Summary

In matched cohorts of patients with degenerative meniscus tears, having medial and lateral tears conferred a 1.5-fold, while complex tears a 1.3-fold risk of TKA within 5 years. Specific meniscal tear patterns and locations confer varying risk of progression to end-stage knee OA.

Abstract

Introduction

Meniscus tears are known to increase the risk of progression towards knee osteoarthritis (OA). However, the relationship between meniscus tear location, tear pattern, and subsequent progression to end-stage OA is not clearly defined.

Methods

The PearlDiver Mariner administrative claims database was queried for patients over 35 years old with a meniscus tear of specified laterality, 2015-2020, and minimum 2 years follow-up. Two cohorts were matched on age, gender, Charlson Comorbidity Index (CCI), obesity, ipsilateral knee OA, and meniscus treatment (meniscectomy versus conservative treatment): one with equal-sized subgroups stratified by tear location (medial only, lateral only, or both medial and lateral) and another by tear pattern (bucket-handle, complex, or peripheral). The rate of subsequent total knee arthroplasty (TKA) was compared between matched groups.

Results

129,987 patients (mean age: 57.8±10.5 years; obesity: 43.9%) were matched by tear location. 1,734 patients with medial-only tears (4.0%), 1,786 with lateral-only tears (4.1%), and 2,611 with medial+lateral tears (6.0%) underwent a total knee arthroplasty within 5 years (P<0.001). When controlling for ipsilateral knee OA, age, gender, comorbidities, obesity, and treatment, patients with medial or lateral tears did not demonstrate a difference in rates of TKA (P=0.42), but patients with both medial and lateral tears were 1.55-fold more likely to undergo TKA. 24,213 patients (mean age: 56.0 ±10.5 years; obesity: 58.8%) were matched by tear pattern. 296 patients with bucket-handle tears (3.7%), 373 with complex tears (4.6%), and 336 with peripheral tears (4.2%) underwent TKA (P=0.01). When controlling for the same factors as above, patients with bucket handle and peripheral tears had comparable rates of TKA (P=0.12), but patients with complex tears were 1.29-fold more likely to undergo TKA than patients with bucket handle tears (P=0.002).

Conclusion

In matched cohorts of patients with degenerative meniscus tears, having medial+lateral tears conferred a 1.5-fold, while complex tears a 1.3-fold risk of TKA within 5 years. Specific meniscal tear patterns and locations confer varying risk of progression to end-stage knee OA. These data may help counsel patients about their likelihood of progressing to end-stage OA and knee arthroplasty.