Successful conservative treatment of patients with MRI-verified meniscal lesions

• Published in: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA sports traumatology, arthroscopy : official journal of the ESSKA, 2015-01, Vol.23 (1), p.178-183
• Main Authors: Rathleff, Camilla Rams, Cavallius, Christian, Jensen, Hans Peter, Simonsen, Ole Højgaard, Rasmussen, Sten, Kaalund, Søren, Østgaard, Svend Erik
• Format: Article
• Language: English
• Subjects: Adult; Arthritis; Arthroscopy; Female; Humans; Knee; Lysholm Knee Score; Magnetic Resonance Imaging; Male; Medicine; Medicine & Public Health; Menisci, Tibial - surgery; Middle Aged; Orthopedics; Osteoarthritis; Pain; Pain Measurement; Patient Outcome Assessment; Patients; Prognosis; Prospective Studies; Regression analysis; Surgeons; Tibial Meniscus Injuries; Variables
• ISSN: 0942-2056; 1433-7347
• DOI: 10.1007/s00167-013-2494-z

Purpose To follow a prospective cohort of consecutive patients with MRI-verified meniscal lesions to identify pre-treatment prognostic factors for long-term results following arthroscopic or conservative treatment. Methods In the course of 1 year, 291 patients with knee pain and clinically suspected of meniscal lesion were referred to the regional orthopaedic division and subjected to MRI and clinical examination by an experienced surgeon. Patients with MRI-verified meniscal lesions were treated according to an arthroscopy restrictive strategy meaning that treatment was initiated by conservative treatment. Arthroscopy was only performed if satisfying pain relief was not obtained. The Lysholm score and Knee Injury and Osteoarthritis Outcome Score (KOOS) were obtained at baseline and after 12–24 months. A multiple linear regression model was used to investigate which pre-treatment prognostic factors were associated with improvement in the KOOS subscale pain from baseline to follow-up. Results An MRI-verified meniscal lesion was found in 185 patients (64 %). Among these, 58 % were treated successfully by conservative treatment. A high KOOS subscale pain score at baseline was associated with less improvement from baseline to follow-up. Bucket-handle lesions were associated with larger improvement from baseline to follow-up compared to flap-tear lesions. Conclusion MRI findings and clinical status measured by KOOS subscale pain are prognostic for improvement among patients treated for MRI-verified meniscal lesions. Good results were observed for both operative and conservative treatment. The success rate for conservative treatment was 58 %. Level of evidence Prospective cohort study, Level II.