Br. J. Surg. Vol. 62 (1975) 977-981
Clinical features of the degenerate meniscus with the results of meniscectomy J O N A T H A N NOBLE* SUMMARY
Findings
A series of 172 patients with an unambiguous diagnosis of horizontal cleavage lesion is reviewed, the average duration of which was 4+ years. Although all thepatients complained of pain, night pain and mechanical instability were not invariable. Joint line tenderness was the commonest physical sign. Whereas all but 7 per cent were either ‘cured’ or ‘improved’,nearly halfthe patients had persistent complaints, usually pain. The objective physical findings at review frequently failed to correspond with patients’ opinions of their knees. Recovery after meniscectomy may be slow.
Age and occupation Fig. 1 shows a predominantly middle-aged series although one-third were below the age of 40 and 2 patients were in their teens. Twenty-eight per cent of the males were coal miners.
INSmillie’s (1 970a) experience a horizontal cleavage lesion is the commonest single meniscus tear. Reference to other literature regarding meniscus pathology suggests that horizontal cleavage is neglected as a diagnostic entity. Smillie (1970b) has described the typical signs and symptoms, but their incidence has not been quantified. Noble and Hamblen (1975) discovered this lesion in at least one meniscus in 60 per cent of an elderly group of random autopsy subjects, and concluded that not all people possessing such a lesion were likely to have had complaints from it. All patients who were recorded as having had a horizontal cleavage lesion removed in the University Department of Orthopaedic Surgery, Edinburgh, between 1963 and 1968 have been reviewed to determine the incidence of clinical features and to assess the results of meniscectomy.
Patients One thousand two hundred and twenty-five patients underwent meniscectomy in this department between 1963 and 1968, from whom there were 172 patients with an unambiguous operative diagnosis of horizontal cleavage lesion. This included menisci with a parrot beak tear and horizontal cleavage and also frayed degenerate menisci with gross horizontal tearing. One hundred and fifty-five patients were still available for follow-up, of whom 113 (74 per cent have been recently reviewed for this study (Table I ) . A further 27 returned a questionnaire regarding their pre- and postoperative symptoms, so that we had information from 92 per cent of the available patients, 8 per cent apparently ignoring all communications. Thirteen patients were untraceable or had emigrated, 5 had died before review and in 2 patients review was precluded by further surgery. Simultaneously, 100 consecutive patients who were admitted for meniscectomy were asked preoperatively if they experienced night pain. Their reply was then correlated with the pathology of the excised meniscus.
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Clinical features of the degenerate meniscus with the results of meniscectomy J O N A T H A N NOBLE* SUMMARY
Findings
A series of 172 patients with an unambiguous diagnosis of horizontal cleavage lesion is reviewed, the average duration of which was 4+ years. Although all thepatients complained of pain, night pain and mechanical instability were not invariable. Joint line tenderness was the commonest physical sign. Whereas all but 7 per cent were either ‘cured’ or ‘improved’,nearly halfthe patients had persistent complaints, usually pain. The objective physical findings at review frequently failed to correspond with patients’ opinions of their knees. Recovery after meniscectomy may be slow.
Age and occupation Fig. 1 shows a predominantly middle-aged series although one-third were below the age of 40 and 2 patients were in their teens. Twenty-eight per cent of the males were coal miners.
INSmillie’s (1 970a) experience a horizontal cleavage lesion is the commonest single meniscus tear. Reference to other literature regarding meniscus pathology suggests that horizontal cleavage is neglected as a diagnostic entity. Smillie (1970b) has described the typical signs and symptoms, but their incidence has not been quantified. Noble and Hamblen (1975) discovered this lesion in at least one meniscus in 60 per cent of an elderly group of random autopsy subjects, and concluded that not all people possessing such a lesion were likely to have had complaints from it. All patients who were recorded as having had a horizontal cleavage lesion removed in the University Department of Orthopaedic Surgery, Edinburgh, between 1963 and 1968 have been reviewed to determine the incidence of clinical features and to assess the results of meniscectomy.
Patients One thousand two hundred and twenty-five patients underwent meniscectomy in this department between 1963 and 1968, from whom there were 172 patients with an unambiguous operative diagnosis of horizontal cleavage lesion. This included menisci with a parrot beak tear and horizontal cleavage and also frayed degenerate menisci with gross horizontal tearing. One hundred and fifty-five patients were still available for follow-up, of whom 113 (74 per cent have been recently reviewed for this study (Table I ) . A further 27 returned a questionnaire regarding their pre- and postoperative symptoms, so that we had information from 92 per cent of the available patients, 8 per cent apparently ignoring all communications. Thirteen patients were untraceable or had emigrated, 5 had died before review and in 2 patients review was precluded by further surgery. Simultaneously, 100 consecutive patients who were admitted for meniscectomy were asked preoperatively if they experienced night pain. Their reply was then correlated with the pathology of the excised meniscus.
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