patients with higher functional demand as well as older patients who may have pre-existing degeneration in the knee [2, 3] Both the British Association for Surgery of the Knee (BASK) and the European Society for Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA) have produced consensus guidelines on the treatment for meniscal tears [4,5,6]. This identifies clinical scenarios where urgent surgery is indicated, surgery after a period of physiotherapy is indicated and no surgery is indicated. Further work is needed to identify the incidence of each type of target lesion diagnosed on magnetic resonance imaging (MRI) and the incidence of degenerative changes in patients with
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