Complex and horizontal cleavage meniscal tears: association with significant cartilage damage (SS-25)

      Experimental studies demonstrated that meniscal tears could lead to chondropathy and osteoarthritis. Clinical studies are controversial. Some authors describe the association of meniscal and articular cartilage lesions as coincidental, whereas others believe that causal link may exists. Some studies suggest that stable tears have good potential for healing and are less likely to produce osteoarthritis. Even though there are not a lot of studies to support this fact, complex tears and horizontal cleavage tears have been considered degenerative tears associated with cartilage degeneration. The objective of the present study was to evaluate whether horizontal cleavage and complex meniscal tears are associated with more significant cartilage damage, in comparison with patients having other pattern of meniscal injury. Data were collected prospectively from 1,000 consecutive knee arthroscopies. Of the 1,000 patients who had knee arthroscopy, 507 (50.7%) patients had meniscal tears and mainly these patients were included in this study. There were 359 men and 148 women with age 13 to 85 years (mean age 40.8 ± 15.2 years). Of these patients, 333 (65.6%) had medial meniscal tears and 184 (34.4%) had lateral meniscal tears. Patients details (age, sex, duration of symptoms, injuries, and possible mechanism of injury), operative details (types and number of portals, equipment used), intra-articular findings (articular, meniscal and synovial lesions, and stability characteristics) and procedures performed were recorded. Pathologic findings were recorded diagrammatically, with articular lesions being represented on accurate anatomic maps of the articular surfaces. The articular maps were divided into different functional zones that were labeled numerically for each bony surface. Outerbridge classification was used for the evaluation of the severity of the cartilage lesions. A maximum of the 3 most significant articular lesions recorded on the data sheet was entered into the database. Of the 1,000 patients, 874 (87.4%) were noted to have chondral lesions and 507 (50.7%) to have meniscal tear. We have not found any increased incidence of chondral lesions or increased severity of chondral lesions (Outerbridge classification) in patients with meniscal tear in comparison with patients without meniscal tear. Comparing patients with horizontal cleavage and complex meniscal tears and patients with other type of meniscal tear increased incidence of chondral lesions (88.5% v 68.9%, respectively, P < .001), increased severity (type III and IV Outerbridge classification) of chondral lesions (53.4% v 29.1%, respectively, P < .001), and increased incidence of patients having more than one chondral lesion (65% v 32.7%, respectively, P < .001) was found for the first group. In conclusion, patients with meniscal tears are not associated with increased incidence and severity of chondral lesions, in comparison with patients without meniscal tear. On the contrary, complex and horizontal cleavage meniscal tears are highly associated with increased incidence and severity of cartilage degeneration, in comparison with other types of meniscal tears.