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Rare and Unexpected Complication of Meniscus Degeneration

There's been a rash of recent cases of osteonecrosis associated with medial meniscus degeneration. More than 35 cases have been reported recently. This study adds another five more cases.

Osteonecrosis is the death of bone. Degeneration of the medial meniscus (cartilage along the inner side of the knee joint) is an age-related condition. The previous 35 patients had the meniscus removed arthroscopically. Then they developed osteonecrosis.

In the five patients from this study, painful knee symptoms of meniscus degeneration were followed by spontaneous osteonecrosis (SON) of the knee. None had knee surgery for meniscus tears. All of the patients were men over 60 years old. MRIs taken early on showed no sign of SON.

Despite exercises and non-inflammatory drugs, all five had increased pain about two months later. A second MRI showed the presence of SON. The authors aren't sure what (if any) connection there is between medial meniscus degeneration and SON. They saw over 800 other patients with medial meniscal tear. All were more than 60 years old. Non had SON.

In earlier studies it was suggested that arthroscopic meniscectomy was the cause of SON. With this study, it appears that some other mechanism is at work. Older adults with meniscus degeneration should be evaluated for the possibility of SON before the meniscus is removed. Removing the meniscus is known to speed up the break down of the joint with early arthritis.

References: D. Luis Muscolo, MD, et al. Medial Meniscus Tears and Spontaneous Osteonecrosis of the Knee. In The Journal of Arthroscopic and Related Surgery. April 2006. Vol. 22. No. 4. Pp. 457-460.

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