Robert LaPrade, MD, PhD composed a rebuttal to: “Surgery to Repair Meniscal Tears in the Knee May Accelerate the Onset of Osteoarthritis and Cartilage Loss“, a presentation at the Radiological Society of North America (RSNA).
Much has been made in the media about the recent study that was presented at the Radiologic Society of North America in Chicago on December 3, 2014. In this study, it was reported that patients with “meniscal repairs” had an “acceleration” of the onset of osteoarthritis and cartilage loss in their knees. However, one must look at the average age of the patients, which was 60, and note from their MRI photos that were presented, that this was not a study about meniscal repairs, but in fact meniscectomies, where a meniscal tear needs to be resected because it was not repairable. In addition, it is important to recognize that it is very rare that meniscal repairs are performed on patients 60 years or older and these are for relatively specific indications.
It is well known in the peer reviewed literature that partial meniscectomies can lead to the development and/or progression of articular cartilage loss, called chondromalacia, which represents the early stages of osteoarthritis. This information had been well reported in the peer review literature. My biggest concern is that this study’s title noting “meniscal repairs,” which is in fact meniscectomies, does a disservice to those who perform meniscal repairs. Preservation of meniscal tissue is very important to prevent the progression of arthritis. Thus, a meniscal repair, where a meniscus is sutured in an attempt to provide both stability to the meniscus and also to assist with healing, is an essentially component of preserving joint health and this has been validated in the peer-reviewed literature.
In summary, meniscal repairs are not equivalent to meniscectomies. While this is commonly confused by patients who present to be examined in the office, it is important to recognize that there is a huge difference between a meniscectomy, where the meniscus is resected and there is loss of the shock-absorbing capacity of the meniscus, compared to a meniscus repair, where the meniscus is sewn in place to preserve it. Thus, this study, which to my knowledge has not been published in the peer reviewed literature as yet, by Frank Roemer, MD, from Boston University, is about the effects of meniscectomies in older patients. I commend the authors for following their patients with MRI scans and assessing their loss of articular cartilage because this can be very difficult to do. However, I would recommend that in the process of peer review that they change their title so that it both does not confuse non-orthopedic surgeons who take care of patients and also patients in general as to the benefits of meniscal repairs to preserve joint health and protect articular cartilage.
Robert F. LaPrade, MD, PhD
THE STEADMAN CLINIC
Complex Knee & Sports Medicine Surgeon
STEADMAN-PHILIPPON RESEARCH INSTITUTE
Chief Medical Officer
Co-Director of the Sports Medicine Fellowship Program
Director of the International Research Scholar Program