In this short video from Dr Mark Fulcher, we discuss the differences between a meniscal tear and osteoarthritis.
When is a meniscal tear not a meniscal tear?
We get quite a few patients referred to us querying a meniscal tear and a lot of them actually don't have a meniscal tear. They have a degree of chondral damage or osteoarthritis and it's difficult because they do present in a similar manner. Localised pain, swelling, sometimes from catching and mechanical symptoms. But the two entities are quite different and we treat them differently.
How can you distinguish between the two?
Well, it can be difficult, but there are some things on history that are really important. So, older patients are more likely to have a combination of a meniscal tear with some chondral disease. So, patient age is one factor and probably, an age cutoff, maybe around 40 to 45. Patients who've had previous injuries to the knee, particularly if they've had surgery before, an ACL reconstruction or an arthroscopy to the debride some meniscus, they're more likely to have some chondral disease and some post-traumatic osteoarthritis.
And I think another useful thing is a simple x-ray. So, patients who have x-ray changes consistent with osteoarthritis, even if it's pretty modest. So, we might be talking about a small amount of joint space narrowing or some marginal osteophytes. Those patients are less likely to have an isolated meniscal tear.
Why is it important to distinguish between these diagnoses?
So I think the key reason to be sure that you've got the diagnosis right, is around treatment. So, patients with an isolated meniscal tear, can get good symptomatic relief from surgery to debride the meniscus. But patients who've already got some established articular cartilage change and certainly when you see some osteoarthritis on an x-ray, those patients really don't do well with surgery. And so we work much, much harder to work on rehabilitation. So, getting the patient moving and managing their pain and there are a variety of different ways we can do that. And addressing other lifestyle factors. Addressing their weight, addressing the activity that they do in their day, and looking at a much more holistic, I guess, a holistic pattern of treatment rather than focusing down on surgery.
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