Natural History of Symptomatic Meniscal Tears: Arthroscopic Evaluation of Chondral Damage at 4-Year Minimum

Abstract

Background: The natural history of meniscal tears is unclear. Studies have tried to clarify many aspects. Association with chondral injuries are of main relevance to the long-term status of the knee but evidence is limited. Objective: The aim of this study is to describe the intraarticular state of the knee focused on chondral injury in patients with persistent symptomatic meniscal tears that were untreated for a minimum period of 4 years. Methods: A total of 47 patients with symptomatic meniscal tears in whom surgery was indicated but was delayed mainly for administrative reasons, were recruited between January 1st, 2004 and April 30th, 2010 in a regional hospital. Follow up ended until circumstances allowed surgical resolution through arthroscopy. Only patients with meniscal tear in which diagnosis was confirmed and remained symptomatic were included. Patients with initial grade IV Kellgren-Lawrence osteo-arthritis were excluded. Statistical chi-square and logistic regression analysis were used. Results: Mean follow up period was 5.8 years (range: 4.3 - 10.2 years). 57 meniscal injuries were found in 47 patients. 25 were lateral and 32 medial meniscal tears. Overall, 29 patients had articular cartilage damage (51%). Chondral injuries were found in 15 of 25 lateral meniscal lesions (60%) and 14 of 32 medial lesions (44%). Patients with lateral compartment meniscal injury had a relative risk (RR) of 2.5 of developing chondral injury (p-value 0.05). Compared to 51% of patients with associated chondral and meniscal damage (n = 29), only 12% of patients with healthy meniscus (n = 7) had chondral injury (p-value 0.05). Conclusion: Persistent symptomatic meniscal tears after medium to long term (4 to 10 years) are associated with chondral damage in 51% of patients. Chondral damage associated with meniscal tears is usually deep and involves femur and tibial sides. Lateral menisci injury is significantly associated with articular cartilage damage in the ipsilateral compartment. This study demonstrates a significant association between meniscal injury and chondral damage.