Mechanical problems with the knee, which patients may describe as locking, grinding or clicking, have traditionally been associated with meniscal tears. But a new study from investigators at Brigham and Women’s Hospital has found that these symptoms are more often driven by cartilage damage rather than meniscal pathology.
Findings from the study were published recently in the Journal of Bone and Joint Surgery.
“We’ve always thought that if a patient comes in and says their knee is catching or locking, it must be due to meniscal pathology,” said senior author Elizabeth G. Matzkin, MD, surgical director for women’s musculoskeletal health and chief of women’s sports medicine in the Brigham’s Department of Orthopaedic Surgery. “This research suggests that’s often not the case.”
Prospective Data Aid in Analysis
For the study, the investigators prospectively gathered data on 565 patients who were scheduled to undergo knee arthroscopy between 2012 and 2019. Patient-reported knee symptoms (PRKS) were collected before surgery using the Knee Injury and Osteoarthritis Score Questionnaire.
When the patients later underwent surgery, the investigators were able to examine the specific pathological conditions in the knee. They found that tri-compartmental cartilage damage was associated with significantly worse PRKS. Surprisingly, they didn’t observe an association between meniscal pathology and preoperative PRKS. Most patients with a degenerative meniscal tear, however, had concomitant cartilage pathology.
“These findings question traditional teaching and force us to dig deeper to understand where these symptoms are coming from,” Dr. Matzkin said. “Patients with these mechanical symptoms have always been grouped together, but perhaps they shouldn’t be.”
Linking Surgical Outcomes to Pathology
Dr. Matzkin’s team is now completing the second part of this study, which looks at one- and two-year outcomes after arthroscopy. The study aims to determine how patients do postoperatively, whether they had meniscal pathology, cartilage damage or both. Early findings suggest that outcomes are good regardless of the underlying causes of the symptoms that led the patients to seek out surgery.
Meniscal pathology and cartilage pathology often go hand in hand, especially in people with osteoarthritis, Dr. Matzkin noted. “We know that we’re helping patients with these surgeries,” she concluded. “But this study will help us further investigate how we are helping them.”