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      Degenerative meniscus: Pathogenesis, diagnosis, and treatment options.

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          Abstract

          The symptomatic degenerative meniscus continues to be a source of discomfort for a significant number of patients. With vascular penetration of less than one-third of the adult meniscus, healing potential in the setting of chronic degeneration remains low. Continued hoop and shear stresses upon the degenerative meniscus results in gross failure, often in the form of complex tears in the posterior horn and midbody. Patient history and physical examination are critical to determine the true source of pain, particularly with the significant incidence of simultaneous articular pathology. Joint line tenderness, a positive McMurray test, and mechanical catching or locking can be highly suggestive of a meniscal source of knee pain and dysfunction. Radiographs and magnetic resonance imaging are frequently utilized to examine for osteoarthritis and to verify the presence of meniscal tears, in addition to ruling out other sources of pain. Non-operative therapy focused on non-steroidal anti-inflammatory drugs and physical therapy may be able to provide pain relief as well as improve mechanical function of the knee joint. For patients refractory to conservative therapy, arthroscopic partial meniscectomy can provide short-term gains regarding pain relief, especially when combined with an effective, regular physiotherapy program. Patients with clear mechanical symptoms and meniscal pathology may benefit from arthroscopic partial meniscectomy, but surgery is not a guaranteed success, especially with concomitant articular pathology. Ultimately, the long-term outcomes of either treatment arm provide similar results for most patients. Further study is needed regarding the short and long-term outcomes regarding conservative and surgical therapy, with a particular focus on the economic impact of treatment as well.

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          Author and article information

          Journal
          World J Orthop
          World journal of orthopedics
          Baishideng Publishing Group Inc.
          2218-5836
          2218-5836
          Nov 18 2014
          : 5
          : 5
          Affiliations
          [1 ] Richard Howell, Neil S Kumar, Nimit Patel, James Tom, Department of Orthopedic Surgery, Drexel University College of Medicine, Hahnemann University Hospital, Philadelphia, PA 19102, United States.
          Article
          10.5312/wjo.v5.i5.597
          4133467
          25405088

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