title: Arthroscopic debridement compared to intra-articular steroids in treating degenerative medial meniscal tears.
abstract: OBJECTIVE
  Virtually all early cases of knee osteoarthritis have degenerative medial meniscus lesions accompanying the chondral defects on MRI. It is difficult to determine if the symptoms are caused by the unstable meniscus or by osteoarthritis, hence unclear guidance towards treatment. We, therefore, aimed to determine the clinical improvement following arthroscopic meniscectomy compared to intraarticular administration of corticosteroids for degenerative ruptures of the medial meniscus in the presence of early stage medial compartment knee osteoarthritis.
  
  
  METHODS
  We included 120 consecutive cases of nontraumatic symptomatic knees which had degenerative lesions of the medial compartment (cartilage and meniscus) on MRI's. They were randomized to receive either intraarticular steroid injection or arthroscopic debridement. We also analyzed the correlation between BMI, age, gender, MRI, intraoperative aspect of the meniscus and cartilage and clinical improvement using the Oxford Knee Score up to one year. At one month there was significant improvement of the scores for all the examined cases. Also at one month, the arthroscopic group performed better in terms of symptom improvement. This was maintained for 79% of the knees in the arthroscopic group and 61% in the intraarticular steroid injection respectively, out of those available for follow up at one year.
  
  
  RESULTS
  At one month, symptoms reappeared for 12 patients in the steroid group and 7 in the arthroscopy respectively. Gender and age did not correlate with treatment, whereas extrusion of the meniscus, bone marrow edema, duration of the clinical symptoms, obesity and a low preoperative score were negative prognostic factors.
  
  
  CONCLUSIONS
  Degenerative medial meniscal tears, in the presence of osteoarthritis, can only marginally benefit from arthroscopic debridement over intraarticular steroid injections in short term follow up. When considering individual cases, factors become more predictive when analyzed in group.
authors: University of Medicine and Pharmacy 'Victor Babes' Timisoara, Romania. raffaele.cagiano@uniba.it.
authors: D
authors: D
authors: Vermesan
authors: R
authors: R
authors: Prejbeanu
authors: S
authors: S
authors: Laitin
authors: G
authors: G
authors: Damian
authors: B
authors: B
authors: Deleanu
authors: A
authors: A
authors: Abbinante
authors: P
authors: P
authors: Flace
authors: R
authors: R
authors: Cagiano
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000368:Aged; D001182:Arthroscopy; D001696:Biomechanical Phenomena; D003646:Debridement / Q000379:methods*; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular; D008279:Magnetic Resonance Imaging; D008297:Male; D008592:Menisci, Tibial / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000503:physiopathology / Q000601:surgery*; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D011859:Radiography; D020127:Recovery of Function; D012008:Recurrence; D012307:Risk Factors; D012383:Romania; D000070600:Tibial Meniscus Injuries; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones