Meniscal Tear with Arthritis

You have knee arthritis and a meniscus tear.

One of the more common conditions that I see in the office is when someone comes in with an MRI that shows a meniscus tear and knee arthritis. Patients nowadays will have their MRI reports often before their office visit with me. Once they see the word meniscal tear, they latch onto this condition and start thinking about all the possibilities for treatment of meniscal tear and the arthritis diagnosis takes a back seat in their mind. It takes standing knee x-rays sometimes to correlate the MRI to see show how much arthritis is in the knee. So sometimes the X-rays are more important than the MRI because when one is standing it shows much cushion is gone in a functional position like standing vs lying down during the MRI.

Why is this important?

This is important because arthritis is by definition, a loss of cushion on the end of the bone of the knee. We grade arthritis on a scale of one through four. Grade 1 is softening of the cushion and deterioration, 2 is fraying with some loss of cushion, 3 is more than 50% loss of cushion, and 4 is having no cushion in certain areas with bone exposed as you can see in the pictures below.

Also, feel free to check out my link on arthritis for more information.

When you lose all the cushion, the nerve endings are exposed and that is why arthritis causes pain. So, what happens when you have a meniscal tear and arthritis?

It depends on the severity of the arthritis and the type of tear one has.

If someone has grade 4 arthritis and the meniscus tear is miniscule and not moving or is just degraded and looks like a tear but is actually the ground down meniscus, surgery for meniscal tears will definitely not help.

If someone has good joint surfaces a grade 1 or 2 arthritis and the meniscus tear is flipping around in the knee, then surgery usually helps that.

There are always cases where surgery does not help even with grade 1 or 2 and that is because meniscal tears are actually the beginning of joint arthritis. The cushion on the end of the bone degenerates and the meniscus also degenerates as it gets older and dries up tearing. We usually say bad arthritis trumps a minor meniscus tear because even if you did smooth out the tear, you are still left with bad arthritis which hurts.

So, what happens when you have both bad arthritis and a small or degenerative meniscal tear on MRI?

YOU TREAT THE ARTHRITIS FIRST.

This can be in the form of: