Abstract
Aims: To correlate clinical imaging and surgical finding in patients with knee arthritis. In an attempt to identify specific lesions that correlate with the location of clinical pain.
Methods: 26 patients and 32 knees were eligible for inclusion in the study. All patients had been admitted for total knee arthroplasty. In all patients an attempt was made to correlate symptoms with radiographic findings and then intraoperative findings. A senior orthopaedic registrar carried out standard knee scores and clinical examinations, radiographs and a radiologist blindly evaluated MRI scans. The integrity of the articular cartilage as well as the menisci and ligaments were all graded.
Results: At clinical examination all patients score 70 or higher on a visual analogue scale. In eighteen patients, the maximum site of clinical tenderness was referable to the medial joint line. In seven patients symptoms were on the lateral aspect. Pain was recorded on a line diagram of the knee for analysis. MR images confirmed advanced arthritis with meniscal derangement with extrusion and maceration. Note was made of osteophyte formation, medial collateral ligament laxity and oedema and discrete osteochondral defects. Bone marrow bruising and oedema was also recorded. In nine patients subchondral cysts were identified with extensive associated bone oedema. At surgery, meniscal degeneration was identified in fifteen of twenty-six, meniscal tears were identified in six; the menisci were normal in two patients.
Discussion: These results suggest that there is a direct correlation between clinical symptoms and meniscal derangement in severe osteoarthritis. Isolated articular defects and bone marrow oedema did not correlate well with location of pain. Presence of medial collateral oedema correlated well with severity of radiological arthritis and clinical findings.
In summary, this study suggests that patients with symptomatic knee arthritis are likely to have meniscal derangement and medial collateral oedema. A greater understanding of the origin of pain in the degenerate knee may assist in the choice of management options for these patients.
The abstracts were prepared by Mr Ray Moran. Correspondence should be addressed to him at Irish Orthopaedic Associaton, Secretariat, c/o Cappagh National Orthopaedic Hospital, Finglas, Dublin 11.
