Clinical and arthroscopic features of meniscal tears and a search for the role of infection in histologically confirmed meniscal mucoid degeneration

Mucoid degeneration (MD) of the meniscus has received little attention. The pathology deserves special interest as it may lead to loss of the meniscus even in very young individuals. The cause of MD and the clinical features of meniscal tears due to that pathology have not been understood. This study analyzed the age profile and the role of trauma in patients with torn menisci with MD, examined meniscal tear patterns and clinical features, and investigated the role of bacterial infection in causing MD. Meniscal samples obtained from 27 consecutive patients during arthroscopic resection of torn menisci considered to be due to MD (typical yellow color) underwent pathological investigation. The samples were scored according to the light microscopic criteria of Copenhaver; 24 menisci (23 patients) with stage 2-3 MD comprised the study group. Magnetic resonance imaging obtained in 11 patients typically revealed increased intrasubstance signal intensity that extended to at least one of the meniscal surfaces. Pieces of resected meniscal tissue were also subject to PCR investigation to search for presence of bacteria. Of the 24 knees 21 (87%) had no history of trauma. Mean Tegner activity level was 4 (1 and 7). Mean duration of symptoms was 11.6 months (1-36). Pain was the most frequent symptom (n=22). Joint line tenderness and McMurray's test (pain and/or clicking) were present in 22 and 16 knees, respectively. Medial meniscus was affected in 16 and lateral meniscus in 8. Meniscal cyst and incomplete discoid meniscus was present in 5 and 2 of the lateral menisci. All of the torn menisci were degenerated and yellow in color. The most common tear patterns were radial and/or flap, and longitudinal-horizontal tears. PCR study revealed no bacteria. Mucoid degeneration of the meniscus does not seem to be related to the aging process. Clinical findings of torn such menisci are insidious compared to traumatic tears. Lack of history of trauma may delay the diagnosis. Bacterial infection has no role in the cause